Question

Marguerite M., an 89-year-old widow, was admitted into the cardiac intensive care unit in Chicago’s Memorial Hospital at 3:00 A.M. on a Sunday morning with a massive heart attack (myocardial infarction). Her internist, Dr. K., who is also a close family friend, has ordered an angiogram to determine the status of Marguerite’s infarction (heart attack). Dr. K. has found that the angiogram and resulting treatment need to be done within the first six hours after an infarction in order to be effective. Therefore, the procedure is going to be done as soon as the on-call surgical team can set up the angiography room. The radiologist, who lives 30 minutes from the hospital, must also be in the hospital before the procedure can begin. At 4:30 A.M. the team is ready to have Marguerite, who is barely conscious, transferred from the intensive care unit (ICU) to the surgical suite.

Coincidentally, at 4:30 A.M. Sarah W., an unconscious 45-year-old woman, is brought in by ambulance with a massive heart attack. The emergency room (ER) physicians, after conferring with her physician by phone, conclude that she will need a balloon angiography (dilating an obstructed vessel by threading a balloon-tipped catheter into the vessel) to save her life. When they call the surgical department to have the on-call angiography team brought in, they are told the room is already set up for Dr. K’s patient. They do not have another team or surgical room for Sarah. A decision is made that since Sarah needs the balloon angiography in order to survive, they will use the angiography team for her.

Dr. K. is called at home and told that his patient, Marguerite, will not be able to have the angiogram. The hospital is going to use the angiography team for Sarah, since she is younger than Marguerite and has a greater chance for recovery. Unfortunately, it took longer than expected to stabilize Sarah before and after the procedure and the six-hour “window” when the procedure could be performed on Marguerite passed. Marguerite expired (died) the following morning.

Case Questions

Do you believe that this case presents a legal or ethical problem, or both?

What do you believe should be the criteria for a physician to use when having to choose between a solution that benefits one patient at the expense of another?

How can Dr. K. justify this decision when speaking to the family of Marguerite M.?

What options does a member of the angiography team or caregiver for Marguerite have if he or she disagrees with this decision?

Answer 1

1. Practically speaking this case has an ethical issue about justice and legal issue also . Treating everyone equally but in this case the issue was that according to the triage ,priority was given to Sarah as she was young , having more chances of survival than Marguerite . In this case the priority is seen more than the ethical issue of justice. In any of the institution ,if this was the case ,they would do the same only . Legally it is incorrect to have Marguerite wait for angiography . The healthcare organisation must have two or more angiography rooms along with staffs ready to work in cases of emergency.

2. According ,to me the chances of survival is the criteria for a physician to use when having to choose between a solution that benefits one patient at the expense of another .

3. Dr. K can justify this decision by explaining the family of Marguerite that she was 89 years old ,had very less chances of survival even if angiography was done . On the other hand they had middle age 45years Sarah who has small childrens ,had more chances of survival than Marguerite , and can tolerate the procedure far better than Marguerite . So ,an ethical decision was made based on the chances of survival .

4. The other option that the member of the angiography team or caregiver for Marguerite have if he or she disagrees with this decision is to refer the patient to another hospital as soon as the decision is made so that procedure can be made within time .