Reference no: EM133915976

Question

Jimmy goes to the ER with a cough, shortness of breath, and chest pain because of his coughing. Dwayne reveals Nadine that he has been living on the streets for the last year after losing his job; Alison begins taking the patient's background. He tells Nadine that he has no idea why he went to the hospital and that he doesn't want anything done because he has pancreatic cancer as well.

Jimmy claims that he would have been on the transplant list before things got this bad, but he couldn't get to the appointments since he was homeless without a car or insurance. He also warns her that being on a breathing machine or having a feeding tube will make him a burden on society. When Nadine asks the patient whether he has a living will, he says he used to have one but that he left it behind when he became homeless. He reveals to Nadine that he has DNR tattooed on his breast to ensure that no one tries to save him. He asks Alison whether the hospital can provide him with a fresh living will that he may sign in the event of an emergency. He claims to have no direct family.

When Alison finishes his health history, she informs him she'll bring the paperwork in for him to examine the living will. The patient states that he is aware that he should take blood pressure meds, but that he cannot afford them and has no safe location to store them because he is homeless.

Alison completes the history lesson and exits the room. Jimmy's EKG indicates ventricular fibrillation within a minute of Alison leaving the room. When Nadine enters the room, the physician is directing the code. Nadine informs the physician that the patient is homeless, has no family, and has wanted to be a DNR, but he codes before she can get him to sign the papers. The physician ends the code after 30 minutes due to futility and announces Jimmy's death time.

1. Jimmy choice to choose to be a DNR been infringed upon under the concept of autonomy?

2. Apply the beneficent concept to Nadine and the ER doctor. Is it correct that when Jimmy falls into ventricular fibrillation, all life-saving procedures are used on him?

3. What does "the code has been stopped due to futility" mean?

4. Should Jimmy have a pancreatic transplant if he was not homeless, had health insurance, and had been on the transplant list prior to his cancer?

5. Should Jimmy obtain a transplant, what if he was homeless but had government-issued health insurance and was able to secure a ride from volunteers at the local Salvation Army?

6. On what grounds should a person be considered for a transplant? What are the ethical considerations when it comes to transplantation?