Pour Let it Pour General

¶ … Pour Let it Pour General presentation of the case describing the overall situation The case study presents the following scenario: the religious hospital in question is being pressured both by the board of directors and the media to reduce the amount of physician assisted deaths of elderly patients and the deaths of children whose parents do not wish to prolong their critically ill children's lives. The media has portrayed this as a situation of "medical errors," but really the hospital's ethical code of conflict is in question.

The patients do not wish to prolong their lives, and their health care providers do not wish them to force them to continue to live a painful existence. On one hand, this seems like an equitable solution for a hospital that both wishes to be compassionate yet to cut costs. On the other hand, donors may be unwilling to contribute funds to a hospital that is in conflict with their personal religious values on the issue of prolonging or curtailing life.

Secondly, fixed costs have been escalating because insurance providers have not been paying for patient's costs of care enough to defray noninsured or impoverished patient's needs. The hospital, to make ends meet, must reduce its operational costs, as well as reduce its extraneously budgeted costs that vary on a patient by patient or a seasonal basis.

One of the reasons costs have become so difficult to meet is because insurance providers have not been able to cover all of the costs of patient care, particularly the elderly and impoverished patients who make use of Medicare and Medicaid. Again, this might seem to be a reason to allow terminally and chronically ill elderly patients to willingly refuse care -- but doing so creates poorer relations with the media, and also might discourage religiously motivated donors to the hospital.

A description or list of the issues that need to be addressed The relations with the media, with the board of directors, with the community, and with health care providers must be addressed. The reasons for the increased rate of patient deaths must be addressed. Furthermore, the costs to the hospital for long-term care of elderly or chronically ill patients must be highlighted, as well as the costs of prolonging the suffering of these patients to other individuals with remediable ailments, who do wish to have full recourse to treatment.

Briefly explore some high level alternative solutions with the pros and cons of each The hospital could institute a policy whereby all patients with chronic ailments could end their lives willingly. This could defray expenses for long-term elderly patient care, and reduce the number of Medicare and possibly Medicaid patients.

However, this could create poor relations with donors to the hospital, the board of the hospital's directors, and with the media, if the policy is not fully explicated and the hospital's death rate appears to go up and is interpreted as attributable to errors, rather than to patient choice regarding care.

The hospital, in contrast, could also decide to simply force all patients to accept care as a condition of enrollment into the hospital, and also force all health care providers to administer treatment to the fullest extent as a condition of their employment. However, this might turn competent healthcare professionals away, who were angry that they no longer could exercise discretion over their treatment, in conference with their patients. Patients might refuse to come to the hospital.

And those that did would cause costs to escalate, as they stayed longer, received more extensive care, and thus exhausted their insurance benefits. A summary presentation of a comprehensive solution that would cover all of the issues Firstly, the board of directors should be convened to establish a policy about what the religiously founded hospital considers to be a quality life and an ethical system of evaluating critical patients, when dispensing care.

Doctors, nurses, and other involved personnel must be convened to discuss various issues that continually arise and a uniform policy must be established, so that such ethical decisions are not solely the burden of patients and healthcare providers in the field.

A press release should be issued to the media and to the community clarifying this policy, so the community, media, and prospective patients and insurance providers know why there was an escalated patient death rate -- it was not due to provider incompetence, but due to the patient's own decision-making, or the family's decision making in regards to the patient's health. Next, the issue of costs must be addressed regarding insurance.

Again, the hospital must determine how many different insurance policies, Medicaid and Medicare patients, and charity patients it can take on and still remain solvent. Of course, it is necessary to take on some charity cases in an America where "approximately 45 million Americans, or 15.6% of the population, were without health insurance coverage in 2003," a.