[6th ed. = Case 29]
Lauren: outline the case, distinguishing ethical from medical/social/legal/other issues, and any other information necessary to understanding the case (you might want to do a tiny bit of research if there's some particular angle that seems interesting to you). You are also responsible for constructing relevant (thought-provoking) questions to start discussion on the case issues.
Others: respond to Lauren's awesome questions/discussion prompts. Sarah: you don't have to post again unless you want to.
Even with the many uncertainties of this case, I believe that the treatment should continue. If the doctor were successful in the bone marrow transplant, Bobbie’s thrombocytopenia and the immunosuppression may be relieved. If this occurs, the baby might gain some strength and the will to eat. It is uncertain if the calcium deposits in his brain will influence his mental functions. The Medicaid system is already set up. It’s not so much society shouldering the expense of the infant, but instead this system which is already arranged. It would not be right for Medicaid to decide certain cases to deny (such as this one). The parents should have a right to reject further aggressive therapies or to insist on them. As long as the parents understand all the advantages and disadvantages of a therapy, as the guardians of the child they should be responsible for making the decisions.
ReplyDeleteAn infant who weighs only 800 g (1.76 lbs) at birth was probably born about the 25th or 26th week of pregnancy—a micropreemie. Full term pregnancy is 37-42 weeks. Anything under 20 weeks is a miscarriage. A few years ago there would have been little chance of this child surviving; now the question is how many treatments do we give? Should he survive, but most likely be in poor health his entire life? If Bobbie lives, at the very least, his bones will have slight deformities, he will have respiratory issues of some sort resulting from the hyaline membrane disease, and his mental capacity will be diminished. If he does not have a bone marrow transplant or the transplant fails he will have a suppressed immune system putting him at risk for severe infections that will cause even more life-long problems. He has spent the 6 months of his life in a hospital on a respirator, being given blood transfusions. With such a poor health prognosis and the likelihood for developing more conditions, if I was the doctor I would inform the parents about the option of a transplant, but my recommendation would be not to do it. It is a last resort for someone that will not ever fully recover; transplants are hard enough on an adult body, I don’t see the benefits as great enough for Bobbie. The parents could make the decision to do the transplant, but I would ask them to consider the lifetime expense for medical equipment for Bobbie and what kind of quality of life he would have and if that is fair to him. It should be an informed decision by the parents.
ReplyDeleteAs far as Medicaid paying the hospital bills, I don’t feel that it is a great issue in the choice of treatment. The Medicaid program itself could be arguable as to whether or not it should exist as a part of the federal government, but for this case it makes no difference. Everyone pays a little bit into the system for those who qualify to gain benefits. Bobbie’s cost of care does not have any effect on an established program.
Bobbie, who was born prematurely, is now 6 months old. He has hyaline membrane disease, rickets, thrombocytopenia, and immunosuppression. He also has calcium deposits in his brain that may be compromising his mental functions. The physician is now considering a bone marrow transplant to treat the thromobocytopenia.
ReplyDeleteSome of the ethical issues in this case involve rather or not the bone marrow transplant is really benefiting the child. Another issue is if an experimental treatment should be done just because it is possible to do so. Also, the doctor could be putting false hope into the parents head about a treatment that really has no proven success in infants.
The medical issues involve the fact that the bone marrow transplant is only helping one of his many problems. If it is not successful, it puts Bobbie at risk for infections which further compromise his already weakened immune system. A bone marrow transplant will put stress on his body and he is already medically fragile.
Some social issues involve whether or not Bobbie will be able live independently. Another issue is if Bobbie may continue to be a cost to society for his medical care.
The legal issues are that Bobbies parents are responsible for the decisions regarding his care. The health care providers have a duty to ensure that the family has informed consent. Informed consent allows the parents to decide what they believe is in Bobbie's best interest.
Questions for Discussion
Should all available treatments always be performed even when the benefit may be minimal?
Is treatment for only one of his problems really going to improve his chances for survival or decrease his hospital stay?
Should cost ever be a factor?
Who decides what quality of life is? Will Bobbie ever develop enough to live a meaningful life?
This case is really no different from many cases involving terminally ill patients. Just as in those cases, I believe there is a limit to what treatments doctors should encourage, especially if the treatments are unlikely to provide any real benefit, and may end up hurting the patient even more. I think it is important to note that Bobby has little chance of survival, with or without treatment, and therefore it makes sense to lessen his suffering and spend the money on someone else who could really benefit from it. Some may think this is cruel given his young age, but the fact is that his quality of life has already been drastically decreased, not just during the time of treatment, but throughout his life (which will undoubtedly be shortened). Life is incredibly valuable, making it understandable to put such high costs to heal the ones we love. At the same time, there is no way to justify the cost of healthcare when chances of recovery are minimal, and quality of life is compromised. Bobbie will likely incur more hospital visits if he lives, adding more money to his already soaring medial bill. I don’t think it is ethical to spend taxpayer dollars on feeble cases that really end up costing the lives of others. Unfortunately, I think many people who have insurance take advantage of the support it provides, forgetting that nothing is free, and that someone else may need that money more.
ReplyDeleteAll this being said, I think parents have the right to be educated on the risks/benefits of treatment, and make a decision for their child, always being reminded that they are not the only ones relying on Medicaid.
I understand the benefits may be minimal but they are in fact beneficial to Bobby if he has the surgery. I don't think the cost and the amount on his medical bill should play a factor in whether or not he gets the surgery. He is entitled to whatever quality of life he can have just the same as any other human being. Also, it is up to the parents to make the final decision about what to do for their child.
ReplyDeleteI think this case is going to be complicated any way you look at it. You could go ahead with the surgery and Bobby could still not make it. But should a slim chance of living give the parents a right to not try the surgery? There are many cases where individuals were told they had a slim chance of living even with their surgery and ended up living healthy lives. On the other hand, the child is so little and has more than one condition. The parents should be educated on every aspect of their child's life, and the final decision should be left up to them. Although the surgery costs an enormous amount of money, Medicaid has already been put into place so that children can have a chance to get the treatment they need if something such as this were to happen.
ReplyDeleteI do believe the parents should have the right to decide on how aggressive the treatment should be and when enough is enough.
ReplyDeleteThe hospital I'm at right now is looking for 5000 donors to match a childs bone marrow so the child can survive. If this doesn't happen by thursday they are out of time. How sad for the family, I pray someone matches, I even wish I could be a donor. Medicaid will take care of the expense so the most important views is to educate the parents of the outcome. Then there[s the hope that Bobby will live and for how long. How much damage etc. It's a sad sad situation and I 'm not so sure how I would handle the situation. I can't make judgement and I can't see a future.