Assuntos
Revelação , Regulamentação Governamental , Custos Hospitalares , Seguro de Hospitalização , Acesso à Informação , Revelação/ética , Revelação/legislação & jurisprudência , Ética nos Negócios , Gastos em Saúde , Custos Hospitalares/ética , Custos Hospitalares/normas , Humanos , Estados UnidosAssuntos
Infecções por Coronavirus/economia , Cuidado Periódico , Planos de Pagamento por Serviço Prestado/economia , Custos Hospitalares/ética , Cobertura do Seguro/economia , Pandemias/economia , Pneumonia Viral/economia , Procedimentos Cirúrgicos Operatórios/economia , COVID-19 , Infecções por Coronavirus/epidemiologia , Planos de Pagamento por Serviço Prestado/ética , Feminino , Política de Saúde , Humanos , Cobertura do Seguro/organização & administração , Masculino , Pneumonia Viral/epidemiologia , Formulação de Políticas , Mecanismo de Reembolso/legislação & jurisprudência , Estados UnidosRESUMO
An 18-year-old male who had been diagnosed at age 7 with a rare, progressive liver disease was referred to the transplant center and received a transplant, even though he did not meet the center's criteria for a patient with hepatopulmonary syndrome (HPS). Complications required relisting the patient urgently, but he eventually fully recovered; total hospital charges for his treatment exceeded $5 million. Reflection upon the case resulted in analysis of two ethical questions: primarily, clinician obligation to balance the provision of actuarially fair health care to society against the healing of a single patient; secondarily, the effects of malleable transplant criteria on trust in the patient selection process. We affirmed that physicians should not be principally responsible for justifying financial investment to society or for upholding beneficence beyond the individual physician and patient relationship in order to contain costs. We concluded, however, that such instances, when combined with manipulation of transplant center criteria, pose a potential threat to public trust. We therefore suggested that transplant centers maintain independent ethics committees to review such cases.
Assuntos
Hepatopatias/cirurgia , Transplante de Fígado/ética , Adolescente , Beneficência , Ética Médica , Custos de Cuidados de Saúde/ética , Alocação de Recursos para a Atenção à Saúde/economia , Alocação de Recursos para a Atenção à Saúde/ética , Síndrome Hepatopulmonar/economia , Síndrome Hepatopulmonar/cirurgia , Custos Hospitalares/ética , Humanos , Transplante de Fígado/economia , Masculino , Princípios Morais , Doenças RarasRESUMO
OBJECTIVES: To discuss the dilemma of adequate decision making in patients with intravenous drug abuse and recurrent valve prosthesis infections or in patients with positive HIV or hepatitis C status. Ethical, social, and economic considerations, not only in terms of technical feasibility but also in terms of unpromising results and aspects of resources, are discussed. Thoughts are presented about the legitimation of cardiac surgery centers refusing to perform surgery in high-risk patients with HIV or hepatitis C infections. METHODS: Presentation of six cases for discussion. Three patients were addicted to intravenous drugs and had recurrent prosthetic valve endocarditis, and the other three patients had either paravalvular leakage of a mitral valve prosthesis or acute aortic dissection or coronary artery disease. Five of these patients suffered from HIV/AIDS and infective hepatitis C. Four of these patients were refused by other centers due to high risk or a lack of capacity. RESULTS: All six patients were operated during 2013. Mortality was 17%. CONCLUSION: Decision making in noncompliant drug addicts with recurrent prosthesis infection and in HIV-positive patients leads beyond surgical challenges to ethical and economic considerations.
Assuntos
Procedimentos Cirúrgicos Cardíacos/ética , Doenças Cardiovasculares/cirurgia , Coinfecção , Usuários de Drogas , Infecções por HIV/complicações , Hepatite C/complicações , Seleção de Pacientes/ética , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Atitude do Pessoal de Saúde , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/economia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/virologia , Análise Custo-Benefício , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/economia , Infecções por HIV/virologia , Conhecimentos, Atitudes e Prática em Saúde , Hepatite C/diagnóstico , Hepatite C/economia , Hepatite C/virologia , Custos Hospitalares/ética , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Recidiva , Recusa em Tratar/ética , Reoperação , Medição de Risco , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/diagnóstico , Abuso de Substâncias por Via Intravenosa/economia , Abuso de Substâncias por Via Intravenosa/reabilitação , Adulto JovemRESUMO
A clinician and the chair of the hospital drug committee debate the merits of the use of palivizumab as prophylaxis against respiratory syncytial virus infection for a preterm baby with oxygen-dependent, chronic lung disease and discuss the issue of public funding of palivizumab. An ethicist comments on ethical aspects of the debate about cost-effectiveness.