TRADITIONAL OPTION FINAL PAPER: CASE II For background material,read A Chronicle: Dax's Case As It Happened (Burton) andCommentaries (White and Engelhardt) in the book. Notice, however,that this paper addresses a different question. Twenty years ago,the question was \"Should Dax be permitted to refuse treatment anddie?\" But the question for this paper is, \"Should medical resourcesbe expended on Dax?\" You are the hospital's bioethicist. Thehospital administrator refers the case of Donald C.(Dax) to you. Heis a twenty-six year old who has been so badly burned that his faceis disfigured, he has lost the use of his hands, and he is blind.(Use the details of Dax's case except in regard to the matter ofpayment for his treatment. Unlike the real Dax’s case, how muchtreatment will be covered by insurance is unclear, and the companywhose gas line caused the explosion denies responsibility.) DonaldC. states that he does not want further treatment because heprefers dying \"to living as a blind and crippled person.\" He alsorefuses to give permission for surgery that might improve thefunction of his hands and of one eye. Donald C.'s mother asks thatthe hospital continue the burn treatments and that the physicianstry to convince him to give permission for the surgeries. However,the hospital is not sure that Donald's insurance will cover thesurgery even if he agrees to it. Some of the medical personneltreating Dax believe that they ought to save his life regardless ofconsiderations of the quality his life will have because of hisinjuries. Other medical personnel treating Dax believe that he willhave such a reduction in quality of life, and therefore will sufferso much, that it is wasteful to expend medical resources on him.The hospital administrator asks you to advise her about the moraldimensions of expending resources on Donald, answering thefollowing questions: a. Is treatment his right, whether he wants itor not? Should the decision about continuing treatment and therebyexpending medical resources on Dax be influenced by considerationsof his prospects of attaining a satisfactory quality of life? b.Should the decision about honoring Donald's mother's request dependon whether the insurance will cover the treatment, or should thedecision about whether to continue treating Dax be independent ofwhether payment is available? Should consideration of the medicalresource need of other actual patients weigh in deciding whether totreat Donald? Should consideration of the needs of potentialpatients weigh? c. As payment is not assured, should the hospitaldistinguish between the basic treatments needed to keep Donaldalive (the burn treatments) and the treatments to try to restorefunction (the surgeries)? What about cosmetic surgery to improvehis appearance - is there an obligation to provide cosmeticsurgery? d. If Donald needs human organic material for grafts (skin?? cornea ??), is it ethical to purchase these? e. How shouldDonald's youth be weighed in the decision to allocate resources?Would the hospital have a different obligation if Donald weresixty-six instead of twenty-six? f. More generally, what is usuallyat issue in considering the cost-effectiveness of allocatingmedical resources? Assess the strengths and weaknesses ofcost-effectiveness as a criterion for deciding how to treatpatients. g. Should decisions about the justice of allocating orwithholding medical resources from Donald be made by hisphysicians? If not by his physicians, than by whom?
