Mrs. A

            At the age of 70, Mrs. A has been admitted to the hospital for the fifth time in as many years for treatment of respiratory difficulty.  The last time she was in the hospital she had nearly died  She has severe emphysema, and when she developed a cold, her deterioration was so rapid that only artificial respiration in the emergency room saved her life.  However, it proved very difficult to wean her from the respirator. She spent 4 weeks in the Intensive Care Unit and required constant care from the medical staff, principally Intern B.  After she was discharged, she remained short of breath even while watching television.

            Now, 5 months later, she has contracted another cold, but this time Intern B has managed to treat her without resorting to the ICU and the respirator.  During her illness, Mrs. A’s two sons have been in constant contact with the medical staff.  They have been anxious, agitated, and demanding.

            It is now 2 a.m. and Intern B is again called to see Mrs. A, who is becoming increasingly lethargic.  It is obvious that she is in respiratory failure, and will probably die before morning if she is not given a respirator. However, hospital policy requires that respirators be used only in the ICU, where the required supporting staff and facilities are available.  There is only one bed open in the ICU.  The residents like to save one bed for an emergency.  As Intern B approaches, Mrs. A’s sons are waiting. He knows their questions:  What’s wrong now?  What will you do?

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-->Crigger, Bette-Jane. Cases in Bioethics : Selections from the Hastings Center Report. 3rd ed. New York: St. Martin's Press, 1998.