Marguerite M., an eighty-nine-year-old widow
Scenario
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Marguerite M., an eighty-nine-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 needs to be done within the first six hours
after an infarction to be effective. The procedure is going to be done as soon
as the on-call surgical team can set up the angiography surgical room. The
radiologist, who lives thirty 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 front the intensive care
unit to the surgical suite.
Coincidentally, at 4:30 A.M. Sarah W., an unconscious
forty-five-year-old woman, is brought in by ambulance with a massive heart
attack. The emergency room physicians, after conferring with her physician by
phone, conclude that she will need a balloon angiography to save her life. When
they call the surgical department to have the on-call angiography team brought
in, they are told that the room is already set up for Dr. K’s patient. They do not
have another team or room for Sarah W. A decision is made that Sarah, who
needs the balloon angiography to survive will receive the procedure.
Dr. K. is called at home and told that his patient.
Marguerite, will not he 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 both before and after the procedure, and the six-hour “window”
when the procedure could he performed on Marguerite passed. Sarah survived,
made a full recovery, and returned to her family. Marguerite expired the
following morning.
A. Should Dr. K. have had a voice in this decision ?
B. Is it ethical to “bump” Marguerite in favor of
the younger patient?
C. Should this decision be discussed with Marguerite’s
family?
D. Does the fact that Sarah’s life has been saved due to the
angiogram team being ready to operate on Marguerite make any difference?
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