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

aphysiciansld is treated with the best of abilities and finance, the chances of getting his original image, both physical and mental image back is really hard. This is going to leave him devastated and he may go into dependency of they save him and that would further his miseries. Dax will face more mockery and disapproval from the society than acceptance and this would push him to a more psychological pain than physical pain.
b) No one would see their loved ones leaving them permanently but request the doctors to save them at any cost. Donald's mother is reacting out of emotional attachment and love but she is not foreseeing the struggles he would undergo after her death or once she becomes old. Who will take care of him then? Who would provide him. She will put him in eternal pain. I don't think it's about the consideration for other patients who need the resources but the hospital will be looking at both money as well as the individual consent.
C. Although medical field is a service field, only basic treatments come free from the state but beatifying treatments such as cosmetic surgery will be a question mark because when one is not willing to see the external world mentally, what difference it is going to make if some physical alignment is made.
d. As long as it is available legally, in my opinion it's alright to purchase them.
e. Donald's age will definitely be a factor in deciding whether to continue with the treatments or not. Although morally speaking each life is important, a young one needs more right to live as they are only starting their life but an aged person has lived their life in full
f. Cost effectiveness is the comparison of the amount spent on treatment and the benefit that resulted from the treatment. When the chances are very slim, it won't be wise to spend more money on it because the same money could be used for basic treatments of many patients.
g. In the wake of no decisions, the state can involve but only in the case of a minor. Donald is 26 years old and he has got the right to decide what he wants. Allocating resources or fund may not be decided by the physicians but by the government and insurance company.