Abstract
In this case scenario, there were two patients both in critical conditions and both needed immediate care. The first patient was Marguerite M. an 89 years old widow, who had a heart attack and needed an angiography. She was scheduled to be operated soon, but in the meantime, another patient came who was younger than the first one and need a balloon angiography immediately. The hospital staff due to lack of operation theaters and angiography team decided to operate Sarah first. Her operation was successful, but Marguerite died. It is a serious ethical and legal issue as the hospital staff changed the line of work for another patient. The hospital staff and the doctor of Marguerite M.K. give their justifications to the family of the deceased. In all the scenario the major fault was the lack of hospital resources
The case of Marguerite M., an eighty-nine years old widow presents both legal and ethical problems. The decision made by the hospital staff was unethical on every step this is because the team was arranged to treat Marguerite in the first place, but the hospital staff treated Sarah first without the consent of Dr. K. or Marguerite family. It is the duty of doctors to save every patient without any discrimination. The reason given by doctors to treat Sarah first was that she was young and had a higher chance of recovery was morally incorrect as this shows that the doctors discriminated the patient by her age. It was utterly wrong that the hospital staff took the life of Sarah more valuable than the life of Marguerite. In the field of medicine discrimination by age, sex, race or disability is prohibited (Hall, Orentlicher, Bobinski, Bagley, & Cohen, 2018). This case also presents legal problems because the hospital staff made interventions based on their standards and rational thinking. It is against the policy of hospitals to change the line of tasks for someone. The team should have maintained the line of treating Marguerite first as she was there first and arrangements were made for her.
In every hospital, the staff comes across such scenarios where they have to make certain difficult choices regarding the treatment of the patients. Therefore it is essential for hospitals and doctors to have a set of standard criteria which can help them in choosing an appropriate solution. The first rules for a physician should be the quality of life. Life of every person is important and holds the same value. Marguerite needed immediate treatment and denying it resulted in her death. It should be accessed by the physician that who came first and need treatment immediately, the time of procedures for both the patients, available resources. It is essential that every physician should take the consent of both the patients and their families and make a rational decision keeping all the points as mentioned above in mind when it comes to making a choice for one patient over the other. In case of Marguerite M., it is essential to consider the criteria of admitting Sarah in the hospital in the first place. Before admitting a patient, the physicians much ensure that the patients already present in the hospital are not affected. Addressing this problematic condition an organization known as World Federation of Societies of Intensive and Critical Care Medicine gave four necessary criteria’s which are input from other medical staff, Triage algorithms and protocols, available resources, and condition of the patient (Blanch et al., 2016).
In case of Marguerite, Dr. K. was not informed about the change. The decision was made by the hospital staff but as he was the doctor of Marguerite M., and he had to face her family members. In this scenario Dr. K. can give a justification to the family that Sarah was more severe and her procedure could not be delayed (Paul Walker, Terence Lovat, BLITT, & THM, 2016). It is a general protocol for doctors to treat the patient who is more severe and could not wait. Although the decision taken by the hospital staff was wrong in every sense, their choice can also be justified by the fact that Sarah had more chance to survive and recover as she was younger than Marguerite M. It is also a fact that the hospital staff made the decision after much thought and rationalizing. Mr. K can justify the decision made by the hospital staff by morality. The hospital staff made the intervention because they thought that Sarah could be treated quickly and they will have time to address Marguerite M. before her six hours are over. But unfortunately, it took longer to stabilize Sarah and six hours of Marguerite were over, and she died. The hospital lacked resources which can also be termed as a justification by Doctor K.
Choosing Sarah over Marguerite was a difficult thing to do. There was a possibility that the angiography team or the caregivers for her would have disagreed with the hospital staff to operate Sarah first. In this condition, it was possible for the hospital staff to find another way which could have saved the lives of both of the patients. The first option would have been not to take Sarah in the hospital in the first place. Another option for the angiography team or caregivers for Marguerite was to transfer any of the patients to another nearby hospital Marguerite had 6 hours, and she could have been moved to another hospital within the six hours window where Mr. K can operate her. Sarah could also be transferred to another hospital after stabilizing her.
I believe that the most important factor which was responsible for the death of Marguerite M. was not the hospital staff but the resources available at the hospital in the first place. In the scenario as mentioned above, it is visible that all the trouble was because the hospital only had one operation theater and only one angiography team. When Marguerite was brought to the hospital, there was no angiography team present in the hospital, and the doctor had to call them from home. If the hospital had the team present in the emergency department the treatment of Marguerite would have been on time, leaving time for the other patient. In a study conducted in 2016, it has been observed that sometimes in an emergency the issue of prioritizing the patient occurs. There are different standard criteria upon which the doctors and the supporting staff make a rational choice, but recent studies have shown that it is better to allocate resources effectively in not only hospitals but ambulance (Sung & Lee, 2016). The given case scenario is a familiar occurring in overcrowded hospitals, so it is very essential to provide the hospitals basic training about rational decision makes. The hospital staff chose Sarah over Marguerite and saved her life. It was not an entirely irrational decision, but it was ethically wrong on many grounds. It is also important to allocate resources in the hospital as this had a significant impact on the life of Marguerite M. and her family. The scenario would have been different if the hospital was fully equipped or the staff was well trained for making a rational choice.
References
Blanch, L., Abillama, F. F., Amin, P., Christian, M., Joynt, G. M., Myburgh, J., … Topeli, A. (2016). Triage decisions for ICU admission: report from the Task Force of the World Federation of Societies of Intensive and Critical Care Medicine. Journal of Critical Care, 36, 301–305.
Hall, M. A., Orentlicher, D., Bobinski, M. A., Bagley, N., & Cohen, I. G. (2018). Health care law and ethics. Wolters Kluwer Law & Business.
Paul Walker, M., Terence Lovat, B. T. H., BLITT, B., & THM, P. (2016). Towards a Proportionist Approach to Moral Decision Making in Medicine. Ethics & Medicine, 32(3), 153.
Sung, I., & Lee, T. (2016). Optimal allocation of emergency medical resources in a mass casualty incident: patient prioritization by column generation. European Journal of Operational Research, 252(2), 623–634.
