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Ok, Lead Surgeon, it is time to do what you do best! There is a lot at stake. The decision must be made almost immediately. Like all actions, you will need to write your decision into medical documentation before you begin. Yes, that means YOU! In the limited time before you would begin surgery, you need to consider the cases; the technical issues involved also, and write a Memorandum for the Record to document what decision you made and what considerations you included in your process. This will be on the record, so it needs to be thorough in case it needs to justify your actions at a later date.
You are the Lead Surgeon in a major hospital, and by virtue of your seniority you are also the key decision maker for transplant cases. Right now you have three people who are waiting and hoping for a suitable heart to become available. Your cell phone rings suddenly, and you are notified that a heart has become available-meaning that you need to make a quick yet sound decision about which patient will receive the heart and then schedule surgery for today.
Male, 55 year old family man, mid-level manage
Jerry, a father of 3 children and at the age of 55, is in the Ward awaiting a suitable heart for transplanting. His wife Joanie is a stay at home mother with no education beyond high school and no career. Jerry is the middle level manager at a carpet distributing business and 5 year short of his retirement eligibility. Jerry and Joanie have three teenage children aged 14, 16, and 19. The 19 year old is a sophomore at college; the 14 year old is mildly autistic, and the 16 year old is an astronaut wannabe. If Jerry gets the heart, his chances of living another 10-15 years are very high. His heart is damaged due to the use of steroids in his early 20s when he was involved with bodybuilding before the dangers of steroid use were fully known.
Female, 12-year-old lifelong health issues
Lisa is one of those precocious girls - a doll-like girl at the edge of becoming a teenager. She reads voraciously and yet likes the activities of a younger girl playing with her Barbie Doll. She has suffered health issues all her life due to various viral infections and a lupus-like immune deficiency. Her heart was damaged during a nasty bout with pneumonia last year and actually stopped for a brief period. Her mother knew to begin CPR on her or she would have died there. Even with a transplant, her chances of surviving into her 20s are not good. She is the only child in the family, and they cannot bear more children. Her parents will do anything for her, and they have offered to donate $2 million to the hospital's construction of specialized facilities if she can get a heart soon enough. Her father is also a noted oncologist working in the same hospital but in a different department.
Male, 38-year-old homeless drug abuser
Ozzy is a single 38-year-old man with no family. He has lived homeless and in shelters for at least a decade. He was brought to the Hospital through the work of a local charity that assists such men with no assets or insurance. His heart condition is due to continued abuse and overdosing of crack cocaine, and without a transplant he will not live out the month. In recent months, has become involved with troubled teens at a local homework and tutoring hangout, and he has provided the wisdom and insight that only an abuser can know about where life can go. He has signed a contract with the same charity that, if he gets the transplant, he will continue working at the after-school homework hangout as a counselor-mentor for at least one year after the transplant. With the transplant and successful staying off the drugs, he could live another 10 years - maybe more. Recidivism is a severe risk with his history of abuse, and if he returns to using crack he would quickly damage the new heart and die within months.
Male, 35-year-old Lisa's Dad, the oncologist
Dr. Jonathan Doe is Lisa's father. He has offered the hospital $2 Million Dollars in exchange that his daughter gets the heart transplant. He is an up-and-coming oncologist in the same hospital. He is loyal and totally committed to Lisa; while not obnoxious and pushy, his presence is keenly felt around the professional community in the Hospital and there is a need for his $2 Million.
Your assignment is to make the decision using utilitarian ethics--as this week's classwork and discussions have brought you that skill--and then to write it up in the form of a Memorandum for the hospital records. Remember that this record could be reviewed by the Peer Review Committee or the Hospital Trustees at a later date. This is Utilitarian Week in our course. Employ what you have learned from J. S. Mill and Utilitarianism this week AND one other of our course's ethicists (of your choice) from earlier weeks. The Memorandum should be at least two double-spaced pages with a maximum of three pages, in memorandum form, ready to become an official item of record.
Extra directions –
One of the great ongoing situations that calls for ethical decision making is the reality that there is almost always a greater need for something than there is a supply to meet the need.
For our assignment and scenario, the demand is the life-and-death situation of the need for transplantable organs and the rather small and transitory supply. Hard decisions need to be made, and there is little time to think things through. These are emergency situations.
Transplantable organs become available on short notice--usually because a donor has died for reasons unrelated to the organ. They need to be removed and transplanted very quickly because they only remain fresh for a limited period. Then there is the whole complicated issue of tissue type matching. There is also an ongoing concern about how long recipients can wait.
The "You Decide" tab to the left presents a difficult and painful dilemma to you in an imagined professional role. Go through the You Decide presentation, make the decision it calls for, and write your weekly paper to make your decision and explain, in the given format, your reasoning and justification for it.
Your dilemma is that you have to make a painful medical decision and to explain, in writing, who benefits from what you decided, who gets denied a needed benefit, and why. The document is to be in the form of an official memorandum that will be kept for the record and could be potentially read by not only your Peer Review Committee, but also possibly those involved in charitable fundraising to support hospital development and others with financial interests in the choice made.
You will see in the You Decide tab that there is time pressure in the simulated situation to make your decision, so remember that you would not have the luxury to dawdle in the decision-making process, and as the decision-maker, you would not have the luxury of consulting others. It all falls on YOU!
Include in the document the utilitarian ethical philosophy of John Stuart Mill (from the lecture and audio for this week) and ONE OTHER ETHICAL PHILOSOPHER of your choice that we have studied to date, and use both of those philosophies to bolster your decision. This paper will be at least two double spaced pages but limited to three pages. Remember both professional written form and potential audience, as well as tone when writing this sensitive paper.
Ok, Lead Surgeon, it is time to do what you do best! There is a lot at stake. The decision must be made almost immediately. Like all actions, you will need to write your decision into medical documentation before you begin.