Hello,

As in Mr. F’s case, the committee members have decided to look at some outside articles on the subject to gain a deeper understanding of Ms. H’s case. For this case, I want to be sure that committee members understand the issues of autonomy and the impact of this procedure on the donor. I’ve chosen articles that will shed some light on these specific issues. Even though the problems the articles discuss may not be the same issue Dr. Robert’s is grappling with, they will help us all understand the ethical issues we are facing here. Please review the articles I have provided those below.

Articles

Doctors May Object to Alternative Treatments on Moral Grounds
This article offers the results of a recent study about whether or not doctors feel obligated to inform patients about treatments they do not agree with and will not perform.

Physician Recommendations and Patient Autonomy: Finding a Balance between Physician Power and Patient Choice
This is an excellent article about balancing paternalism and autonomy. It looks at different approaches to case studies and makes suggestion to physicians for appropriately balancing their own opinions with their patient’s needs.

Role of Living Donor in the United Kingdom
This article provides a good overview of living donation and some of the ethical arguments to allow it. As you read, keep in mind that this is written for an audience in the UK and some of the transplant requirements and laws are slightly different. As you read this article focus on the sections that describe the procedure and the related ethical issues.

Role of the Living Donor
This article offers a dissenting opinion on live donation.

As you read the attached material, please keep the following issues in mind:

• This issue of performing a complicated procedure on 1) a person with only a 4% chance of post-surgery survival and 2) an otherwise healthy person (the donor).


• The ramifications of denying an operation to a patient who may benefit from it, despite the slim survival rate, and who will very likely die without it.


• The issue of performing an operation that utilizes limited hospital resources when the risk is so great.

Keep in mind that we want to reserve making any judgment at this stage of the process. Rather, we are looking to uncover any mitigating circumstances you may not have considered, or to better understand issues you have already discovered.

Your Task
Again, I hope that by reviewing these articles you will be able to see this issue in a broader context and perhaps consider some new opinions. As you review each article, consider the following:

• How does the article address one or more of the problems we are dealing with in this case?


• Does the author offer an opinion on how to handle the problem?


• Does the author offer any new information about this topic that might influence your ultimate decision? Do they suggest anything you haven’t thought about before?

I look forward to your thoughts on this important material.

Thanks,
Chris Jones, M.D.
Chair, Ethics Committee
Lincoln Regional Medical Center