J.R.

            J.R. is a combative 21-year-old female who presents in the emergency room disoriented, with a fever, chills, and a cough.  J.R. is well known by the medical staff.  She has had three previous admissions with endocarditis and twice has left the hospital AMA.  On her most recent previous admission her mitral valve was replaced with a porcine prosthesis.  J.R. is HIV positive and has a history of prostitution and substance abuse.  She refuses counseling. On the 12^th day of her hospitalization, J.R. leaves AMA even after her physician warns that the bacteria in her blood is still active.  Two days later she returns to the ER and it is obvious her heart valve must once again be replaced.  J.R. demands another valve, saying it would violate her civil rights to be refused. Would it be wrong to refuse J.R.?

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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.