You are resident on duty in the
ER of a private hospital. Then a frantic mother comes in with her 1 month old
baby boy who was found unresponsive. She comes from a poor town at least 20
minutes away from the hospital. The mother said the baby had been sick with
cough and fever for more than a week now. You quickly check on the vital
signs of the baby boy: CR=0, RR=0 and unresponsive. The mother begs you
to “do the best that you can to help my baby live.” You look at the baby and
you think it is next to impossible to revive him. If the impossible does happen
and you were able to get a heartbeat, there is only a slim chance the baby will
live. You look at the mother and see her anguish. If you do the CPR, you know
it will cost her a lot of money. Money she does not have, causing her to delay
medical consult for her baby. Yet, you also want to give mother and baby a
fighting chance. It is also a bonus as
you know it will help you gain valuable clinical skills intubating the patient,
doing CPR and providing correct emergency drugs.
Is it
OK to perform an expensive procedure to a dead or dying patient when there are no clear
medical benefits? Is it justifiable to do a procedure out of
compassion even if it may lead to more suffering for the family? Is it OK to do it because there are benefits the doctor
can gain?
In this scenario, I suggest we consider 5 Ethical Principles. There are other more principles but let me focus on these five. It is important
we consider the ethical principles of 1.)“beneficence” and 2.)“non-maleficence” to the patient. Remember that the CPR is a medical procedure designed to reverse clinical death. Would the procedure benefit the patient? Would it not cause undue harm or suffering to him? How about to the family? However, we must not forget the 3.)"Principle of Futility." This principle looks into the length of life and quality of life. If there is low chance of survival and low quality of life after the procedure then it is futile. Of course, we need to consider the consequence of
our decision to the family involved. The issue of 4.) surrogate decision making and 5.) justice must also be considered. Since the baby cannot decide for himself, who decides best for the baby? Also, more
than our own gain as doctors, we must prioritize the patient and the family’s
welfare. What will happen to the family emotionally, psychologically, financially and socially after the procedure? Is it justifiable to decide clinically based on the financial capacity of the family? Communication with the family is also important. Being honest to the patient
and the family will help us better decide on our actions.
So, what would you do?
So, what would you do?
