Jacob M. Appel
MedPageToday
Originally posted 28 Jan 23
Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true, but anonymized, patient care case. You vote on your decision in the case and, next week, we'll reveal how you all made the call. Bioethicist Jacob M. Appel, MD, JD, will also weigh in with an ethical framework to help you learn and prepare.
The following case is adapted from Appel's 2019 book, Who Says You're Dead? Medical & Ethical Dilemmas for the Curious & Concerned.
Alexander is a 49-year-old man who comes to a prominent teaching hospital for a heart transplant. While awaiting the transplant, he is placed on a machine called a BIVAD, or biventricular assist device -- basically, an artificial heart the size of a small refrigerator to tide him over until a donor heart becomes available. While awaiting a heart, he suffers a severe stroke.
The doctors tell his wife, Katie, that no patient who has suffered such a severe stroke has ever regained consciousness and that Alexander is no longer a candidate for transplant. They would like to turn off the BIVAD and allow nature to take its course.
Not lost on these doctors is that Alexander occupies a desperately needed ICU bed, which could benefit other patients, and that his care costs the healthcare system upwards of $10,000 a day. The doctors are also aware than Alexander could survive for years on the BIVAD and the other machines that are now helping to keep him alive: a ventilator and a dialysis machine.
Katie refuses to yield to the request. "I realize he has no chance of recovery," she says. "But Alexander believed deeply in reincarnation. What mattered most to him was that he die at the right moment -- so that his soul could return to Earth in the body for which it was destined. To him, that would have meant keeping him on the machines until all brain function ceases, even if it means decades. I feel obligated to honor those wishes."
