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The following vignette was one of several presented to physicians of various specialties at last month's CMSS conference, "Contemporary Health Care and the Ethic of Medicine: What Is a Physician to Do?" The vignettes were contributed by Ronald B. Berggren, M.D., W. Mitchell Sams Jr., M.D., John M. Eisenberg, M.D., Mary H. McGrath, M.D., and John Santa, M.D.
You are the director of a burn unit at a major medical center. A 66-year-old woman is admitted with burns over 35 percent of her body surface. She is an insulin-dependent diabetic and has a history of asthma. Products of combustion are seen in her tracheobronchial tree. There is no chance of her surviving this injury.
You should
After discussion with both the family and the patient, they are unanimous in requesting that she receive maximum care.
You should
The patient's primary care physician requests that you give only supportive care. She explains that the cost of maximum care will be charged against her capitation pool of funds. Since survival is unprecedented in this situation, the expenses would curtail her ability to deliver care to other patients for whom she is responsible.
You should
Of 42 physicians at last month's conference who registered a vote for the final set of choices, four said they would give supportive care; 15 said they would explain to the family and patient that the cost of treatment will make fewer funds available to treat other patients who have a better chance of recovery; and 15 said they would tell the primary care physician that the family and patient have made their opinion known and that their request for maximum treatment must be followed. Eight physicians at the conference voted for an additional category: to tell the primary care physician "to get lost."
(Psychiatric News, May 16, 1997)