Ethics: The Case of Medical Futility

The case of Karen Ann Quinlan brought about the moral issue of whether it was ethical to give patients extended medical attention or service, irrespective of whether the medical services being offered is improving the condition of the patient. In this case, after returning from a party, Ms. Quinlan lost her conscious and stopped breathing. Emergency medical intervention saved her life but the extended lack of oxygen in her brain left her in a vegetative state. Several months passed with no noticeable improvement and her parents requested the doctors to remove the ventilator helping her breath. The doctors refused and there was a court case where the court ruled that the parents had the right to make the decision for the ventilator to be removed. The ventilators were removed and to the shock of many, she did not die. She actually continued breathing on her own and she stayed in this condition for nine more years when she died of pneumonia.
This case involves the issue of medical futility. Darr (2011) defines medical futility as the interventions given or provided to a patient that is unlikely to produce any noteworthy benefit to the patient regarding their medical condition. There are two types of medical futility and they are often distinguished as:
The first one is the quantitative futility and in this case, the likelihood that medical intervention will help improve the patient’s condition.
The second one is the qualitative futility where the quality of benefit of the medical intervention will lead to exceedingly poor results.
The case of Karen Ann Quinlan falls into this category because the medical treatment and procedures she received did not improve her quality of life. In fact, she continued to be in a coma and in a vegetative state for a period of nine years until she died. The main objective of medicine and nursing is to help the sick and improve their quality of life (Darr, 2011). Medical doctors have no duty to give treatments that do not help the patient in any way. Futile medical interventions give patients and their relatives’ false hope and in many cases, it prolongs the patient’s discomfort and pain in the final days of their lives.
Microallocation vs. Macroallocation
In medicine, micro-allocation focuses on decisions on which patients should receive a medical procedure. For example, I was working in a hospital as an intern when I experienced micro-allocation decision-making process. Two patients needed a heart transplant. One patient was a young girl of about 14 years of age and the other one was an old woman of about 70 years. The doctors chose to give the only available heart to the young girl and the old woman was put on the waiting list. She eventually lost her life. Macroallocation, on the other hand, means determining which area in society needs urgent medical care or resources and allocating such services to such areas (Darr, 2011). As an intern, I observed the macro-allocation of resources, which happened when there was an outbreak of flu in one area of the city. All the doctors and facilities were directed to go and attend to the people in the infected area and help prevent the spread of the flu.
Constraints/ Challenges Faced by Providers Affiliated to Managed Care Organizations
Many doctors in the United States work under a Managed Care Organization. This arrangement poses major challenges to doctors as they go about treating their patients (Darr, 2011). One major challenge is that doctors working under this arrangement charge their patients lower rates and this may lead to cash constraints.
Within a Managed Care Organization network, there are patients that can be described as either light/moderate users or heavy users. Heavy users are the ones that go to hospitals very frequently while light users are the patients that visit doctors very few times in a year. Patients that are frequent visitors do so because they are sick and one way to help them is to encourage them to live healthy lives. This way, they will not be visiting the doctors frequently.

References
Darr, K. (2011). Ethics in Health Services Management. (Fifth Edition). Baltimore, MD: Health Professions Press, Inc.

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