Question

TRADITIONAL OPTION FINAL PAPER: CASE II

For background material, read A Chronicle: Dax's Case As It Happened (Burton) and Commentaries (White and Engelhardt) in the book. Notice, however, that this paper addresses a different question. Twenty years ago, the question was "Should Dax be permitted to refuse treatment and die?" But the question for this paper is, "Should medical resources be expended on Dax?"

You are the hospital's bioethicist. The hospital administrator refers the case of Donald C.(Dax) to you. He is a twenty-six year old who has been so badly burned that his face is disfigured, he has lost the use of his hands, and he is blind. (Use the details of Dax's case except in regard to the matter of payment for his treatment. Unlike the real Dax’s case, how much treatment will be covered by insurance is unclear, and the company whose gas line caused the explosion denies responsibility.) Donald C. states that he does not want further treatment because he prefers dying "to living as a blind and crippled person." He also refuses to give permission for surgery that might improve the function of his hands and of one eye.

Donald C.'s mother asks that the hospital continue the burn treatments and that the physicians try to convince him to give permission for the surgeries. However, the hospital is not sure that Donald's insurance will cover the surgery even if he agrees to it. Some of the medical personnel treating Dax believe that they ought to save his life regardless of considerations of the quality his life will have because of his injuries. Other medical personnel treating Dax believe that he will have such a reduction in quality of life, and therefore will suffer so much, that it is wasteful to expend medical resources on him. The hospital administrator asks you to advise her about the moral dimensions of expending resources on Donald, answering the following questions:

a. Is treatment his right, whether he wants it or not? Should the decision about continuing treatment and thereby expending medical resources on Dax be influenced by considerations of his prospects of attaining a satisfactory quality of life?

b. Should the decision about honoring Donald's mother's request depend on whether the insurance will cover the treatment, or should the decision about whether to continue treating Dax be independent of whether payment is available? Should consideration of the medical resource need of other actual patients weigh in deciding whether to treat Donald? Should consideration of the needs of potential patients weigh?

c. As payment is not assured, should the hospital distinguish between the basic treatments needed to keep Donald alive (the burn treatments) and the treatments to try to restore function (the surgeries)? What about cosmetic surgery to improve his appearance - is there an obligation to provide cosmetic surgery?

d. If Donald needs human organic material for grafts (skin ?? cornea ??), is it ethical to purchase these?

e. How should Donald's youth be weighed in the decision to allocate resources? Would the hospital have a different obligation if Donald were sixty-six instead of twenty-six?

f. More generally, what is usually at issue in considering the cost-effectiveness of allocating medical resources? Assess the strengths and weaknesses of cost-effectiveness as a criterion for deciding how to treat patients.

g. Should decisions about the justice of allocating or withholding medical resources from Donald be made by his physicians? If not by his physicians, than by whom?

Answer 1

Case II:

a) Saving the life of the person is more important than anything. Even though death with dignity is patient's right, but it is responsible for the medical personnel to explain the importance of the treatment and Its progression and ways to improve the quality of life. Moreover, his mother is willing for the continuing of the treatment. So convincing the patient with all positive aspects and make him realize the right of treatment. Saving the life is the primary thing. Then improving the quality of life is depends on the patient's ability and wishes.

b) According to the Federal Law, the emergency services should be provided to all patients irrespective of the insurance coverage. It is necessary to provide the needed basic treatment for burn without waiting for the insurance coverage. Further, the treatment for improving the quality of life will be decided based on the insurance coverage. This has to be explained properly and discussed with his mother and their willingness to pay out of the packet. Try to treat the patient Donald based on the need of the medical resources.

c). The Patient Donald should be treated first with the basic treatment without waiting for the insurance coverage. As he was so worried about his quality of life, the restoration surgery and cosmetic surgery should be definitely considered to improve the quality of life. Let them choose the alternative options such as the ability to pay more money from the pocket, getting treatment from the other country where the cost is affordable to them to improve his appearance. Thus the physician can only give assurance of the possibility of percentage in improving quality of life, but the patient and his mother have to decide it.

d) Grafts save and improve the quality of life. Using human organ and cornea is common in certain conditions. The demands are increases than the supply. The ethical and legal issues such as autonomy, beneficence, non-maleficence, justice, informed consent should be followed.

e) Definitely, Donald has considered as a weigh person as he is in young age. The progress and outcome of the treatment will be good. It was preferable for allocation of resources to this patient. The hospital would not have a different obligation even he is 60 years old, but give more respect to his decision either willingness of treatment or dying as he is in the age of deciding the right one.

f) Allocation of resources is a considerable problem in the healthcare system. The medical personnel should consider of cost-effective and cost benefits. The allocation should be adjustable. The benefits should be considered as an important thing in the allocation of resources. The ethical decision will be taken on basis of the life saving for a significantly longer period of time. Secondly, the age weighing should be considered as it gives an extension of life. Cost should not be counted in the analysis of the intervention. Resources should be allocated for better outcomes.

g) The decision of the justice in the allocation of resources is made by the Organizational authority personnel. The physicians can only do their job and inform of the needs. But the Organization and the departmental head should decide about the allocation of resources.