Naples

Hospital Ethics Committee TranscriptLinks to an external site.

Committee Members

Â· Advanced Practice Nurse: You

Â· Administration: Wes, Chief Operating Officer

Â· Physician: Dr. Hasweh, Cardiovascular Surgeon, Head of Transplant Services

Â· Social Services: Mahalia, worked closely with all clients on the transplant list

Â· Chaplain: Pastor Arturo, pastor of a local church and lead chaplain at the facility

Â· Community Member: Dr. Bashist, retired general surgeon who serves on the Board of Directors

Patients

Â· Helen Adams

Â· Quentin West

Â· Earl Hope Eubanks IV

Original Response

After viewing the Hospital Ethics Committeeâ€”Who Gets the Heart? (7:48 minutes)Links to an external site. presentation, answer the following questions in a numbered list in your original response:

1. Your vote decides who gets the heart. Who would you choose and why?

2. How did health inequality and inequities affect your decision?

3. What ethics would you use to back up your decision?

4. Why did you not choose the other candidates?

5. Was this an easy or a difficult decision for you?

6. Would you want to serve on an ethics committee in the future? Why or why not?

In your original response, provide at least two references with in-text citations to current literature and assigned readings to support your assertions. If you copy and paste references from the course into your discussion, be sure to confirm APA formatting before submitting.

Peer Responses

In your response to each peer, respond to the following prompts:

Â· Do you agree or disagree?

Â· What are the perceived flaws in logic?

Â· What ethical principles support your view?

Â· What else would you have liked your peer to consider?

PEER TO RESPOND TO:

I vote for Quentin West to receive the heart.

Impact of Health Inequality and Inequities on the Decision

Health inequalities and inequities significantly influenced my decision to prioritize Quentin West. As an African American man, Quentin has faced systemic health disparities that have historically affected access to quality healthcare and health outcomes. African Americans often have higher rates of chronic conditions like hypertension and cardiomyopathy and face significant barriers to healthcare access, leading to poorer health outcomes. By choosing Quentin, we acknowledge these disparities and take a step toward addressing them. This approach aligns with the health justice framework, which prioritizes those disproportionately affected by societal and health system biases (Powell, 2021).

Quentin’s case exemplifies how social determinants of health, such as race, socioeconomic status, and access to care, influence health outcomes. Factors like limited access to preventive care, socioeconomic barriers, and historical mistrust of the medical system have disproportionately impacted African Americans. Considering these factors, the decision to allocate the heart to Quentin addresses broader health equity and justice issues.

Ethical Principles Supporting the Decision

1. Justice: The principle of justice involves ensuring fair and equitable treatment for all patients. Allocating the Heart to Quentin West addresses historical and systemic inequities in healthcare access and outcomes for African Americans, aiming to rectify some of these long-standing disparities. This decision helps balance the scales in a healthcare system where minorities have often been underserved and overlooked.

2. Beneficence: This principle involves acting in the best interest of the patient by doing good and maximizing benefits while minimizing harm. Given Quentin’s young age and his role as a father of four children, a successful heart transplant could significantly enhance his quality of life and ability to support his family. His prognosis with a new heart appears favorable, suggesting a more significant potential for long-term benefit. The principle of beneficence supports choosing a candidate who can substantially benefit from the transplant and improve their overall well-being.

3. Utility: Considering the overall benefits and harms, Quentin’s potential for a longer life span and his role as a father of young children align with maximizing the benefits of the transplant. His improved health could lead to better outcomes for him and his dependents, thereby creating a ripple effect of positive impacts (Courtwright et al., 2021). The principle of utility emphasizes the importance of maximizing the positive outcomes of medical interventions, and Quentin’s situation aligns well with this principle.

Reasons for Not Choosing the Other Candidates

Â· Helen Adams: Helen has made positive lifestyle changes, such as quitting smoking, but her ambivalence about receiving the transplant raises concerns about her psychological readiness for the procedure. Her less favorable health status, including her reliance on oxygen and older age, makes her a less optimal candidate than Quentin. Additionally, her hesitation and the potential for rejecting the heart reduce the likelihood of a successful outcome and may waste valuable time in an urgent situation. Helen’s uncertainty about the transplant and its impact on her health outcomes weigh heavily against her candidacy.

Â· Earl Eubanks: While the financial implications of Mr. Eubanks receiving the heart are significant due to his father’s potential donation, prioritizing him would undermine the principles of fairness and equity. His recent collapse and unstable condition, coupled with his history of cocaine use, make him a less ideal candidate for a successful transplant. Ethical guidelines emphasize that financial incentives or external pressures should not influence decisions. The inconclusive drug screen and the need for a drug-free history further complicate his candidacy (Dudzinski et al., 2024). Prioritizing Mr. Eubanks based on financial contributions would set a dangerous precedent and undermine trust in the transplant allocation process.

Ease of Decision

This decision took work due to the high stakes and the potential impacts on each candidate’s life. However, ethical principles and the consideration of health inequities provided a clear rationale for prioritizing Quentin West. As a nurse, I have faced many ethical dilemmas in the NICU, which has prepared me for the complexities of such decisions. While these experiences inform my judgment, they also underscore the weight of responsibility in making life-and-death decisions.

Quentin’s situation presents a compelling case for applying ethical principles and addressing health inequities. Although the decision is challenging due to the gravity of the outcomes, the alignment with ethical frameworks makes it a clear and justified choice. This decision underscores the importance of considering broader social and health justice issues in medical decision-making.

Interest in Serving on an Ethics Committee

Serving on an ethics committee is both challenging and rewarding. The role involves critical decision-making that requires balancing complex ethical principles, individual circumstances, and broader societal considerations. However, given my experiences in the NICU, I recognize that the responsibility would weigh heavily on me. The emotional toll of such consequential decisions and the potential for second-guessing oneself make it a strenuous commitment. Despite this, ethics committees ensure that healthcare decisions are made transparently and ethically, promoting justice, equity, and beneficence in patient care.

While I appreciate the importance and benefits of ethics committees, I am aware of the role’s significant emotional and psychological burden. My experience in the NICU has exposed me to numerous ethical dilemmas, and the responsibility of making decisions that profoundly affect patients’ lives is immense. Serving on an ethics committee would require careful consideration, empathy, and a solid commitment to ethical principles, all crucial for ensuring fair and just healthcare practices.

References

Â· Courtwright, A. M., Erler, K. S., Bandini, J. I., Zwirner, M., Cremens, M. C., McCoy, T. H., Robinson, E. M., & Rubin, E. (2021). Ethics consultation for adult solid organ transplantation candidates and recipients: A single centre experience. Journal of Bioethical Inquiry, 18(2), 291â€“303.

Â· Organ Procurement and Transplantation Network. (2010). Ethical principles in the allocation of human organs. Last modified June 2015.

Â· Powell, R. M. (2021). Applying the health justice framework to address health and health care inequities experienced by people with disabilities during and after COVID-19. Washington Law Review, 96(1), 93.

Â· Khazanie, P., & Drazner, M. H. (2019). The Blurred Line Between Gaming and Patient Advocacy: Heart Transplant Listing Decisions in the Modern Era. Circulation, 140(25), 2048â€“2050. https://doi-org.proxy.library.maryville.edu/10.1161/CIRCULATIONAHA.119.043034Links to an external site.

Dudzinski, D. M., Pal, J. D., & Kirkpatrick, J. N. (2024). Ethical and Equity Guidance for Transplant Programs Considering Thoracoabdominal Normothermic Regional Perfusion (TA-NRP) for Procurement of Hearts.

American Journal of Bioethics, 24

(6), 16â€“26.

https://doi.org/10.1080/15265161.2024.2337393Links to an external site.

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