Jessica Glaspell and Lee Dies

Too Old for By-Pass?

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Dilemma 8

Hannah is 87 and lives at the nursing facility of a retirement home. She is a Medicare patient and had been a member of an HMO. She is under the care of Dr. Nicely, a cardiologist with a contract with the HMO. She has suffered from a debilitating stroke, arteriosclerotic heart disease and diabetes. Together they left her semi-mobile. She is mentally lucid and able to understand her situation. She is now complaining of intermittent chest pain.

She has heard that bypass surgery might address her chest pain. Dr. Nicely is not supportive of the idea. He explained that the risks for a 87 year old and that she might not survive the operation.

Hannah listened carefully, and after some hesitation, decided she wanted the procedure. She pointed out that if she did not survive the surgery it would not be the worst possible outcome. She was more concerned about the continual chest pain.

What to Consider?

Should Dr. Nicely Agree to Perform the Operation?

Should Dr. Nicely take into account that, in addition to the risks to Hannah, the procedure would generate considerable costs for the HMO?

Should the medical director take into account the costs to the HMO in deciding whether to authorize the CABG?

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Works Cited

American Medical Association. http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/patient-physician-relationship-topics/patient-confidentiality.shtml

American Medical Association. http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics.

American Medical Association. http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion8021.shtml

Legal Help Mate. http://www.legalhelpmate.com/health-care-directive-patient-act.aspx.

McCarthy, Robert L. Health Care Ethics. http://www.jblearning.com/.../Health%20Care%20Ethics, %203rd

%20addition.doc.

The Law Firm of Baker and Daniels, LLP. Stark Act. 2011. http://www.bakerdaniels.com/services/practices/stak_act.aspx

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