From the Guidelines
From an ethical standpoint, the appropriate action would be to keep the patient on ventilator without any compromise (option C). When a patient is in the ICU and requires life-sustaining treatment, the primary ethical obligation is to continue providing necessary care regardless of payment status. Discharging a critically ill patient or transferring them solely due to financial constraints would violate the principle of non-maleficence (do no harm) and potentially endanger their life. Healthcare providers have a duty to prioritize patient welfare above financial considerations. Most hospitals have financial counseling services, social work departments, and charity care programs that can be engaged to address payment concerns while care continues. Additionally, many facilities can help arrange payment plans or identify government assistance programs for which the patient might qualify. The ethical framework of medicine demands that life-saving care not be withdrawn based on inability to pay, particularly when the patient is in a vulnerable critical condition requiring intensive care, as supported by the American Thoracic Society's policy statement on making medical treatment decisions for unrepresented patients in the ICU 1.
The European Society of Intensive Care Medicine also emphasizes the importance of aligning ICU treatments with patient preferences and values, highlighting the need for effective communication and support in decision-making processes, especially for patients without advance directives or surrogate decision-makers 1.
Key considerations in this scenario include:
- The patient's critical condition and need for life-sustaining treatment
- The ethical principles of non-maleficence and beneficence
- The availability of hospital resources to address financial concerns
- The importance of communication and support in decision-making processes
- The need to prioritize patient welfare above financial considerations, as emphasized by recent guidelines and policy statements 1.
From the Research
Ethical Considerations
- From an ethical point of view, the primary concern is the well-being and dignity of the patient 2, 3.
- The patient's autonomy and right to make informed decisions about their care should be respected 3.
- The hospital's responsibility is to provide appropriate care and treatment, regardless of the patient's ability to pay 4.
Possible Courses of Action
- Discharging the patient (option A) may not be the most ethical choice, as it could compromise the patient's safety and well-being 5.
- Referring the patient to another hospital (option B) may be a viable option, but it would depend on the availability of resources and the patient's condition 6.
- Keeping the patient on ventilator without any compromise (option C) may be the most ethical choice, as it prioritizes the patient's immediate needs and dignity 2, 3.
Patient-Centered Care
- The patient's fundamental care needs, including comfort, relationships, and communication, should be prioritized 6.
- The care environment and culture should be adapted to meet the patient's unique needs and promote patient- and family-centered care 6.
- Nurses play a crucial role in providing holistic care and advocating for the patient's needs and rights 5, 6.