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Scenario

Marguerite M., an eighty-nine-year-old widow, was admitted into the cardiac intensive care unit in Chicago's Memorial Hospital at 3:00 A.M. on a Sunday morning with a mas­sive heart attack (myocardial infarction). Her internist, Dr. K., who is also a close family friend, has ordered an angiogram to determine the status of Marguerite's infarction (heart attack). Dr. K. has found that the angiogram needs to be done within the first six hours after an infarction to be effective. The procedure is going to be done as soon as the on-call surgical team can set up the angiography surgical room. The radiologist, who lives thirty minutes from the hospital, must also be in the hospi­tal before the procedure can begin. At 4:30 A.M. the team is ready to have Marguerite, who is barely conscious, transferred front the intensive care unit to the surgical suite.

Coincidentally, at 4:30 A.M. Sarah W., an unconscious forty-five-year-old woman, is brought in by ambulance with a massive heart attack. The emergency room physi­cians, after conferring with her physician by phone, conclude that she will need a balloon angiography to save her life. When they call the surgical department to have the on-call angiography team brought in, they are told that the room is already set up for Dr. K's patient. They do not have another team or room for Sarah W. A de­cision is made that Sarah, who needs the balloon angiography to survive will receive the procedure.

Dr. K. is called at home and told that his patient. Marguerite, will not he able to have the angiogram. The hospital is going to use the angiography team for Sarah since she is younger than Marguerite and has a greater chance for recovery. Unfortunately, it took longer than expected to stabilize Sarah both before and after the procedure, and the six-hour "window" when the procedure could he performed on Marguerite passed. Sarah survived, made a full recovery, and returned to her family. Marguerite expired the following morning.

A. Should Dr. K. have had a voice in this decision ?

B. Is it ethical to "bump" Marguerite in favor of the younger patient?

C. Should this decision be discussed with Marguerite's family?

D. Does the fact that Sarah's life has been saved due to the angiogram team being ready to operate on Marguerite make any difference?

My Answer* I really don't think it is an ethical question. This has to do with an emergency situation. In my experience emergencies are always handled first it does not matter who is older or younger. The age of the patient is irrevaant in this instance and the fact that Sarah was saved is also irrevalant.

* Please help me on this one.

Thanks

Solution Preview

Yes, you are correct. The decision of the hospital staff was improper. The decision had already been made to give the procedure to Marguerite. Therefore, the line should have been maintained. When the staff intervened and moved Sarah ahead of Marguerite, they made a value decision of their own, based on no moral or ethical standard whatsoever. It was highly subjective to say the least.

Therefore, of course, Dr. K. should have been consulted, but more importantly, whoever had legal jurisdiction over Marguerite's life should have been consulted. Typically, at her age, it ...

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