The case of Marguerite and the angiogram

Case Studies
The case studies are taken from real-life situations. These situations have happened, and continue to happen, even though it seems to be common sense to follow the law and ethical standards of behavior. For some cases, the student may need to refer to a medical dictionary for assistance with terminology.

The case of Marguerite and the angiogram

Marguerite M., an 89-year-old widow, was admitted into the cardiac intensive care unit in Chicago’s Memorial Hospital at 3:00 AM on a Sunday morning with a massive heart attack (myocardial infarction). Her internist, Dr. K., who is also a close family friend, has ordered an angiogram to determine the status of Marguerite’s infarction (heart attack). Dr. K. has found that the angiogram and resulting treatment need to be done within the first six hours after an infarction in order to be effective. Therefore, the procedure is going to be done as soon as the on-call surgical team can set up the angiography room. The radiologist, who lives 30 minutes from the hospital, must also be in the hospital before the procedure can begin. At 4:30 AM the team is ready to have Marguerite, who is barely conscious, transferred from the intensive care unit (ICU) to the surgical suite.

Coincidentally, at 4:30 AM, Sarah W., an unconscious 45-year-old woman, is brought in by ambulance with a massive heart attack. The emergency room (ER) physicians, after conferring with her physician by phone, conclude that she will need a balloon angiography (dilating an obstructed vessel by threading a balloon-tipped catheter into the vessel) to save her life. When they call the surgical department to have the on-call angiography team brought in, they are told the room is already set up for Dr. K’s patient. They do not have another team or surgical room for Sarah. A decision is made that since Sarah needs the balloon angiography in order to survive, they will use the angiography team for her.

Dr. K. is called at home and told that his patient, Marguerite, will not be able to have the angiogram. The hospital is going to use the angiography team for Sarah, since she is younger than Marguerite and has a greater chance for recovery. Unfortunately, it took longer than expected to stabilize Sarah before and after the procedure and the six-hour ‘window’ when the procedure could be performed on Marguerite passed. Marguerite expired (died) the following morning.

1. Analyze the Marguerite M. case using the Seven-step Decision Module found in Module 3.Preview the documentView in a new window

a. Determine the facts.

b. Define the precise ethical issue.

c. Identify the major principles, rules, and values.

d. Specify the alternatives.

e. Compare values and alternatives.

f. Assess the consequences.

g. Make a decision.

2. What do you believe should be the criteria for a physician to use when having to choose between a solution that benefits one patient at the expense of another?

3. How can Dr. K. justify this decision when speaking to the family of Marguerite M.?

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