Posted: April 4th, 2023

From Chapter 9: Last Resort Options (Curlin & Tollefsen)

Week 13, Both questions should be a total of 500 words combined
1. From Chapter 9: Last Resort Options (Curlin & Tollefsen): For this question, please offer some personal reflections (i.e., a few short paragraphs) on which argument(s) or point(s) stood out to you the most or that you found most intriguing.
2. A Real-Life Case Study + Chapter 6: Beneficence (Beauchamp & Childress): Suppose that you are a clinical ethicist at a local hospital. You get an ethics consultation from an observation unit nurse whose patient has a self-sanctioned DNAR code status (Do Not Attempt Resuscitation) and is also on suicide watch. The nurse has contacted you because, on the one hand, she knows that she is observing the patient in order to prevent acts of attempted suicide. Yet, on the other hand, she also knows that the patient has a self-sanctioned DNAR status because of their terminal condition and deteriorating health. The nurse's questions to you in the consult are as follows: "What should I do if the patient engages in an act of attempted suicide? Do I stop them? And what if I'm too late and their act is successful? Do I resuscitate them despite their DNAR code status?" Utilizing what you've learned from the Beauchamp and Childress reading (e.g., their definition of paternalism, the distinction between soft and hard paternalism, the conditions under which B&C think hard paternalism is justified, the relationship B&C see between paternalistic intervention and acts of attempted suicide, etc.), what would you say in response to this ethics consult? What recommendations would you give to the nurse? Explain.

Week 14, Both questions should be a total of 500 words combined
1. After reading "Ethical Distribution of COVID-19 Vaccines to Health Care Workers: One Hospital System’s Attempt at a Moral Allocation Algorithm," please: (a) Briefly summarize the moral allocation algorithm developed by the hospital system from the article; and (b) Offer some personal reflections (i.e., a few short paragraphs) on which argument(s) or point(s) stood out to you the most or that you found most intriguing in this piece.
2. A Real-Life Case Study + Chapter 7: Justice (Beauchamp & Childress): A 23 year-old male patient is unresponsive in your surgical ICU. He is currently ventilated, heavily sedated, and on sustained low-efficiency dialysis (SLED). The patient has been transferred to your level I trauma center after quickly exceeding the needed level of care offered at his local regional hospital. He had to be emergently stabilized and underwent several surgeries after showing up to their emergency room status post multiple gunshot wounds. After several surgical interventions at his regional hospital, the patient was stabilized but lost a kidney, had to have his right arm surgically reconstructed, lost his right hand, had his liver severely damaged, and lost part of his intestine. Right before transferring to your hospital for escalation of care, the patient suffered a cardiac arrest but was resuscitated and re-stabilized. As a member of the hospital's Ethics committee, you've been consulted to assess the patient's current situation. After transferring by helicopter, the patient underwent further surgeries, but the surgical team has now informed you that there are no further interventions that they can offer. The surgical team explains that they have consulted the Ethics team because the patient is now suffering from multi-organ failure and, because of his worsening liver damage, is unable to coagulate his blood. As a result, the patient is using an incredibly high amount of blood products while he continues to actively decline. On top of all of this, the patient's right arm has become necrotic and his ventilator support is now increasing. The patient's family has consistently and firmly told the hospital staff that they want "everything done" to save the young patient's life. With the patient seemingly actively dying, the question before the Ethics committee is: What would you recommend that the patient's care team do and why? Continue "doing everything," including providing an incredibly high amount of very scarce blood products? Recommend withholding further blood products? Change the patient's code status to Do Not Resuscitate against the family's consent? Would you recommend something else? Rely on the principles of biomedical ethics that you've learned over the course of this semester to analyze the dilemma and determine how the patient's primary care team should proceed. Be sure to include a discussion of B&C's Chapter 7 material as well concerning how the abstract material principles of justice discussed there might be able to help us figure out an ethically appropriate course of action with respect to the scarce blood products. Finally, be sure to also relate special medical ethics terminology as appropriate, and to demonstrate a close reading of the case description. Aim at sufficiently defining and analyzing the dilemma.

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Week 13

In Chapter 9: Last Resort Options, Curlin & Tollefsen discussed the ethical implications of interventions that may be considered as last resort options. One argument that stood out to me was the idea that some interventions could be considered as a form of abuse, especially when the intervention imposes a burden on the patient, does not benefit the patient, or even causes harm. This argument resonated with me because it highlights the importance of considering the patient's autonomy and wellbeing when making treatment decisions.
Another argument that intrigued me was the idea that some interventions may be considered futile and, therefore, may not be worth pursuing. This argument raises important questions about the goals of medicine and the role of healthcare professionals in promoting the best interests of their patients. It also highlights the need for healthcare professionals to be honest and transparent with their patients about the limitations of medical interventions and to work collaboratively with them to make treatment decisions that align with their goals and values.

Overall, Chapter 9 provides important insights into the ethical complexities of last resort options, and it underscores the need for healthcare professionals to approach these interventions with careful consideration of the patient's autonomy, values, and best interests.

In the case study presented in Chapter 6 of Beauchamp & Childress, a nurse is faced with a patient who has a self-sanctioned DNAR status and is also on suicide watch. The nurse is concerned about how to respond if the patient engages in an act of attempted suicide and whether to resuscitate the patient despite their DNAR code status. In this scenario, the principle of beneficence is in tension with the principle of autonomy.
As a clinical ethicist, I would recommend that the nurse prioritize the patient's autonomy and respect their wishes regarding their DNAR code status. However, if the patient engages in an act of attempted suicide, the nurse should intervene to prevent harm and ensure that the patient receives appropriate medical attention. This intervention may be considered as soft paternalism because it seeks to promote the patient's best interests while still respecting their autonomy.

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If the patient's suicide attempt is successful, the nurse should not resuscitate the patient in accordance with their DNAR code status. However, the nurse should provide emotional support to the patient's family and offer any necessary resources to help them cope with their loss.

In conclusion, the case study underscores the need for healthcare professionals to balance the principles of autonomy and beneficence when making treatment decisions. It also highlights the importance of approaching ethical dilemmas with sensitivity, empathy, and a commitment to promoting the best interests of the patient while respecting their autonomy.

Week 14

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In "Ethical Distribution of COVID-19 Vaccines to Health Care Workers: One Hospital System's Attempt at a Moral Allocation Algorithm," the authors describe a moral allocation algorithm that was developed to guide the distribution of COVID-19 vaccines to healthcare workers. The algorithm considers factors such as the worker's risk of exposure, their job responsibilities, their age, and their medical history. The authors argue that the algorithm promotes fairness and transparency in the distribution of vaccines and helps to address concerns about the inequitable distribution of healthcare resources.
One argument that stood out to me was the idea that the algorithm should prioritize healthcare workers who are at higher risk of exposure to COVID-19, such as those working in emergency departments and intensive care units. This argument underscores the importance of considering the needs and vulnerabilities of different groups when making decisions about the allocation of healthcare resources. It also highlights the ethical imperative to protect the health and safety of healthcare workers who are on the frontlines of the pandemic.

Another point that intrigued me was the authors' emphasis on the need for transparency and public engagement in the development of allocation algorithms. This argument highlights the importance of involving stakeholders in the decision-making

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