Would you request an ethics committee consultation in T.H.’s case?

Rationing

Situation

T.H., a 43-yr-old female patient with cirrhosis of the liver, is

frequently admitted to the hospital. She has been told that her

continued alcohol use will inevitably lead to her death. She now has

GI bleeding and needs blood transfusions. She has a rare blood type

that is hard to match. Should you ask for an ethics consultation?

Ethical/Legal Points for Consideration

• Rationing, or the controlled distribution of scarce resources, is a

difficult ethical problem. The needs of an individual patient or

group of patients are weighed against the needs of many

patients, who may have a greater chance of recovery, and the

availability of the necessary resources.

• Health interests can supersede the interests or rights of a person.

For example, in anticipation of an anthrax attack, the government

could confiscate all relevant antibiotics and restrict their use to

treat the disease.

• Two individual rights that must be considered regarding

rationing are the (1) constitutional right to privacy and (2) right to

consent to or refuse medical procedures and therapy.

• The competent adult is the only person who may consent to or

refuse treatment for his or her health care problems.

• If T.H. consents to a blood transfusion, an intervening party may

be allowed to refuse that treatment only given substantial

intervening circumstances and not as a threat to compel adherent

future behavior.

• If involved parties cannot reach an agreement, legal intervention

by way of a court order may become necessary.

Discussion Questions

1. Do you think patients with diseases that have a behavioral

component, like substance use, deserve aggressive treatment?

2. Would you request an ethics committee consultation in T.H.’s

case?