Ethical Dilemmas about Economic Aid, Kidney Transplant and Attempted Suicide
Here are some additional ethical dilemmas that I would hope my visitors would take as a challenge to find the best decision. ..Maurice.
1) A first-world nation offers to give a third-world nation equivalent of millions of dollars to provide services and medication to HIV/AIDS victims but with the proviso that 50% of the money is to be used solely for sexual abstinence education programs. That 50% could currently be readily used to enlarge the service and medication programs to cover a greater area and population of the HIV/AIDS patients. What is the ethical conflict here and should the third-world country accept the humanitarian economic aid as stated?
2) Two brothers each have a congenital kidney disease and they are both in the end-stage kidney failure. Both are critically ill at the same time and both need the one donated kidney which is currently available. One brother is rich and can readily pay for the transplant but has a long history of criminal activity including fraud. The other brother is poor, dependent upon the State to pay for his medical care but has never engaged in criminal activity. To which brother should the transplant surgeons provide that kidney?
3) A man has hung himself in his jail cell in an apparent suicide attempt. He was rescued in time to transfer him to a hospital and the intensive care unit. The lack of oxygen has caused what the neurologists say is irreversible severe brain damage but the patient can still breathe on his own and therefore is not “brain dead”. However the patient may never regain consciousness. The family tells the hospital doctors that if he can’t regain consciousness, he should not be given medications to keep him alive and that if his heart stops, the hospital staff should not try to resuscitate him. However, the hospital has religious directives which dictate that the hospital should never aid and abet a suicide. The hospital’s administration tells the family that if the hospital followed the family’s request, the hospital would be going against that religious directive. A hospital ethics committee meeting was held with the family, physicians and administration representatives. What should the ethics committee advise?
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posted by Maurice Bernstein, M.D. @ 6:16:00 PM
3 comments
3 Comments:
1. This situation strikes me as blackmail, making humanitarian aid contingent on population control. Another ethical problem is that abstinence programs don't work and don't prevent AIDS. Perhaps the country would be willing to accept the money if such programs already fit the country's own philosophy and if the two funds were separated from one another (that the nation doesn't have to accept both). Perhaps they might also ask to determine for themselves what kinds of AIDS prevention education they need.
2. There should be prioritized waiting lists or lottery systems/randomization if several people are tagged as possible recipients. The decision should have nothing to do with a patient's monetary circumstances. We cannot punish people for being poor, nor dole out health care according to someone's perceived social worth. Part of me expresses reluctance in that regard when I think about giving prisoners who have committed terrible crimes organs. I'm not sure how to work that out.
3. The hospital should not impose its religious values on its patients or their families. And in this case, the hospital is not aiding the attempt at suicide but dealing with its aftermath, much as it would deal with similar effects from a bad stroke or car accident.
FriedaWrites, in dilemma #1, I took the ethical issue from the Bush administration's apparently well-received AIDS African support program. Unfortunately that 50 percent clause is within the stated requirements of the U.S. offer.
In #2, social status is also said to be ignored in selecting the candidate recipient.
In #3 Catholic hospitals do follow religious directives regarding not performing abortions where the life of the mother is not at stake or tubal ligations when future pregnancies would not put harm on the woman's health. ..Maurice.
Interesting...
1) In my view this is clearly imposing some kind of agenda, however what if the proviso were not spending 50% on abstinence per se, but spending 50% on programs that have been shown to work (but might not be implemented by the third-world country for whatever reason)? In the second case it would seem prudent so ensure the third-world country uses its funds effectively. Is it the imposing of the agenda that is wrong, or does it depend on the agenda itself?
In practicality though, the other 50% would be still be very useful so it would be sensible to take the money. In a matter of life and death, sometimes principles must come second.
2)I can only agree with Fridawrites here - an impartial lottery. It would be wrong to judge either man morally or financially as being more worthy of living.
3)I don't believe religious views should be informing medical practise. A moral code is necessary (after all, you don't kill people so you can have cadavers to practise on!) Take, for example, a hospital with a Jehovah's Witness directive - they could refuse to do surgery and blood transfusions.
The patient and their family must come before the personal/religious views of the physician/hospital.
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