Transcript Medical Ethics A Case Study: What to Do About Thomas?

CTE Introduction – Utah State Office of Education
Medical Ethics
A Case Study:
What to Do About
Thomas?
Medical Ethics
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In discussing ethics, rarely is there only
one answer, rarely is it comfortable, and
rarely is it enough.
Ethics is the study of right and wrong
conduct.
Ethics focus on moral situations – a choice
of behavior involving human values.
Medical Ethics
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3 criteria for judging ethical dilemmas:
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3.
Obligations – rights, rules, oaths.
Ideals – goals, concept of excellence,
fairness, loyalty, forgiveness, peace.
Consequences – may be beneficial or
harmful effects that result from the action
and the people involved. Can be physical,
emotional, obvious, or hidden.
Basic Principles of Medical Ethics
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Saving of life and promotion of health
above all else.
Make every effort to keep the patient as
comfortable as possible and preserve life
when possible.
Respect the patient’s choices when all
options have been discussed.
Treat all patients equally.
Basic Principles of Medical Ethics
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Provide for all individuals to the best of
your ability.
Maintain competent level of skill.
Stay informed and up-to-date.
Facts about
Low Birth Weight Infants
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Any baby born weighing less than 5.5 lbs.
Most common cause of serious illness
among newborn infants.
Threatened by problems such as brain
bleeds, poorly developed lungs, poor body
temperature control, malfunction of liver.
High likelihood of birth defects, heart
disease, mental deficiencies, poor nervous
system development, susceptible to
infections.
Facts about
Low Birth Weight Infants
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Smoking, drugs, poor nutrition, stress all
increase a pregnant woman’s chance of
having a low birth weight infant.
Intensive hospital care exceeds $50,000.
Care of the smallest exceeds $150,000.
7% of all babies born in U.S. each year.
Require more community and school
resources for their education.
Cast of Characters
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Dr. Fisher – pediatrician; developed new
procedure that has an 80% survival rate
for extremely low birth weight infants (< 1
lb) costing $450,000 per baby.
Joy Smith – Mother, still smoking and
drinking socially, plans to not work for 2
years after baby.
Michael Smith – Father, family just
bought new home, works a lot of
overtime.
Cast of Characters
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Emily Smith – Sister, 12, in band, drama,
trying out for cheer leading, has lots of toys and
wants to go to a private college.
Dennis Copa – Owner of electronics company
father works at, needs to decrease amount of
overtime worked by employees, and reduce
health benefits.
Joseph Sullivan – CEO of health insurance
company, profits have been decreasing,
increasing number of procedures not being
covered.
The Case
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Joy goes in to premature labor, has baby
boy – Thomas. He weighs 15 ounces at
birth.
Parents informed about Dr. Fisher’s
procedure.
Hospital’s policy on high cost procedures is
that they will do it only if it is covered by
medical insurance or if parents agree to
full financial responsibility.
The Case
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Otherwise, Thomas will be put in the
NBICU where chance for survival is very
small.
Father contacts health insurance company
and finds out they will not cover.
Maximum payment to NBICU is $150,000.
Parents need to come up with $300,000.
Also told that even if Thomas does
survive, the chance of him being a normal,
healthy child are <50%.
The Case
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Smith’s total savings is $20,000.
Have rich family member that can help them get
a loan for the remaining $280,000.
Decide to involve Emily in decision.
Will require a drastic change in lifestyle – sell
home, move to less expensive home; Emily will
have small room and will have to baby-sit to pay
for own expenses; will have to take care of
Thomas after school so mom can go back to
work so no after school activities and no private
college.
Dad needs to see if boss will let him continue to
work overtime.
Questions
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3.
Is it ethical for a hospital to provide a
technically feasible treatment only to those
who can pay for it?
Under the circumstances described, should
Mega Insurance be required to pay for the
Fisher procedure?
Does Dr. Fisher have any moral responsibility
to try to make his procedure available to those
with limited financial resources? If so, how
does the hospital pay for it?
Questions
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Should everyone have medical insurance
or should better policies be available to
those who can afford them?
Is it fair for the Smith’s to ask for Emily
to help make a decision that will have
negative impacts on her?
If you were the Smith’s, what decision
would you make?
Questions
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If the Fisher treatment could provide a
100% guarantee of Thomas surviving
and living a full life as a normal
individual, would your answers to any of
the preceding questions be different.
When the Smith’s make their decision,
should they take into account how they
would feel if they agreed to pay for the
treatment and then Thomas either died
or became severely handicapped?
Questions
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10.
What moral responsibility should Joy feel
for creating this predicament, since her
drinking and smoking increased the
chances that it would occur?
If Thomas survives, but is severely
handicapped, should he have the right to
either sue his mother for child abuse or
to sue the hospital or his parents for
treating him, rather than letting him die?
Additional Questions
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Using intensive care procedures on
children who would otherwise die results
in larger numbers of mentally disabled
and handicapped children. What is your
response to this ethical problem?
Should decisions about whether to use
expensive medical techniques be based
on some form of comparison of costs
and benefits?
Additional Questions
3.
According to a U.S. Child Abuse law that went
into effect in 1984, all infants with disabilities
are to receive nutrition and other medically
indicated treatment with 3 exceptions:
Irreversible coma
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Treatment would only prolong dying
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Treatment would be futile in terms of survival and
would be inhumane
Do you agree with this law? Do you think that it would
require a hospital to use an expensive experimental
method like the Fisher procedure on all very low
birth weight infants?
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Additional Questions
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Some obstetricians will not make a great
effort to resuscitate a severely
handicapped newborn infant that
experiences cardiac arrest. Do you think
this is ethical?
Would it ever be ethical to withdraw
treatment from an infant with a poor
chance of survival in order to provide
intensive care for an infant whose
chances of surviving are greater?
Additional Questions
6.
Some medical policy makers have
proposed that public funds that are now
made available to provide intensive care
to infants with poor survival chances
should be reduced in order to provide
more funds for prenatal care for women
who are at risk of giving birth to a low
birth weight infant. What do you think
about this proposal?
Additional Questions
7.
Wrongful life lawsuits brought against
hospitals, doctors, and even parents
involve a claim that a severely
handicapped child’s life is worse than
death or non-existence. What is your
opinion about such lawsuits?