Week 14 Discussion - Ethical Distribution of COVID-19

Discussion Questions

Week 14,  

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.