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Spring 2002
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Allocation
of Resources
The Last Bed in the ICU
From
Case Studies 4 –Hastings Center and Mappes and Zemburty
At the age of 70, Mrs. A has been admitted to the hospital for the fifth
time in as many years for treatment of respirator difficulty. The last
time she was in the hospital she had nearly died. She has severe
emphysema, and when she developed a cold, her deterioration was so rapid
that only artificial respiration in the emergency room saved her life.
However, it proved very difficult to wean her from the respirator. She
spent four weeks in the Intensive Care Unit and required constant care
from the medical staff, principally Intern B. After she was discharged,
she remained short of breath even while watching television.
Now, five months later, she has contracted another cold, but this time
Intern B has managed to treat her without resorting to the ICU and the
respirator. During her illnesses, Mrs. A’s two sons have been in
constant contact with the medical staff. They have been anxious,
agitated, and demanding.
It is now 2 a.m. and Intern B is again called to see Mrs. A, who is
becoming increasingly lethargic. It is obvious that she is in
respiratory failure, and will probably die before morning if she is not
given a respirator.
However, hospital policy requires that respirators be used only in the
ICU, where the required supporting staff and facilities are available.
There is only one bed open in the ICU. The residents like to save one
bed for an emergency. As Intern B approaches, Mrs. A’s sons are
waiting. He knows their questions: What’s wrong now? What will you do?
What should the
intern do? And on what basis should he make his decision?
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Course
Overview