Medical Ethics

CTE Introduction Utah State Office of Education

A Case Study: What to Do About Thomas?

Medical Ethics

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

3 criteria for judging ethical dilemmas:

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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

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 patients choices when all options have been discussed. Treat all patients equally.

Basic Principles of Medical Ethics

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 womans 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

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

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

Joy goes in to premature labor, has baby boy Thomas. He weighs 15 ounces at birth. Parents informed about Dr. Fishers procedure. Hospitals 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

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

Smiths 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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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?

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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 Smiths to ask for Emily to help make a decision that will have negative impacts on her? If you were the Smiths, what decision would you make?

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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 Smiths 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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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
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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 2. Treatment would only prolong dying 3. 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
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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
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Wrongful life lawsuits brought against hospitals, doctors, and even parents involve a claim that a severely handicapped childs life is worse than death or non-existence. What is your opinion about such lawsuits?