Memo – You Decide

 
Instructions
This assignment presents a difficult and painful medical dilemma, with you in an imagined professional role. Go through the You Decide scenario and make the decision it calls for. Then, compose an official memorandum that will be kept for the record and could potentially be read not only by your Peer Review Committee but also by those involved in charitable fundraising, which supports hospital development, as well as by others with financial interests in the decision.

In the memo (use the Memo Template), explain your decision and your reasoning for it. Include the following:

1. Who benefits from what you decided? Explain why.
2. Who gets denied a needed benefit? Explain why.

You will see notice that there is time pressure in the simulated situation, so remember that you would not have the luxury to dawdle in the decision-making process, and as the decision maker, you would not have the luxury of consulting a broad spectrum of advisors. It falls on you to decide!

Include in the memo the utilitarian ethical philosophy of John Stuart Mill (from the lesson last week) and one other ethical philosopher of your choosing that we have studied to date. Use both of those philosophies to bolster your decision.
You can use—- .Mill, J. S. (1991). Utilitarianism. Oxford: Oxford University  Press. 
                         .Kant, I. (2008). Grounding for the metaphysics of morals. Brantford, Ont.: W. Ross MacDonald School Resource Services Library.

 — Length: 2-3 pages (not including title page or references page)

SCENARIO
 Okay, Lead Surgeon, it is time to do what you do best! There is a lot at stake. The decision must be made almost immediately. Like all actions, you will need to write your decision into medical documentation before you begin. Yes, that means YOU! In the limited time before you would begin surgery, you need to consider the cases; the technical issues involved also, and write a Memorandum for the Record to document what decision you made and what considerations you included in your process. This will be on the record, so it needs to be thorough in case it needs to justify your actions at a later date. 

ROLE.
 You are the Lead Surgeon in a major hospital, and by virtue of your seniority you are also the key decision maker for transplant cases. Right now you have three people who are waiting and hoping for a suitable heart to become available. Your cell phone rings suddenly, and you are notified that a heart has become available-meaning that you need to make a quick yet sound decision about which patient will receive the heart and then schedule surgery for today.

PLAYERS 

 JERRY: (Male, 55 year old family man, mid-level manage)
 Jerry, a father of 3 children and at the age of 55, is in the Ward awaiting a suitable heart for transplanting. His wife Joanie is a stay at home mother with no education beyond high school and no career. Jerry is the middle level manager at a carpet distributing business and 5 year short of his retirement eligibility. Jerry and Joanie have three teenage children aged 14, 16, and 19. The 19 year old is a sophomore at college; the 14 year old is mildly autistic, and the 16 year old is an astronaut wannabe. If Jerry gets the heart, his chances of living another 10-15 years are very high. His heart is damaged due to the use of steroids in his early 20s when he was involved with bodybuilding before the dangers of steroid use were fully known. 

LISA: (Female, 12 year old lifelong health issues) 
 Lisa is one of those precocious girls – a doll-like girl at the edge of becoming a teenager. She reads voraciously and yet likes the activities of a younger girl playing with her Barbie Doll. She has suffered health issues all her life due to various viral infections and a lupus-like immune deficiency. Her heart was damaged during a nasty bout with pneumonia last year and actually stopped for a brief period. Her mother knew to begin CPR on her or she would have died there. Even with a transplant, her chances of surviving into her 20s are not good. She is the only child in the family, and they cannot bear more children. Her parents will do anything for her, and they have offered to donate $2 million to the hospital’s construction of specialized facilities if she can get a heart soon enough. Her father is also a noted oncologist working in the same hospital but in a different department. 

OZZY:  (Male, 38 year old homeless drug abuser)
 Lisa is one of those precocious girls – a doll-like girl at the edge of becoming a teenager. She reads voraciously and yet likes the activities of a younger girl playing with her Barbie Doll. She has suffered health issues all her life due to various viral infections and a lupus-like immune deficiency. Her heart was damaged during a nasty bout with pneumonia last year and actually stopped for a brief period. Her mother knew to begin CPR on her or she would have died there. Even with a transplant, her chances of surviving into her 20s are not good. She is the only child in the family, and they cannot bear more children. Her parents will do anything for her, and they have offered to donate $2 million to the hospital’s construction of specialized facilities if she can get a heart soon enough. Her father is also a noted oncologist working in the same hospital but in a different department. 

Dr Doe: ( Male, 35 year old Lisa’s Dad, the oncologist)
 Dr. Jonathan Doe is Lisa’s father. He has offered the hospital $2 Million Dollars in exchange that his daughter gets the heart transplant. He is an up-and-coming oncologist in the same hospital. He is loyal and totally committed to Lisa; while not obnoxious and pushy, his presence is keenly felt around the professional community in the Hospital and there is a need for his $2 Million. 

 
One of the great ongoing situations that calls for ethical decision making is the reality that there is almost always a greater need for something than there is a supply to meet the need.
For this assignment and scenario, the demand is the life-and-death situation of the need for transplantable organs and the rather small and transitory supply. Hard decisions need to be made, and there is little time to think things through. These are emergency situations.
Transplantable organs become available on short notice–usually because a donor has died for reasons unrelated to the organ. They need to be removed and transplanted very quickly because they only remain fresh for a limited period. Then there is the whole complicated issue of tissue type matching. There is also an ongoing concern about how long recipients can wait.

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