A Pennsylvania hospital is faced with a non-U.S. born 5-year-old daughter of undocumented immigrants who has a life-threatening need for a 2 million dollar transplant. Using critical analysis and your ethics knowledge render and defend a decision about whether to provide the transplant.
One of the ethical problems present is the fact that the 5-year-old was born in undocumented immigrants parents. She also was a non-United States citizen. Another problem is the child has a life threatening disease that requires a transplant for a substantiate amount of money that is two million dollar to be spending on a non-U.S. citizen. The case that is being presented brings into focus a number of the most currently vital questions that occur in the gap of medicine and politics. If this case were one of only medicine, then both the questions and the answers would be relatively simple: Would the patient benefit in a substantial way from receiving the transplant? If the answer would be yes, then doctors could be free of political and economic constraints and would treat the child. However, the practice of medicine is most certainly not free of financial questions. And whenever money involves somewhere, politics is not too far behind because politics always follow the path of money.
Several key ethical questions are raised by this scenario. More than anything, what one considers depends on the political perspective on things. And most of the time that is always considers being very important and obvious. This leads to the other major perspective on this issue, which is a laissez-faire or progressive one. A dispute would focus on the fact that a five-year-old girl has a potentially full life before her in which she can both contribute to society and enjoy the happiness that the people believed to have when living their lives. Medical care should not hold back when it comes to a situation like that when it comes to do the right thing as suppose to the political world. One needs to be realistic and acknowledge the obligation of this case. Then the society will eventually feel the obligation and the rationale of a child with life-threatening disease. People that are conservatives are likely to focus on the fact that the girl is not a U.S. citizen and therefore see the question not so much as one of medical care, but of immigration policy. The reality is that the little is a human being who needs care.
In this scenario, one asks to consider not simply whether the whole society should take on the medical costs of those who cannot provide for their own care but how much value different types of people have to our society. In America, a system in which health care has to be rationed, who will get how much becomes a politically charged issue. In the current atmosphere, in which anti-immigrant feelings run high, there would certainly be many people who would object to a non-U.S.-citizen receiving medical care. In addition, there would be many other people would stand out and defend the other side of the equation.
It would be critical to get information from the family, gather the little girl's history of the disease and the all the information needed from the physician's to assess and measure the amount of work and length of the whole case from the beginning to the treatment after the transplant. Furthermore, information from the pharmaceutical companies to see in what capacity they can help, either by donate medication for free or for a reducing price, information can be also obtain from outside charitable organizations that can help and that can make donations on the girl's behalf. The information is needed to see how much would be needed for the entire ordeal.
The stakeholders in this scenario are the family which includes the child' parents, the doctors, state public health officials who are likely to have to serve as mediators between state and federal health law, as Kershaw (2007) describes in the case of the state of New York, in which state law requires that illegal immigrants be given certain medical care while federal law prohibits is. Also, there are the nurses, the specialists, the social worker, the physical therapist who eventually will be involved in the case. Another stakeholder that should not be forgotten is the little girl who is the patient and has to go through the entire political and medical ordeal.
Moreover, among the key stakeholders is the staff and administration hospital where treatment has been required and the ethics boards of the institution. One important issue that must be addressed in the assessment of the case of the little girl would be the real cost to the hospital of such a transplant: because there are, for example, the physicians' fees, and are there physicians and other medical personnel who would be willing to donate their time? There are also other considered stakeholders, such as pharmaceutical companies who could be asked to reduce the cost of their drugs in such a case or if they could give away some of the drugs and charitable organizations that might be asked or might consider taking on some of the cost of the girl's care. One could also include among the stakeholders the American nation as a whole.
Dwyer revealed an interesting assessment that neither totally conservative nor totally progressive perspective that helps one to address such ethical approach because it is very rough and complicated to deal with. In Dwyer's assessment, he mentions that "I think both these answers are off the mark. The first focuses too narrowly on what we owe people based on legal rules and formal citizenship. The other answer focuses too broadly, on what we owe people qua human beings. We need a perspective that is in between, that adequately responds to the phenomenon of illegal immigration and adequately reflects the complexity of moral thought (Dwyer, 2004, p. 34). That kind of situation where everyone has mixed feelings about the subject, ethics is such ambivalence subject that an ethic committee in the hospitals is well placed to intervene. And such committee will have experienced qualified individuals to help make difficult decisions.
Every decision should be carefully made by everyone involved. That will include the patients' parents and family, the physicians and staff involved in this case scenario. Because there is a lot of money involved, the institution itself is one of the main players. Arrangements need to be made before proceeding with any process. Mainly, meeting needs to be planned with the stakeholders in order to insure of the financial supports if there are going to be continued with the procedure. The medical professionals need to be there and help make a decision if they want to donate their time or to make any other arrangement. Other people who should make the decision in this case would be the people in the ethic committee and professional ethicists. Another important group of people who can be included in the decision making is the clergy group just in case the family would need such service. Having other organizations involved could be beneficial to this case because if everyone donates their time and money, the transplant and after the transplant treatment will go smoothly financially for the little and the parents. Even part of the money could alleviate the tension that exists within that case if outside help could be found.
Before any decision is taking, nevertheless, some questions ought to be asked. All this efforts that are being made, is the transplant going to be successful? What would be the percentage of the transplant being successful? Should they proceed with it? If the percentage is low, what other alternatives can be taken to alleviate the pain of the patient and the family?
It is extremely important to involve all the stakeholders in the decision making process and have a point-of-view from representatives of every party that is affected by this ethical issue. There is a huge amount of money involved in such cases, and the stakes are very high as it is an issue that will affect the future outcomes. The decision makers need to consider the political influences and the social consideration both at the same time.
The presence of medical experts is a must and the medical representatives should be neutral who are free from all kind of biasness and are able to make suggestions on ethical grounds. An ethical committee should be formed in order to make sure that whatever decision is taken should be in compliance with the ethical code of conduct established by governing authorities. The decision made should be on the basis of the various theories of ethics. The theory that must be taken into consideration with relevance to this case is discussed in detail.…