The facts related to the case are:
- Adkins was admitted to the Hospital after falling to get a hip replacement.
- She has diabetes, which has resulted in poor circulation in her extremities and signs related to necrotic tissue.
- The patient is 83 years old and lives with her son.
- She is a widower and her son is currently not working
- A surgery was performed, it was successful, but she did not tolerate the anesthesia
- She was nauseous and after three days, she suffered a stroke
- An emergency tracheostomy was performed and she was later placed on a ventilator.
- She lost unconsciousness and brain activity declined with time
- Reasons for brain inactivity are cut off oxygen to the brain and effects of the stroke.
- Dialysis was initiated after a period of two weeks from the onset of the stroke and no upper-brain activity was evident.
- Even after six weeks, the patients have showed no signs of recovery.
- The doctors and staff see no hope.
- Brother in-law suggested that the ventilator be withdrawn and allow Mrs. Adkins to die peacefully. However, the rest of the family does not support the idea.
- The Hospital Ethics Committee has written to the patient’s son indicating that he is to accept the responsibility for planning for his mother’s care.
- The hospital has a continuation responsibility to Mrs. Adkins.
The ethical problems, challenges, questions to consider
- The hospital is faced with the issue of whether to discontinue the ventilations and let the patient die peacefully, or to continue supporting her. This is in spite the existence of policies that give the hospital the power to discontinue the treatment and live support even without the consent of the family.
- There is issue of medical futility, which has become a major concern for healthcare administers.
- The issue of devoting community health resources to a patient who is not medically responding to treatment. Thus, the hospital should be careful when devoting the resources to provide care that is not medically appropriate.
The challenges faced by the hospital and administrators are
- Financial support for the patient while she is in life support machine
- To terminate the care or not with or without the consent of the family members.
- To devote community resources when the case at hand was not medically appropriate as the patient was not responding.
- To replace the patient under hospice care
Questions to Consider
- Does the hospital have a moral responsibility and obligation to support the patient?
- Should the patient be transferred to another hospital level or to another hospital?
- Should the hospital exercise its continuing responsibility to Mrs. Adkins and should they discontinue the treatment and support without the consent of the family?
- Is it ethical and morally right to devote the community resources to provide care that is deemed as medically inappropriate?
- What would have Mrs. Adkins done if she was faced in the current dilemma and was in a better position to exercise autonomy
Course of action
Since further treatment to Mrs. Adkins has been deemed futile based on the staff responsible for her daily care the healthcare facility does not have any other effective treatment that can be administered to Mrs. Adkins and as such, the most obvious solution would be to transfer her to another level of care.
The healthcare organization has an obligation to ensure that public resources are put to efficient use. Considering the issue of organizational resources, the Medicare cover to Mrs. Adkins would be exhausted after six weeks of receiving treatment. When this happens, either Mrs. Adkins would have to make out-of-pocket payments to finance her continued stay in hospital or the hospital would have to assume this responsibility
Considering that the healthcare administrators have a duty to ensure that healthcare resources are put to good use, it would only be reasonable that Mrs. Adkin’s family assume the responsibility of covering the cost incurred once the patient’s medical insurance is exhausted.
Ethical facts related to the case
- A 27 year old woman was admitted at a Catholic hospital located in Phoenix, Arizona and while eleven week pregnant.
- Upon assessment of her condition, it was deemed to be dire, promoting the treatment physician to recommended that her pregnancy be terminated
- Entities affiliated with the Catholic health-care ministry are expected to provide services in a way that is in keeping with the directives of the ERDS (Ethical and Religious Directives for Catholic Health Care Services). It includes among others, proscribing such services as abortion and sterilization (Tuohey, 2011).
- Refusing to treat a patient at a Catholic health care facility on moral grounds is likely to violate the federal EMTALA (Emergency Medical Treatment and Labor Act). According to this Act, any patient under emergency care ought to receive treatment. Where this cannot be done in the present facility, such a patient should then be safely moved to another hospital where they are assured of receiving medical care for the condition in question.
- Violating the Act raises a number of licensing, liability and accreditation issues for Catholic healthcare providers and hospitals
- The Arizona case is a valid example of how an immediate and direct conflict could arise between the right to religious liberty that Catholic health care providers are expected to uphold, and the patient’s life that is likely to be lost in case nothing is done.
Ethical Questions to Consider
- Does Catholic identity as upheld by the ERDS involve refusal to provide health services?
- In a maternal-fetal conflict such as the one reported in the Phoenix case, would it be morally right to save the mother, as the treatment physician recommended, by procuring an abortion at the expense of the unborn fetus?
- Did the procedure to terminate the pregnancy in order to save the life of the mother violate the ERDS?
- Does the decision by the hospital administrator, herself a catholic nun and who was part of the ethics committee, imply that she is not a Catholic based on her decision give consent for the termination of the pregnancy?
- How can it be that the Catholic identity seems more inclined towards protecting the life of the unborn fetus without appearing to find moral ways of preventing the death of its mother too?
- Had the patient in the Phoenix case died while at the Catholic healthcare would the Catholic Church have assumed this blame, considering that the hospital is run based on the Catholic identity?
- Did the local bishop have the moral authority to insinuate that by her actions, the hospital administrator automatically deserved to be excommunicated from the Catholic Church?
Defensible course of action
Had the ethics committee consider transferring the patient to another facility to have the pregnancy terminated, the hospital administrator would not have contravened the Catholic identity by consenting to procure an abortion (Tuohey, 2011). In addition, the hospital would not also have contravened the federal EMTALA by refusing the patient treatment. However, considering that the patient’s life is in crisis, transferring her to another healthcare facility could likely complicate matter, resulting in the loss of the mother and the unborn child. Therefore, deciding to terminate the pregnancy as it puts the mother in grave danger of losing her won life, though this contravenes the Catholic identity, could be considered as a defensible course of action.
If you were the hospital administrator, what would you do?
The issues of conscientiousness and moral tolerance are key aspects of this case. The underlying element of the concept of tolerance (moral tolerance) is respect for conscience (Nairn, 2002). On the other hand, tolerance entails respecting other individual with whom we share a connection. However, the basic self-identifying moral commitments of one individual differ from those of another individual. In the same way, moral judgments will also differ. However, conscience “is the fundamental commitment to be moral: the fundamental commitment to respect others” (Sulmasy 2008, p. 145). This is the kind of dilemma that the hospital administrator must have found herself in. It would have been tolerant to give consent for the procurements of an abortion at the Catholic hospital because it contradicts the Catholic Church’s moral teachings, but doing so when this pose a threat to the life of a patient contravenes the basis of tolerance. As the hospital administrator, I would have thus respected my conscience by doing what I deem as being morally good namely, to protect the life of the woman. Significantly higher moral justification is needed to force an individual to perform an action on the basis of tolerance compared to the one needed to force an individual to avoid doing an action on grounds of tolerance.
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Nairn, T.A. (2001). Institutional conscience revisited. New Theology Review, 14: 39-49.
Sulmasy, D.P. (2008). What is Conscience and why is respect for it so important? Theor Med
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Tuohey, J.F. (2011). A Fatal Conflict: Can Catholic Hospitals Refuse to Save Lives?
Retrieved from https://www.commonwealmagazine.org/fatal-conflict