Failure to Diagnose - Case Study

Please give me some ideas on how to approach this case. Thank you.

Case Study - Failure to diagnose

Presenting Ethical Dilemma:

The Resident of MICU asks for an Ethics Consult to help decide if a 80 year old chronic alcoholic with recurring GI bleed should be given more than 20 units of blood.

Medical Indication:

The patient has been in MICU numerous times in the last few years for GI bleeds due to alcoholism. He had a stroke two years ago, with partial paralysis, but he cares for himself in a single hotel room where he lives along on a coal miner's pension. He is a poor surgery risk. He has been given 18 units of blood so far. He is being treated with crushed ice.

Patient Preference:

He states that he wanted to live, but did not want surgery. He is competent and has the capacity to decide and is a compliant patient. He has been given through several alcohol treatment programs and stays sober for up to a year after thee programs.

Quality of Life:

His stroke was treated successfully (90%) enough that he left the nursing home he had been convalescing in, and returned to his hotel room and his life alone. He has some malnutrition.

Contextual Issues:

The Resident believes this patient should not receive more than 20 units of his blood type. More would deplete the hospital's supply. He believes the patient's quality of life as a chronic alcoholic patient with residual paralysis is too poor to warrant further utilization of the valuable resource of blood supply.