Two Cardiac Arrests, One Medical Team
Almost all healthcare professionals face some ethical issues in their practice. They have to make tough choices, telling patients about problems they have, opting for treatment, preserving the confidentiality and many others. The most difficult choices are always connected with preserving some life, sacrificing another. The greatest problem is that there is no law or a set of rules that dictates the right option. One similar case is described in the case study “Two Cardiac Arrests, One Medical Team” (Crigger, 1998).
A man with developmental deficiency, George, had suffered a third cardiac arrest. Before it, he can hardly take care of himself, apart from eating and staying clean. Donald, a businessman, active member of society, and a father of four children, had a minor stroke, but managed to recover soon. As well as George, he had a cardiac arrest. George was brought a few instances earlier. If there were two crash carts and CPR teams, both of them could have been resuscitated. Team leader did not know the medical history of any patients, and he decides to save the man that was brought earlier. Consequently, Donald died (Crigger, 1998).
The team leader had to make a decision as fast as possible because there was no time for reflection on the matter, so he opted for the principle “first come, first served”. It is hard to answer the question whether the team leader made a right choice, as there can be different approaches to the case. If to consider the way of conduct suggested by the Code of ethics, “A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights” (AMA, 1958). Therefore, all patients must be treated equally and every person has a right for necessary medical care. If to use this approach, the team leader made a right choice. According to Medical Council (2009), “Patients with disabilities are entitled to the same treatment options and respect for their autonomy as any other patient” (p. 14). For this reason, George deserves equal treatment and cannot be deprived of this right.
Another approach to the case is made on the principles of the theory of utilitarianism. According to them, the leader’s decision is wrong as both men died. There would not have been the right choice, in this case. Still, if to follow the theory, saving Donald’s life would have been more appropriate as, in that case, less people would have suffered and George would have finally revealed from his life-long suffering. Donald could have been assumed to be useful for the society, however, if the team leader followed this principle, he would have been biased and the decision would have been personal.
If the ethicist had a chance to consult the CPR team members, he or she would probably has advised the leader to try to save both as there was such a possibility if to defibrillate George and ventilate Donald’s lungs and use external chest compression. If there were no other choice than to save only one person, the ethicist would have suggested applying the principle the team leader used. Both patients had the right for urgent healthcare and as George was brought first, he had to receive the care first.
One cannot assume that the principle “first come, first served” is proper to apply in such cases. Everything depends on the healthcare provider. If he or she wants to remain impassionate, unbiased and objective, then this approach will be right. If this person considers the issue from the point of view of society member, the decision to resuscitate Donald will be most appropriate, because this man could have been valuable for the society. He would have paid taxes and, probably, help people; his children would have a father and a wife – a husband; and he would have participated in the life of the community as he did before cardiac arrest. George would have died, but his death would not have caused as much suffering to others as Donald’s. Still, the issues like this should be evaluated from the point of the ethicist, so the right decision would have been to help George as he was delivered first, if there were no possibility to save both men.
In this particular situation, there would have been no choice, which ended up without blames and ethical considerations. The team leader had to make a decision. It was the doctor’s capacity to choose, so he opted for the variant, which, in his opinion, was right. There is no doubt that knowing patients’ histories, the doctor could have made another decision. However, he had to think as a doctor, not as a society member or a parent; therefore, the choice would have been the same if he knew the histories of both patients. Even if Donald had more chances to survive, Gorge had to be treated in any case. Despite the fact that the decision was rather tough, it was still right. Every patient has a right to live and receive urgent qualified healthcare, irrespective to his or her origin, health state, social and economic status and other things. As all patients have equal rights, they should be given care when they need. If there is no possibility to provide care for many patients at the same time, doctors must save those they can.
If there is a case like the one described above, the decision gets miles more difficult to make. The team leader started to work with one patient, when the second arrive. Apparently, he could not leave George to die and save Donald who was brought later. There was no time for thinking too much, careful considering of all aspects and studying and comparing the patients’ histories. Even though histories could have been studied, the leader could not have decided which one of these two men more deserved living. A doctor must be impassionate towards evaluating a patient’s personality traits. It is not his or her task to determine who can be more prepared for further life in the society. The only thing required is trying to do everything possible to save both patients.