Mission statement of St. Vincent de Paul Hospital

“Saint Joseph’s Medical Center is a Catholic Health Care facility, sponsored by the Sisters of Charity of St. Vincent de Paul of New York. We strive for Excellence in health care in an atmosphere of support and shared ministry [1].”

Mission of the hospital is to provide supporting environment to the patients and bring excellence in the services of the health care centers.

An 83 year old diabetic woman was admitted to St. Vincent de Paul Hospital for a hip replacement after she fell. This resulted in necrosis in left toes of Mrs. Adkins; she is the mother of three children, two daughters and one son who used to work in same Steel mills his late husband used to work in. The surgery was successful but she could not tolerate the aesthesia therefore she was nauseous and could not sit up. After three days of surgery she had a stroke and aspirated some food which caused an obstruction which further resulted in Tracheostomy.

She was on ventilator and lost her consciousness and post stroke her condition got worse which resulted in decline of cerebral activities. According to neurologist the stroke stopped the transportation of oxygen to the brain. Nutrition was provided to her through feeding tube and after two weeks of her dialysis began and after three weeks, no brain activity was observed in her. She stayed in the same condition for next four weeks.

The physician handling this case was very straight forward with Mrs. Adkins’s family that there is no progress. Physician and neurologist gave no hope or encouragement to the family but they were still hopeful that she will return to them. When no progress was made and no change was observed by the end of sixth week the staff felt the situation is hopeless and there is no solution for it. Therefore, the hospital should no longer provide their services or care to a patient who shows no chance of progress and is on her death bed. Gangrene spread through her left foot and necrosis began in her right foot.  The neurologist, physician and hospital chaplain met the family and advised them to shift her to nursing care as her condition is stable. Upon social worker’s suggestion, ethics committee was consulted.

 What are the relevant facts?

The relevant facts of the study include:

·         Condition of Mrs. Adkin’s was stable so she should be shifted to nursing home rather than be in hospital using its resources and care without any hope or display of change.

·         No medical center is present in nearby area to provide kind of care Mrs. Adkins needs at the time.

·         Issue of futile care was raised by a social worker.

·         Medicare will not take responsibility of medical care after six weeks. And if medical services to continue than hospital will pay for it.

·         Patients and families cannot have unlimited access to the resources of hospital it can be used by the patients who truly needs them.

·         It is unjustified with mission of the hospital and other patients.

·         After the exhaustion of Medicare services Mrs. Adkins will have to pay to hospital for the services, said the draft of letter by social worker.

·         Ethics committee could not evaluate how far can the hospital go to put pressure on patient’s family but it was well-aware of the institutional futile care policies. The policy can allow the hospital to discontinue the treatment of patient with consent of family but it was hesitant with the use of such policy.

What are the ethical conditions to consider?

Mrs. Adkins was admitted to hospital for hip replacement which went successful. As she was diabetic and old she could not tolerate the anesthesia which led to tracheostomy, feeding tube, ventilator and dialysis. This is the increased burden on the Medicare. As there is no significant change in her current condition it is morally wrong to not provide this care and services to patients who are liable to show progress. Mrs. Adkins should be shifted to nurse care as per required and hospital should be allowed to follow its work policy as they are bounded to it and has no control over it. Mrs. Adkins is not financially strong and after exhaustion of six weeks validity of Medicare, the family will have to pay the hospital themselves which can be costly and unaffordable.\

It is important to save a human life but it is wrong to keep patients who need medical care services and need deprive of it. The administration, physician, neurologist, all were very frank and clear with the family from the very beginning. Hospital cooperated with the family and now family should do the same. It will not be like giving up on her but giving policies and regulations a chance as expenditure is not affordable for the family either as Michael does not have a job and the family relay’s on Mr. Adkins’s pension.

What are some apparently defensible courses of action?

The Organizational Ethics section of JCAHO says that the transfer or refusal of a patient does not depend upon economics of hospital or patient but the policy is applicable to patient who have specific medical conditions and the disease cannot be treated well in their hospital then the patient can be diverted transferred to any other hospital or refused the admission.

On this ground hospital is not wrong to cut services for Mrs. Adkins as there is no change or progress and it is alright to recommend her to shift to another nursing center. The Medicare expense is expiring as well and it is not wrong of hospital to put some of cost responsibility on family for the services they provide. People can disagree about this but families’ should take their share of responsibilities as well.

What finally do you think should be done and why

Health care is responsible for providing medical care to the patients. Physicians and all the doctors are liable to provide their best services to their patients and they do. Patients have a say in type of services they receive from the hospital. The administrators of the hospital are greatly responsible for what goes on in their hospital. The interest of hospital is a priority for them; it is bounded to provide their best services to the patient. The purpose of obligations is to facilitate the patients and interests of both the parties should coincide more than they conflict.

In this case Mrs. Adkins was provided all the medical care that she needed when she got seriously sick from surgery to dialysis she received every kind of treatment that she needed. Hospital gave her 4-6 weeks even when she was not showing any progress. But the administration is bounded with certain policies. It cannot exhaust it resources over someone who is showing no signs of getting better. This exhausts the services of hospitals as well as put burden on the family.

Before providing a treatment its benefits and burdens are checked, if burden is more than the benefit then family gets to decide and if benefits are more, then whether the treatment will be provided or not it will be decided by the quality of life, mortality or religion. In this case of Mrs. Adkins, she shows lower chances of getting better. In my opinion the decision of administration to put the responsibility of cost on family is not wrong otherwise the company and its policies suffer. [2]

Reference St. Vincent de Paul Hospital

 

[1]	Stvincentswestchester.org, "MISSION AND VALUES," 2018. [Online]. Available: https://www.stvincentswestchester.org/about-us/mission-and-values. [Accessed 09 12 2018].
[2]	R. T. Hall, "AN INTRODUCTION TO HEALTHCARE ORGANIZATIONAL ETHICS," pp. 1-80, 2000.