Question

Case Study

Katie is an advanced practice nurse who works in a busy neurosurgical unit in a large teaching

health care center. She has become friends with several of the neurosurgeons who are

nationally recognized for their skills. One day she is approached by an RN friend of hers,

Ginger, who works with immigrants in a free clinic, on behalf of a patient who recently came to

the United States from Costa Rica. The woman brought her twin sons who were born joined at

the head. She approaches one of her physician friends about examining the twins for possible

surgery. The physician agrees and after the exam, is very excited about the prospects of

surgery to correct the defects and separate the twins. It would be a first-time cutting-edge

surgery that he could get published in major medical journals and also gain international

recognition for. Unfortunately, the patient will not be able to pay for the surgery.

The physician orders a number of image studies which appear to indicate that both

infants should survive the surgery, but they will need intensive hospital care for several months

after the surgery. They will also need long term outpatient rehabilitation and home care. Quite

often, children who have severe neurological problems will have life time deficits including

retardation and mobility issues.

After explaining the procedure to the Chief of Staff, the department expresses its

interest in performing this ground-breaking surgery. The physician and several other surgeons

offered to perform the surgery without pay, and the hospital, because of its status as a major

teaching institution, agreed to provide post-operative inpatient care at no expense to the family.

However, no one has come forth to pay for the care after the twins leave the ICU and for

outpatient follow-up. Because the condition of the twins has been deteriorating, the physician

schedules the surgery in two days’ time.

Questions:

• Should the family's ability to pay for long-term and home care for these children play a

role in the physician's decision about when and whether to perform the surgery?

• What should Katie include in the teaching plan for this family?

• If no funds are available for future care, should the surgeon operate? Where might the

mother of the twins find additional funding?

• Is the surgeons’ and hospital’s willingness to forgo any payment purely altruistic? If not,

how might they leverage the media attention into funding the recovery of the twins?

• How do you feel about people from foreign countries coming to the US to receive

advanced health care for free?

• Is there an issue of distributive justice in the use of scarce resources?

Answer 1

Q1.

Answer: The family's ability to pay for the long term and home care for the twine child plays an important role in the decision about the surgery. Before doing the surgery, always first need to take the consent from the parents. If the parents are refusing to do the surgery or they want to postponed it because of lack of financial support for the long term treatment then the surgeon has no right to schedule the time and place for the surgery without the permission of the parents. Also if the long term and home care are not done then the outcome of the surgery and its complication or recovery process may not understand properly. So, the surgeon should keep in mind these consequences before taking decision regarding the surgery.

Q2

Answer: Katie, as a advance nurse, she should provide health education to the parents before the surgery. It should include the types of surgery, what are the complication, what are the care to be done before and after the surgery like surgery part preparation, bowel and bladder preparation, any investigation to be perform, etc. It also should include the financial support given by the hospital for the surgery and post operation in-patient care.

Q3

Answer: The decision of the operate of child in base on the decision of the decision of the parent. Before operating the patient, first the surgeon should take the decision or take the consent from the parents. If the parents Is willing after knowing that there will be no financial support for the follow up care after the discharge then the doctor can proceed the surgery. But the surgeon also need to keep in mind that if the follow up care and the home care are not done properly then the outcome of the surgery will be difficult to understand.

The hospital only have to provide the additional financial support as they are going to published the case globally and they will get the good image if the surgery is success and the child recovered properly after the surgery. So, the financial support should be given by the hospital itself. The mother should discuss with the hospital administrator.

Q4

Answer: Yes, the surgeon and the hospital's willingness to not take the money for the surgery and the post operative care is a kind of altruistic. This will help the parents for the huge financial support and also the hospital will get high image if the surgery is performed successfully.

Q5

Answer: It is not true that the foreigner comes to the US to get free treatment but obviously the US is very advanced in the health care facilities as compared to other countries. Because of this advancement in health care, most of people from different countries come to treat and get a high recovery rate. As the advancement in health care, the price of the care also very high, so some poor people cannot afford it leads to take financial support but it does not means that all people comes to take treatment in free of cost.

Q6

Distributive justice is a very good law for the people for getting equity in getting the resources. But there is an issue in distributive justice in the use of scarce resources. Due to increase the number of foreigners entering US leads to make it more difficult to distribute the resources properly due to high in population. This leads to an increase the price of the resources and those having money will get it and those with no money will not get the adequate resources.