ETHICAL DECISION-MAKING
CASE #1
The Last Bed in the ICU
At the age of seventy, Mrs. A. has been admitted to the hospital for the fifth time in as many years for treatment of respiratory difficulty. The last time she was in the hospital she had nearly died. She has severe emphysema, and when she developed a cold, her deterioration was so rapid that only artificial respiration in the emergency room saved her life. However, it proved very difficult to wean her from the respirator. She spent four weeks in the Intensive Care Unit (ICU) and required constant care from the medical staff, principally Intern B. After she was discharged, she remained short of breath even while watching television.
Now, five months later, she has contracted another cold, but this time Intern B managed to treat her without resorting to the ICU and the respirator. During her illnesses, Mrs. A’s two sons have been in contact with the medical staff. They have been anxious, agitated, and demanding.
It is now 2 a.m. and Intern B is again called to see Mrs. A, who is becoming increasingly lethargic. It is obvious that she is in respiratory failure, and will probably die before morning if she is not given a respirator.
However, hospital policy requires that respirators be used only in the ICU where the required supporting staff and facilities are available. There is only one bed open in the ICU. The residents like to save one bed for an emergency. As Intern B approaches, Mrs. A’s sons are waiting. He knows their questions: What’s wrong now? What will you do?
QUESTIONS:
- Which ethics principles do you see as possible issues in this case? (Autonomy, Justice/distributive justice, fidelity, beneficence, Non-malfeasance, veracity, best interest, legal or moral issues, rights).
Non malfeasance, legal and moral, personal rights
- What are possible alternative solutions that may satisfy all parties—patient, family, staff, physicians?
Patient: evaluate what pt knows? About her condition ? ask her how she feels about it and how she would like to be treated? Does she want to sing DNR while she steel able to make decisions
Family: explain what their mother condition is right now and what her prognosis and ask then about their wishes for the care of their mother
Staff: call ethical committee in the hospital staff should not be dealing with decisions like that.
Physicians: consult with ethical committee at the hospital. Communicate with the family and pt.
- What values are evident in the possible solutions?
Legal, moral and pt right
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