Ethical and legal perspectives in healthcare

Health Care

How would you resolve this dilemma?

If I was present in this case, I would work to convince the mother about how futile this ventilator support really is. Being a mother, the woman surely doesn't want anything to happen to her child. It only seems necessary to try to explain the congenital abnormality to the mother and to show her no amount of ventilator support or treatment will fix her daughter. Despite the court proceedings, I would remove the baby from the ventilator. Surely, at that time there would be more cases in the hospital that would require the use of ventilators. Regardless of how big the hospital is, the resources are bound to be scarce at one time or another.

Studies have shown that anencephalic babies tend to have a very limited life span even with the use of ventilator support. Anencephalic babies are now being used as a source of organ donation because there is no chance of their survival. It was seen that between 1978 and 1982, 205 anencephalic babies were delivered alive in California. It was seen that most of the babies were not given support and they tended to live only till about a week. It is true that modern intensive care facilities have increased the survival time but that is the only thing they do. Pomerance and Morrison et al. (1989) stated that with the use of seven to 14 days of ventilator support the infants can survive to a significant time and become competent organ donors.

The fact that these infants are being considered and research for organ donors is enough evidence in itself that these infants would not survive. There is no point in keeping someone alive if they cannot interact, feel or even recover from the condition that they are in.

Question 2: In a time of scarce resources is it reasonable to require the hospital to provide seemingly futile services?

In my opinion, it is not reasonable for the hospital to provide seemingly futile services. Anencephaly is a condition that results from a neural tube defect and can be detected by ultrsonography. It is seen that 95% of the women who find out that their child suffers from anencephaly would chose to go for an abortion. (Doyle, 2010) It is seen that in most or all of the cases, anencephalic infants are not resuscitated because there is zero chance of these babies reaching a normal conscious existence. (Doyle, 2010) Our brain is the major organ behind human functioning and if that is absent or missing, the person far away from being medically healthy. Most of the doctors and hospitals normally just price hydration, comfort and nutrition to the babies and allow nature to take its course.

Clinicians have stated that anencephaly and brain death are the two conditions which do not require any medical intervention. There is no point in treating these conditions, thus it is better for doctors and staff to direct their efforts to someone who has a chance of living. Seeing how diseases and illness are so widespread, it is not a decent act to have precious resources like life support machines or ventilators is used for cases that do not have chances of survival.

Resources are scarce in almost every medical facility regardless of where a person goes. (Gardent & Reeves, 2009) Scarce recourses do lead to organizational failure and disputes many a times. The major approach taken by the doctors and hospitals is that they consider which case would attain the most benefit from the resources. Keeping this in mind, they a lot the resources and make them work in the favor of the patient. Considering this argument, it is quite clear that it is not reasonable to use the resources in this futile case.

Question 3: How would you define futility?

The term futility basically means ineffectiveness and uselessness. Considering the scenario we are discussing, the term of medical futility comes up. Futile medical care is the ongoing provision of medical treatment or care to a patient who does not show any hope of recovery. It is either that his condition is not curable and therefore the treatment that he is receiving is of no benefit. The common examples of these are that a surgeon is performing a surgery on a patient with terminal cancer. Patients who have terminal cancer have gotten the cancer spread all throughout their body. It is only until time that their organs will go into failure and they will pass away. Another example is of keeping brain dead people on life support for other reasons. As it would be expected, this is quite a sensitive area and it would involve arguments with the patient's relatives and friends.

It is understandable that the loved ones do want to do anything they can to keep the patient in front of them and to cure them in whatever means possible. The major argument with futile care is that it only prolongs death and that there is no positive outcome with it. (Appel, 2009) In places where resources are limited, futile care takes away resources from patients who do have a chance of survival. It is true that it's not ethical to deprive a person medical assistance, but it is not also fair to hog up resources that could be used in more hopeful cases.

Question 4: Read over the EMTALA statute to see why the courts have used it to cover the case.

The Emergency Medical Treatment and Active Labor Act (EMTALA) is an act passed by the United State Congress. This act basically requires hospital to give care to anyone who requires emergency healthcare regardless of their legal status, economical condition or their citizenship. The hospital that is presented with the patient can switch hospital or discharge the patient under the patient's own consent. They can also move the patient after he or she is stabilized or they can move the patient to a facility where services are better.