Ethical considerations in healthcare: A case analysis

On a bright, clear afternoon one day after Easter, sixty-eight-year-old Harry Aveni was brought to the ER after he had collapsed on the patio of his house.  Mr. Aveni had been brought to the ER twice before. Both were episodes of congestive heart failure, and this third occasion was no different.  Mr. Aveni had broken his diet during the holidays and consumed an unaccustomed amount of salt. He responded well to emergency treatment. The fluid around his heart was withdrawn and medication was administered, and his condition seemed to stabilize. Then, that evening, there was a sudden onset of fibrillation – his heart started beating erratically. Again he responded well to treatment and after emergency defibrillation his condition again stabilized.

“He needs to be put into the ICU,” Dr. Ellen Gracian said.  “We can’t care for him on the ward because he’s got to have constant monitoring.”

“I don’t think Dr. Franklin is going to want to admit him,” the nurse said.  “There’re only three beds left.”

Dr. Gracian immediately left the floor and went to the ICU director’s office.  She explained what she wanted and waited while he seemed to be thinking it over.

“I don’t think I can admit him,” Dr. Franklin said.  “Here we have an elderly man who has gone through three episodes of congestive heart failure and seems to have something additional causing his fibrillation.  He didn’t stick to his diet, and his days are rather small in numbers.”

“But if he doesn’t have intensive care, the numbers may be even smaller,” Dr. Gracian said.

“We have a seriously ill staff member, a young girl, and a father with 5 kids who might crash at any moment with this flu. They might all suddenly go into respiratory distress and need those ICU beds.” 

“But all I need, is just one bed.” Said Dr. Gracian.

“I understand that, said Dr. Franklin.  “But let’s suppose we install your patient in the IU and fifteen minutes later, our other patients need those beds.  They’re going to have to have close monitoring, or they’re likely to die.”  I’m sorry, but the chances are somebody will need those beds, somebody who’s got a better chance to live a long and more normal life.”

“I see,” Dr. Gracian said.  “But I thought we were in the business of saving lives.”

“We are,” Dr. Franklin said. “But we can’t save them all, and that’s where the problems come in.”

Write an essay that discusses the case.  Address the questions below in your essay, and be sure to let the reader know which of the questions you are addressing.

1. Of the following ethical principles, which might apply and how might they apply to this case:
Beneficence – Above all, do no harm
Nonmalificence – Don’t do evil

2. Is Dr. Franklin expressing a Kantian, Utilitarian, or Ethical Relativism point of view?  Explain.

3. Is Dr. Gracian expressing a Kantian, Utilitarian, or Ethical Relativism point of view? Explain.

4. Mr. Aveni seems to have received his treatment and medical advice during his visits to the ER. What societal conditions exist in the US regarding access to medicine might have contributed to Mr. Aveni’s poor condition?  Does the fact of these conditions affect the way that we might understand Mr. Aveni’s current right to emergency care?  Would any information such as Mr. Aveni’s race and/or ethnicity affect the way you view his right to the scarce ICU bed?

5. What views of Justice do each of the physicians seems to demonstrate?

6. What would you do if you were the ICU physician in this case?