Question

You have a four-bed intensive care unit and seven patients who need a bed. The following is a short description of the seven patients. You cannot select on the basis of first-come, first-served, as they showed up at your door at exactly the same time.

• Jones, a 75-year-old pulmonary patient with chronic emphysema. He is retired and has a DNR order.
• Cho, a 27-year-old hemophiliac patient with AIDS contracted from a transfusion of contaminated blood.
• Rogers, a 65-year-old retired general with congestive heart failure.
• Rankin, a 52-year-old housewife, an alcoholic with acute liver disease.
• Reubin, a 23-year-old college student in a persistent coma following an alcohol/drug overdose at a party.
• Carlton Child, a 12-year-old with head trauma and in a persistent vegetative state, following a beating by his stepfather.
• Joey Scoy, a teenager suffering from aspiration pneumonia. He has Down syndrome and is severely intellectually disabled, with a mental age of five years.

Select your four patients, and state what criteria you used to exclude the other three. What ethical codes did you take into consideration? What healthcare values did you take into consideration? How did you consider the quality of life vs. life itself? What legal obligations did you take into consideration?

Answer 1

The four patients who can be admitted are

• Cho,27year old heamophilic patient with AIDS contacted from a transfusion of contaminated blood
  • Here the patient needs an immediate post exposure prophylaxis. Usually the treatment should as early as possible or less than i.e. hours.The more earlier the treatment started ,the more faster the patient can recover
• Rankin, with acute liver failure
  • is a very fatal condition if not treated can lead to haemorrhage and cerebral edema which are life threatening
• Reubin, in persistent coma due to drug overdose
  • A drug overdose needs a chelation therapy ,antidote to remove the toxics and recover .This will prevent the transformation of persistent coma to permanent or irreversible coma
• Joey Scoy suffering pneumonia
  • This needs an immediate treatment because the alveolar sacs are filled with fluid and making breathing difficulties and severe complications
• The criteria for excluding the other cases are
  • DNR order where professionals are not supposed to do any aggressive treatment due to very poor or no prognosis and death is inevitable in these type of cases
  • Congestive Heart Failure patient with no dyspnea or any clinical symptoms needs an ICU admission than a ward admission
  • Patient in vegetative state cannot been recovered
• The ethical codes like principle of beneficience that who will be benefited the most in accordance to their condition
• The health care values like patient centered,being honest,compassionate to the patiwnt can be followed
• The quality if life here the importance has to be given where survival is possible rather than admitting patients on the basis of disease condition status .Provide care to the above patiwnts will definitely save the life at any cost with appropriate care and timely intervention
• The legal obligations like negligence of patient can be faced here,this can be prevented by proper explanations and following the hospital's policies, rules and regulations. Even a support and guidance from Ethics committee can be helpful.