On a busy night in the ER a member of the hospital board comes in with her sick child and asks that you see him right away. The child has a sore throat and red eye and he appears subdued, but alert. You have a full waiting room.
What should you do?
A 28-year-old male is admitted with bacterial endocarditis and needs a replacement of his prosthetic heart valve. After his first replacement, he continued to abuse intravenous drugs. The medical team feels it would be "futile" and a waste of medical resources to replace this heart valve yet again.
Is the team's judgment appropriate in this case?
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Authors:
A 28-year-old male is admitted with bacterial endocarditis and needs a replacement of his prosthetic heart valve. After his first replacement, he continued to abuse intravenous drugs. The medical team feels it would be "futile" and a waste of medical resources to replace this heart valve yet again.
Is the team's judgment appropriate in this case?
While it is likely that this patient will require additional counseling and support services to improve his health outcomes, replacing the heart value is not "futile" in this case (see the topic page on Futility for further discussion). It is also likely that the medical team is using biased criteria to judge "wasted" vs. "properly used" medical resources. Thoughtful discussion may provide an opportunity for the team to voice their frustration and think through a treatment plan that will maximally support this patient's recovery.
On a busy night in the ER a member of the hospital board comes in with her sick child and asks that you see him right away. The child has a sore throat and red eye and he appears subdued, but alert. You have a full waiting room.
What should you do?
Cases where famous or influential people are asking for special treatment ask that we review our ethical criteria for resource allocation. Do some people "deserve" special treatment over others? What would justify such a claim? In this case, the ER staff might be swayed by the powerful position the board member holds in their institution and want to do their best for her. However, the other people waiting in the ER have been subject to triage criteria based on medical need. It would be unjust to waive these criteria on the basis of social position. While this may seem unrealistic, one might also consider the effect on the hospital if the board member faces a long, tedious wait in the waiting room along with everyone else. A complaint voiced by this powerful person may enact change on staffing considerations more effectively than a number of patient complaints. To let her sail through would be to create an impression of smoothness that is most likely not part of the everyday ER experience.
For further discussion of this case, please refer to Douglas S. Diekema's article, "The preferential treatment of VIPs in the emergency department," American Journal of Emergency Medicine 1996; 14(2):226-229.