Moderator: Robert Orr, MD
Panel: Sam Casey, JD; John Dunlop, MD; Pat Emery, MSN, RN; Daniel McConchie, MA; and Pastor Keith Plummer, PhD (Cand)
Clinical ethics looks at the patient with the obligations of beneficence and compassion.
Case: Peter is 10 3/4 years old. 2 months - severe cardiomyopathy. 7 months received heart transplant. 27 months, severe rejection episode with cardiac arrest and hypoxic brain damage. Now he has markedly diminished renal function. Transplant? sever coronoary artery disease. Re-transplant?
KP - Are there other children?
RO - Mom is single, no siblings
PE - What does Mom want?
RO - let's assume she will want to pursue these things?
DM - What is the prospect for longterm dialysis?
RO - Covered by medicaid,
JD - Other issues with new organs?
RO - Kidney's might quit earlier than heart, likely not a combined transplant. Each transplant has a high chance for success.
SC - if successful, what is the longterm prognosis?
RO - Rest of body seems to be functioning well. Nothing in particular anticipating to take his life in the forseeable future.
RO - Mom wanted more education to care for him. Son is in institution and she cares for him on weekends. Mom content with his level of function.
DM - Child's level of cognition?
RO - Nonverbal. First able to sit at age 4. now he can walk with assistance. Can drink from a cup but needs assistance with self-feeding. Is in diapers, doesn't speak. Tries to mimic sounds. Loves music.
PE - Mother's support system?
RO - well connected
PE - mother's level of education?
RO - high school/college
SC - Concern: child is profoundly disabled. Other child on transplant list are otherwise normal. Are their listing criteria?
RO - Criteria: Adequate, cognitive attention.
SC - does this listing violate American's with Disabilities Act?
RO - What if this child were in PVS?
SC - if the child is PVS, that doesn't mean that the AwDA doesn't apply.
RO - Allocate upon some neutral criteria? Is there discriminatory criteria that the law points out?
Other questions/comments:
Something within this child that keeps him alive.
How much would all this cost. Public money that might be spent on more otherwise healthy children?
Has he had seizures? No
What is the relationship between his suffering and what he might have to gain?
Is that appropriate given his cognitive state?
Does he recognize his mother and respond differently to other people?
Is he in crisis right now? (no)
...the discussion continues...
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