Asunto(s)
Revelación , Regulación Gubernamental , Costos de Hospital , Seguro de Hospitalización , Acceso a la Información , Revelación/ética , Revelación/legislación & jurisprudencia , Ética en los Negocios , Gastos en Salud , Costos de Hospital/ética , Costos de Hospital/normas , Humanos , Estados UnidosAsunto(s)
Infecciones por Coronavirus/economía , Episodio de Atención , Planes de Aranceles por Servicios/economía , Costos de Hospital/ética , Cobertura del Seguro/economía , Pandemias/economía , Neumonía Viral/economía , Procedimientos Quirúrgicos Operativos/economía , COVID-19 , Infecciones por Coronavirus/epidemiología , Planes de Aranceles por Servicios/ética , Femenino , Política de Salud , Humanos , Cobertura del Seguro/organización & administración , Masculino , Neumonía Viral/epidemiología , Formulación de Políticas , Mecanismo de Reembolso/legislación & jurisprudencia , Estados UnidosRESUMEN
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.
Asunto(s)
Hepatopatías/cirugía , Trasplante de Hígado/ética , Adolescente , Beneficencia , Ética Médica , Costos de la Atención en Salud/ética , Asignación de Recursos para la Atención de Salud/economía , Asignación de Recursos para la Atención de Salud/ética , Síndrome Hepatopulmonar/economía , Síndrome Hepatopulmonar/cirugía , Costos de Hospital/ética , Humanos , Trasplante de Hígado/economía , Masculino , Principios Morales , Enfermedades RarasRESUMEN
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.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/ética , Enfermedades Cardiovasculares/cirugía , Coinfección , Consumidores de Drogas , Infecciones por VIH/complicaciones , Hepatitis C/complicaciones , Selección de Paciente/ética , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adulto , Actitud del Personal de Salud , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/economía , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/economía , Enfermedades Cardiovasculares/virología , Análisis Costo-Beneficio , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/economía , Infecciones por VIH/virología , Conocimientos, Actitudes y Práctica en Salud , Hepatitis C/diagnóstico , Hepatitis C/economía , Hepatitis C/virología , Costos de Hospital/ética , Humanos , Masculino , Persona de Mediana Edad , Cooperación del Paciente , Recurrencia , Negativa al Tratamiento/ética , Reoperación , Medición de Riesgo , Factores de Riesgo , Abuso de Sustancias por Vía Intravenosa/diagnóstico , Abuso de Sustancias por Vía Intravenosa/economía , Abuso de Sustancias por Vía Intravenosa/rehabilitación , Adulto JovenRESUMEN
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.