Determine the Ethical issue(s): Two patients are admitted to a hospital for very different reasons. Both patients are males, one being twenty years old and the other being forty. The twenty-year-old man is admitted for pancytopenia – a condition relating to the stem cells in the bone marrow – and chronic kidney disease. The forty-year-old man is admitted for pulmonary congestion – the accumulation of fluid in the lungs – and he is admitted to the hospital for longer. Because they have different illnesses, it is hard to determine which one has the worse illness. However, based on their current situations, it seems likely that the twenty-year-old man would pass first, despite being younger and relatively healthier than the forty-year-old man. On a particular day, a double code – a situation when two patients simultaneously stopped breathing and with a heart rate of zero at the same time – happened on the hospital floor and the patients involved were the two aforementioned patients. The doctor in charge called forth residents and interns to assist in doing CPR for both patients at the same time. However, there weren’t that many who came to assist as there was only one intern, one resident and one nurse on the floor at that time – the hospital floor was understaffed at the point of the double code as it was in the middle of the night when it happened. It should be noted that at least four people (excluding the doctor on standby, overlooking the entire situation) were needed to attend to one patient. Upon assessing the situation, it was found out that the forty-year-old man is a DNR – Do Not Resuscitate – patient, meaning no life saving procedures should be done on him whatever may happen. It was the patient who wrote himself as DNR, this was before he was not in a coma and was not intubated. It had been a while since this decision was put down by the patient. However, his family do not agree with his decision, saying that the patient wasn’t in his right mind when he wrote himself down as DNR, as he was in so much pain and was borderline delirious. This situation can happen in the hospital, with patients in too much pain and making decisions left and right without thinking or lacking rationality. The family believes that this is what happened to the forty-year-old patient. Because now that the patient is unconscious and intubated, they stated that they have the right to make decisions for him, as clearly, due to the situation, he cannot make his own decisions. Writing someone down as DNR is a reversible thing and the patient can do this at any time, provided that they are conscious and coherent, able to make decisions with a level of rationality. In the case of unconscious patients, the family has the right to make decisions for them. In this situation, the family wants to revoke the DNR status on the forty-year-old male. The decision to revoke it or not was not finalized until the point of the double code, therefore, the doctor is stuck with a dilemma. Now, at first glance, one might think that the answer to the question of who should the doctor choose to prioritize and spend resources on would be obvious. After all, the forty-year-old patient did write himself as DNR, however, was the decision really made with rationality, or was it made under the influence of pain, just as the family claimed it was? The doctor could respect the decision of the forty-year-old man and prioritize the twenty-year-old man; however, the other patient’s family could sue him for not respecting their wishes to revoke the DNR code on him, essentially leaving the forty-year-old patient to die. Additionally, wouldn’t leaving a person to pass go against the principles of a doctor who’s supposed to save lives?
Determine the Ethical issue(s):
Two patients are admitted to a hospital for very different reasons. Both patients are males, one being twenty years old and the other being forty. The twenty-year-old man is admitted for pancytopenia – a condition relating to the stem cells in the bone marrow – and chronic kidney disease. The forty-year-old man is admitted for pulmonary congestion – the accumulation of fluid in the lungs – and he is admitted to the hospital for longer. Because they have different illnesses, it is hard to determine which one has the worse illness. However, based on their current situations, it seems likely that the twenty-year-old man would pass first, despite being younger and relatively healthier than the forty-year-old man.
On a particular day, a double code – a situation when two patients simultaneously stopped breathing and with a heart rate of zero at the same time – happened on the hospital floor and the patients involved were the two aforementioned patients. The doctor in charge called forth residents and interns to assist in doing CPR for both patients at the same time. However, there weren’t that many who came to assist as there was only one intern, one resident and one nurse on the floor at that time – the hospital floor was understaffed at the point of the double code as it was in the middle of the night when it happened. It should be noted that at least four people (excluding the doctor on standby, overlooking the entire situation) were needed to attend to one patient.
Upon assessing the situation, it was found out that the forty-year-old man is a DNR – Do Not Resuscitate – patient, meaning no life saving procedures should be done on him whatever may happen. It was the patient who wrote himself as DNR, this was before he was not in a coma and was not intubated. It had been a while since this decision was put down by the patient.
However, his family do not agree with his decision, saying that the patient wasn’t in his right mind when he wrote himself down as DNR, as he was in so much pain and was borderline delirious. This situation can happen in the hospital, with patients in too much pain and making decisions left and right without thinking or lacking rationality. The family believes that this is what happened to the forty-year-old patient. Because now that the patient is unconscious and intubated, they stated that they have the right to make decisions for him, as clearly, due to the situation, he cannot make his own decisions.
Writing someone down as DNR is a reversible thing and the patient can do this at any time, provided that they are conscious and coherent, able to make decisions with a level of rationality. In the case of unconscious patients, the family has the right to make decisions for them.
In this situation, the family wants to revoke the DNR status on the forty-year-old male. The decision to revoke it or not was not finalized until the point of the double code, therefore, the doctor is stuck with a dilemma.
Now, at first glance, one might think that the answer to the question of who should the doctor choose to prioritize and spend resources on would be obvious. After all, the forty-year-old patient did write himself as DNR, however, was the decision really made with rationality, or was it made under the influence of pain, just as the family claimed it was? The doctor could respect the decision of the forty-year-old man and prioritize the twenty-year-old man; however, the other patient’s family could sue him for not respecting their wishes to revoke the DNR code on him, essentially leaving the forty-year-old patient to die. Additionally, wouldn’t leaving a person to pass go against the principles of a doctor who’s supposed to save lives?
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