Hospital Ethics

Hospital Ethics

Hospital Ethics Committee

Every life is its own excuse for being.

--Elbert Hubbard

Overview

Ethical consideration in making decisions about who lives and who dies are generally made by biomedical ethics committees. These committees are located in hospitals, universities, and sometimes in the community at large. They are generally composed of medical staff, clergy, social workers, and patient advocates from the community. Family input is encouraged. This decision-making process is often painful. Each committee member has an agenda they want represented. How decisions and a consensus are finally made tells a lot about a society's values. As the following exercise will demonstrate, the “power of life and death,” can be a painful process. You should have some understanding of the following: (1) passive and active euthanasia, (2) the Patient Self-Determination Act (PSDA), (3) advance directives, (4) living wills and living trusts, and (5) an understanding of some of the landmark “right-to-die” cases and situations. These include Karen Ann Quinlan, Nancy Cruzan, and Jack Kevorkian and physician-assisted suicide.

Directions

You are part of a bioethics committee in your community. Each committee is comprised of an administrator, a doctor, a patient advocate from the community, and a member of the clergy. Together you must judge whether or not a patient should receive life-sustaining treatment.

The following are the bioethics cases to consider. A life depends upon your decision.

1. A 62 year-old patient who has suffered a heart attack is resuscitated and placed on a respirator. After 24 hours, an electroencephalogram (EEG) shows no brain activity. Should life support be withdrawn?

2. An emergency medical team is called to the scene of a “man down,” where they find a 75-year-old resident of a posh district in a major metropolitan city with no vital signs. Is this patient D.O.A. or should resuscitation efforts be started?

3. An emergency medical team is called to the scene of a “man down,” where they find a 75 year-old “skid row” derelict with no vital signs. Is this patient D.O.A. or should resuscitation efforts be started?

4. The patient is an anencephalic newborn with a congenital malformation such that there is no brain development. The parents request that physicians withdraw intravenous feeding. Should the ethics committee consent to the parents' request?

5. The patient is a newborn with Down's syndrome and intestinal blockage. The parents refuse to give their consent to surgery and request that physicians withdraw intravenous feeding. Should the ethics committee consent to the parents' request?

6. A patient dying of AIDS asks to be released from the hospital in order to return home and commit suicide. What is the hospital's responsibility?

7. A newborn is given no medical possibility of living longer than five to seven days because of a congenital, always fatal condition. The adjacent incubator in the neonatal intensive care unit holds a newborn who will die within 48 hours without a heart transplant. Is it ethical to shorten the first infant's life by a couple of days so that another child has a chance to live? Who should decide?

8. A husband and wife are diagnosed, respectively, with Alzheimer's and untreatable, terminal cancer. They mutually decide on a suicide pact, desiring to die as they have lived for the previous six decades - together. Do they have the right to end their lives like this?

9. A major medical center announces that it wishes to open a special wing to keep the bodies of neomorts (brain-dead corpses) functioning on life support until the organs can be harvested to aid patients with life-threatening conditions. Should the medical center be allowed to proceed ahead? Who should benefit financially from such harvesting of organs?

10. A woman who has received governmental assistance (welfare) for the last 45 years of her life is killed in a automobile accident. There is no known next-of-kin and she did not complete an organ donor card or leave other instructions about the disposition of her remains. Given that the woman was supported by the state for more than four decades of her life, does the state have any “vested interest” in deciding whether her organs can be used for transplantation? Should the hospital ethics committee make such a request of the state?