Elodie Irvine was diagnosed with end-stage liver disease and kidney disease. Due to her condition, doctors determined that she was in need of both a liver and a kidney transplant and she was added to the UNOS waiting list. After months turned into years, she grew concerned. Doctors at the University of California at Irvine (UCI) hospital "continuously assured [her] that [she] was high on the priority list to receive a transplant due to [her] serious life-threatening medical condition."

After four years on the waiting list, Elodie consulted another doctor. Her new physician informed her that the wait time was unacceptable and probably due to internal problems at UCI hospital. Her transplant application was sent to Cedar-Sinai Medical Center in Los Angeles. She received a liver and a kidney two months later and subsequently filed a lawsuit against the UCI hospital claiming medical malpractice, negligence, infliction of emotional distress, fraud, and conspiracy.

During the pre-trial phase, UNOS indicated that they had made offers to UCI hospital almost 40 different times that potentially matched Elodie's criteria.

ISSUE: The question before the court was whether the UCI hospital "... conspired to keep her low on the transplant list and granted priority to healthier patients to increase the percentages of successful transplantation and thereby attracting more prestige, more patients, more profit and more research funding."

RULE: The parties entered into a confidential settlement agreement prior to the court ruling on the case.

EMPHASIS: This case presents multiple ethical issues. It demonstrates how the organ donation program is supposed to work but also demonstrates some of the flaws in the system.The more serious a person's medical condition, the higher on the donation list they should be.

Questions:

1. Having a history of successful transplant outcomes is important to hospitals.Without it, they could lose the ability to do transplants. Do you think that this should be a factor in deciding who gets an organ? Explain your answer.
2. The parties entered into a confidential settlement agreement. Why do you think that was? Explain your answer.

11-2 Court Case:

FACTS: In 2005, Estella Lujan was admitted to Evergreen Nursing Home, a Life Care Facility. Her physician wrote in her medical records that due to Estella's dementia, she lacked decision-making capacity and the family needed to designate a healthcare proxy.Sometime later in 2005, she was discharged. [The record does not indicate why she was discharged or whether it was home or to a hospital.]

Estella was readmitted to Evergreen Nursing Home in 2006. She was accompanied by her son Alvin, who completed all of the admission paperwork, purportedly acting as Estella's "legal representative." Part of the paper work included an agreement to arbitrate any disputes arising out of her care or stay at the Life Care Center. Alvin did not hold any form of a power of attorney, nor was he designated by the courts as a guardian for her. Estella died in late 2006.

After Estella's death, her daughter Kathryn was designated as executor. Kathryn filed a lawsuit against Life Care Centers claiming (1) wrongful death; (2) violations of Colorado Consumer Protection Act; (3) outrageous conduct; and (4) requesting to invalidate the arbitration clause because Alvin did not have the legal authority to enter into it. [The exact nature of Estella's death was not disclosed in the court records.]

ISSUE: There were two questions before the court: first, did Alvin have the legal authority to enter into an arbitration agreement on behalf of Estella and second, was the decision to agree to arbitration a medical treatment decision that can be made by a healthcare proxy?

RULE: The court ruled that Alvin did not have the legal authority to enter into an arbitration agreement on behalf of Estella. They also ruled that arbitration is not a "medical treatment decision" that can be decided by a healthcare proxy.

EMPHASIS: This case demonstrates what authority a healthcare proxy has and when their authority can be used. "The person selected to act as the patient's health care proxy should be the person who has a close relationship with the patient and who is most likely to be currently informed of the patient's wishes regarding medical decisions."

Questions:

1. Alvin signed the initial admission paperwork, but Kathryn was later appointed executor.Why do you think that was?Explain your answer.
2. What are your thoughts on arbitration clauses for something like wrongful death? Explain your answer.

11-3 Court Case:

FACTS: On February 25, 1990, Terri Schiavo collapsed in her home.Although she was alive when paramedics arrived, she had suffered extensive brain damage and determined to be in a persistent vegetative state. She did not have advance directives at the time to indicate what her medical wishes were nor did she identify who could make medical decisions for her.

After 8 years in a vegetative state, Terri was no longer on life support, but did have a feeding tube in place. Terri's husband Michael, petitioned the court to have the feeding tube removed. Michael testified that Terri would not want to be kept alive by artificial means.But Terri's parents disputed that testimony by arguing that she was a devout Catholic and would not violate the church's position on suicide or euthanasia.

Terri's parents raised unsubstantiated claims that Michael had abused Terri, which contributed to her brain damage. During the court proceedings, Michael was living with his girlfriend with whom he had fathered a child, but legally, he and Terri were still married. Terri's parents argued that doing so negated these rights as a husband.

A 7-year legal battle ensued, which included over 14 appeals. The governor of Florida, the United States Congress, President George W. Bush, and Pope John Paul II tried to intervene by offering their opinions on the case.

During the legal battle over Terri's life, her feeding tube was removed three times, but twice re-inserted pursuant to court orders while the lawsuit went through the appeals process.

Terri's feeding tube was removed for the last time on March 18, 2005. Terri expired on March 31, 2005 - 15 years after her initial collapse.

ISSUE: The ethical question boiled down to whether it was Terri's husband or Terri's parents who had the right to make medical decisions.

RULE: The court concluded that, absent a divorce or legal separation, Michael is still the legal spouse and the person who would make medical decisions for her.

EMPHASIS: Although the law of intestacy's initial intent was to determine the distribution of property, this case represents how the law is used in other situations as well. The court, in its decision, used the law of intestacy to give Michael the right to make final decisions.

Questions:

1. Do you think the fact that two people are no longer living as husband and wife should be a factor in determining who gets to make medical decisions? Explain your answer.
2. This court case dragged on for 15 years with Terri in a vegetative state. What ethical principles do you think Michael and Terri's parents were using to drive their decisions? Explain your answer.

11-4 Court Case:

FACTS: On February 8, 1994, Tracy Messenger went into labor.At 25 weeks gestation, doctors administered medication to stop her labor to prevent the child from being born prematurely. Dr. Karna, a neonatologist, was called in to consult. Dr. Karna told the Messengers that if the child were born at 25 weeks gestation, it had a 30-50 percent chance of survival and, if the child did survive, it had a 90 percent change of having some degree of mental retardation and physical impairment.

The Messengers testified that they told Dr. Karna that if the child was born, they did not want resuscitative measures performed.Dr. Karna testified that if the child was born, it was better to evaluate the child first to identify any deficits before making any decisions about resuscitative measure.

Later in the evening, Tracy had a reaction to a medication she was given to stop labor. When the medication was discontinued, Tracy went into active labor again. Tracy was rushed to surgery, where a baby boy was delivered by cesarean section.

A neonatal physician's assistant who was present in the operating room testified that Dr. Karna told her not to initiate resuscitative measures unless the child looked "vigorous." When the child was born, it "appeared a deep purple color and limp" so she initiated resuscitative measures. The child was then taken to the NICU on a ventilator.

When Gregory Messenger arrived at the hospital, he was shocked to learn that the child had been placed on a ventilator against his and his wife's express wishes not to do so. Dr. Karna arrived and examined the child, testifying that the child was pink and looked good.

When Tracy returned from the operative room, she and her husband requested some time alone with their child. Gregory Messenger placed the child in his wife's arms and disconnected the ventilator. The child died shortly afterwards.

Ingham County Prosecutors decided to charge Gregory Messenger with manslaughter.

ISSUE: Did Gregory Messenger commit manslaughter by removing the child from life support, ultimately allowing the child to die?

RULE: Gregory Messenger was found not guilty of manslaughter charges.

EMPHASIS: This is a rare example of what can result from actions related to euthanasia. One interesting aspect of this case was that not only was Gregory Messenger a caring husband and father, he was also a practicing physician. As such, question arose about whether or not he had violated the medical code of ethics.

Questions:

1. Do you think that his being a medical doctor had a role in prosecutors filing a manslaughter charge? Explain your answer.
2. A common questions in ethical situations is "Were the actions justified?" Take a look at the ethical principle of justice and indicate whether you think it applies here or not. Explain your answer.