There Can Only Be One Imagine you are a member on the ethics committee of a local hospital that's still under construction but has been forced to open early because of the Covid-19 pandemic

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There Can Only Be One
Imagine you are a member on the ethics committee of a local hospital that's still under construction but has been forced to open early because of the Covid-19 pandemic. Despite only having been open a few weeks, the emergency care unit is already overrun with Covid-19 patients, stretching supplies and personnel thin.

Most patients in the intensive care unit are improving. Nonetheless, four with respiratory failure are not responding to treatment. This urgently requires intubation and ventilation. Unfortunately, only one ventilator is available, and a decision must be made immediately.

 

In the medical community there is broad agreement that decisions regarding the allocation of scarce medical resources should be determined by a carefully considered institutional policy, and not by those providing direct care to patients. Sadly, due to the premature opening of your facility, no such policy is in place.

 

Looking to similar kinds of hospitals and their policies, you can see that some focus on the equal dignity and worth of every patient and try to preserve that equality in the form of giving each patient an "equal chance" to get therapy, and when a lack of resources make that impossible, to employ a fair lottery to determine who gets care. Others try to maximize benefits to the larger community of which the hospital is a part. The question then becomes how to justly take account of the facts of these patients' lives to predict which of them, if they recover, will benefit the community the most. Some hospitals have even tried to blend these two approaches.

 

Regardless, you and the rest of the ethics committee need to make an ad hoc recommendation today. Here's what we know about the four patients in urgent need of intubation and ventilation: 
Patient 'A' is a 53-year-old male, currently unemployed because the restaurant he worked at was shuttered because of Covid-19 fallout. A permanent resident of the U.S., he is single and has no living relatives left in the country, although he claims that he has "lots of cousins with lots of land" in another one. Well known to the local police on account of some misdemeanor public intoxication charges, he is nonetheless widely considered to be harmless. And he claims that he is not alcohol dependent and can "quit whenever he wants to." There's also no evidence of liver or other alcohol-related health damage. Patient A began suffering from significant shortness of breath after he "caught a cold," but he did not want to go to a hospital for fear that they would "treat him like dirt". An ambulance brought him to your Emergency Department after he collapsed on the street.

 

Patient 'B' is a 41-year-old female. She is married and the mother of three children aged 15, 12, and 5. She is a successful interior designer who has donated her services to various community organizations. She suffers from amyloidosis, an unusual and little understood disease of unknown cause characterized by the extracellular accumulation of amyloid--i.e., -nonfunctional protein fibers--in the organs and tissues of the body. There is presently no known cure or treatment for this disease. It is ordinarily fatal over time, depending on which organs or tissues are affected and at what rate; but no dependable life-expectancy statistics are available to apply to her case. Patient B became sick shortly after volunteering in a local soup kitchen. "I knew there was some risk," she explained, "but those people need all the help they can get." When her condition worsened, she immediately came to your Emergency Department.

 

Patient 'C' is a 29-year-old female. At age 3 she suffered cerebral hemorrhage after a blow to the head from a fall and has been severely developmentally disabled since then. Her mental age is approximately that of a three-year-old. She resides in a state home for the developmentally disabled. Her mother is a 62-year-old widow who has no other children and whose only income is her husband's social security survivor pension. Theresa was visiting her mother at her home when Theresa came down with a cold accompanied by fever and her mother's PCP said she should be taken to your Emergency Department. Her mother has visited her on several occasions and has spoken of the joy she brings to many friends and family members. 

 

Finally, patient 'D' is a 41-year-old male. He is single and works as a radiation technologist at another local hospital, where he's been for the last nine years. An avid sports fan, prior to this he was in otherwise peak physical shape, and spent his spare time coaching a local little league team - something he's been doing for years now. In fact, it was during a league game in the fall that he caught a chill and woke up the next day with what he kept telling relatives was just a "cold or flu". Patient D refused to believe that Covid-19 was real or a mortal threat, and by the accounts of his own family members he has been extremely careless with respect to abiding by pandemic restrictions. Relatives called 911 after he developed a fever and shortness of breath and couldn't get out of bed.

 

QUESTION:
Which, if any, of these patients is most obviously deserving of care, and which one is most obviously undeserving of it? Utilize moral principles/argumentation to justify your decisions.