Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true patient care case. You vote on your decision in the case and, next week, we'll reveal how you all made the call. Bioethicist Jacob M. Appel, MD, JD, will also weigh in with an ethical framework to help you learn and prepare.
The following case is adapted from Appel's 2019 book, Who Says You're Dead? Medical & Ethical Dilemmas for the Curious & Concerned:
Edith is diagnosed with a rare bleeding disorder. Fortunately, there is a treatment that cures most people with one or two infusions. It's very expensive, at $70,000 per infusion, and must be delivered over several hours in a hospital.
But in Edith's case, it brings her bleeding temporarily under control without curing it. To prevent fatal hemorrhaging, she needs an infusion daily, bringing the cost to nearly $500,000 per week. Her insurer has capped its coverage at $1 million, and while the product's manufacturer has a patient assistance program, it only covers two courses; the company will not make an exception for Edith. Plus, she must stay in the hospital's medical ward to receive the infusions. Not surprisingly, Edith cannot afford to pay $500,000 per week out of pocket.
Thus, after Edith accrues more than $3 million in unpaid charges in two months, nearly exhausting the hospital's entire annual budget for charity care, hospital officials discuss ending her treatment.
Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at the Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College.
And check out some of our past Ethics Consult cases:
Liver Transplant for Alcoholic Baseball Legend?
Should Doctors Perform Genital Cutting on Girl?
Let Alzheimer's Patients Have Sex?
Last Updated April 02, 2021
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