Chapter 4: Decision-Making Capacity

ICU Bed Shortage Case Description: A hospital has one ICU bed left during a flu outbreak. A 30-year-old woman with pneumonia and a 70-year-old man with heart failure both need it. The younger patient has a better prognosis. Ethical Question: Who should get the ICU bed?

A. The younger woman, due to better prognosis.
B. The older man, as he arrived first.
C. Flip a coin to decide fairly.
D. Follow the hospital’s triage protocol.

Organ Transplant Priority Case Description: Two patients need a liver transplant: a 40-year-old recovering alcoholic with a recent relapse and a 25-year-old with a genetic disorder, both equally ill. Only one liver is available. Ethical Question: Who should receive the transplant?

A. The younger patient, due to age and no substance use.
B. The older patient, as he’s been sober longer recently.
C. Use a scoring system like MELD to decide.
D. Give it to whoever has waited longer.

Ventilator Allocation in a Pandemic Case Description: During a COVID-19 surge, a hospital has one ventilator left. A 50-year-old doctor and a 20-year-old student, both critical, need it. The doctor serves the community. Ethical Question: Who should get the ventilator?

A. The doctor, due to social utility.
B. The student, due to younger age.
C. Follow a first-come, first-served rule.
D. Use a triage scoring system.

Expensive Treatment Access Case Description: A new cancer drug costs $100,000 per patient. A 60-year-old insured patient and a 45-year-old uninsured patient both need it, but the hospital can fund only one. Ethical Question: Who should receive the drug?

A. The insured patient, as funding is available.
B. The uninsured patient, to address disparity.
C. The patient with the better prognosis.
D. Split the dose between them.

Emergency Room Triage Case Description: In a busy ER, a 35-year-old with a gunshot wound and a 65-year-old with a mild stroke arrive simultaneously. Only one trauma bay is open. Ethical Question: Who should be treated first?

A. The gunshot victim, due to severity.
B. The stroke patient, due to age vulnerability.
C. Whoever arrived first.
D. Consult the triage nurse’s judgment.

Vaccine Distribution Case Description: A limited supply of flu vaccines arrives. A 25-year-old healthy nurse and a 70-year-old diabetic patient both want it. The nurse works with vulnerable patients. Ethical Question: Who should get the vaccine?

A. The nurse, due to occupational risk and utility.
B. The patient, due to higher medical risk.
C. Split the dose if possible.
D. Use a lottery system.

Dialysis Machine Allocation Case Description: Two patients need dialysis, but only one machine is free: a 50-year-old with chronic kidney disease and a 30-year-old with acute renal failure from an overdose. Ethical Question: Who should use the machine?

A. The chronic patient, due to ongoing need.
B. The acute patient, due to reversibility.
C. Whoever has better insurance coverage.
D. Decide based on waitlist order.

Rural vs. Urban Resource Disparity Case Description: A rural clinic has one MRI slot, needed by a local 60-year-old farmer and a 40-year-old urban patient willing to travel. The urban hospital has more resources. Ethical Question: Who should get the slot?

A. The farmer, to address rural access.
B. The urban patient, due to travel effort.
C. Whoever has the more urgent condition.
D. Split the time between them.

Pediatric vs. Adult ICU Bed Case Description: A hospital has one ICU bed left. A 10-year-old with sepsis and a 45-year-old with a heart attack both need it, with equal severity. Ethical Question: Who should get the bed?

A. The child, due to years of life potential.
B. The adult, due to equal medical need.
C. Use a random selection method.
D. Follow hospital policy.

Transplant Waiting List Ethics Case Description: A 55-year-old man bribes a hospital official to move up the kidney transplant list, bypassing a 30-year-old who’s been waiting longer. Ethical Question: Is this ethical?

A. Yes, if he can afford it.
B. No, it violates fairness.
C. Yes, if his condition is worse.
D. No, unless the other consents.

Resource Allocation in War Case Description: In a war zone, a medic has one dose of morphine. A soldier with a leg wound and a civilian with abdominal trauma both need it, equally severe. Ethical Question: Who should get the morphine?

A. The soldier, due to military priority.
B. The civilian, as a non-combatant.
C. Whoever is in more pain.
D. Split the dose between them.

Expensive Equipment Use Case Description: A hospital has one ECMO machine, needed by a 20-year-old with reversible lung failure and a 60-year-old with chronic lung disease, both critical. Ethical Question: Who should get the ECMO?

A. The younger patient, due to reversibility.
B. The older patient, due to equal need.
C. Use a lottery system.
D. Whoever can pay for it.

Social Status in Allocation Case Description: A VIP politician and a homeless man both need the last ventilator during a crisis. Their conditions are equally severe. Ethical Question: Who should get the ventilator?

A. The politician, due to social influence.
B. The homeless man, to avoid bias.
C. Use a neutral triage score.
D. Give it to whoever arrived first.

Limited Chemotherapy Supply Case Description: A hospital has one course of chemotherapy left, needed by a 40-year-old single mother and a 65-year-old retiree, both with equal cancer stages. Ethical Question: Who should receive it?

A. The mother, due to family dependents.
B. The retiree, due to equal medical need.
C. Use a random draw.
D. Split the course between them.

Triage in Mass Casualty Case Description: After a bus crash, a 25-year-old with severe burns and a 50-year-old with a broken leg need the last trauma surgeon. The burns are life-threatening. Ethical Question: Who should the surgeon treat first?

A. The burn victim, due to severity.
B. The leg injury, due to quicker treatment.
C. Whoever is closer to the surgeon.
D. Follow a triage protocol.

Organ Donation Allocation Case Description: A heart is available for transplant. A 30-year-old with a criminal record and a 50-year-old teacher are matches, equally ill. Ethical Question: Who should get the heart?

A. The younger patient, due to age.
B. The teacher, due to social contribution.
C. Use a medical priority score.
D. Whoever has fewer comorbidities.

Resource Denial Due to Behavior Case Description: A 45-year-old smoker with lung cancer and a 60-year-old non-smoker with the same cancer need a rare drug. Only one dose exists. Ethical Question: Who should get the drug?

A. The non-smoker, due to no self-inflicted cause.
B. The smoker, as need is equal.
C. Use a lottery system.
D. Whoever has better insurance.

Limited Surgical Slots Case Description: A hospital has one OR slot. A 20-year-old needs urgent appendectomy, and a 70-year-old needs elective hip replacement, delayed for months. Ethical Question: Who should get the slot?

A. The younger patient, due to urgency.
B. The older patient, due to wait time.
C. Split the time if feasible.
D. Follow hospital scheduling policy.

Resource Allocation in Poverty Case Description: A free clinic has one specialist visit slot, needed by a 35-year-old unemployed man and a 50-year-old working single mother, both with chronic pain. Ethical Question: Who should get the visit?

A. The man, due to unemployment hardship.
B. The mother, due to family responsibility.
C. Use a first-come, first-served rule.
D. Assess medical urgency.

Donor Preference in Allocation Case Description: A deceased donor specified their kidney go to a child. A 12-year-old and a 40-year-old are matches, but the adult has waited longer. Ethical Question: Should the donor’s wish be honored?

A. Yes, give it to the child.
B. No, give it to the adult based on wait time.
C. Use a medical priority score instead.
D. Consult the ethics committee.

ICU Transfer Decision Case Description: A small hospital has one ICU bed, occupied by a stable 60-year-old. A 25-year-old trauma patient arrives needing it urgently. Ethical Question: Should the stable patient be transferred?

A. Yes, to prioritize the urgent case.
B. No, to respect the current patient’s care.
C. Transfer to another facility if possible.
D. Use a triage score to decide.

Medication Rationing Case Description: A hospital has limited antibiotics during an outbreak. A 30-year-old with mild infection and a 70-year-old with severe sepsis both need it. Ethical Question: Who should get the antibiotics?

A. The older patient, due to severity.
B. The younger patient, due to milder case recovery.
C. Split the dose between them.
D. Follow a priority protocol.

Resource Allocation in Research Case Description: A research grant funds one patient’s experimental treatment: a 40-year-old with a rare disease or a 60-year-old with a common one, both terminal. Ethical Question: Who should get the treatment?

A. The rare disease patient, for research value.
B. The common disease patient, for broader impact.
C. Use a random selection.
D. Whoever consents first.

VIP Treatment Demand Case Description: A celebrity demands the last chemotherapy dose, threatening legal action, while a 45-year-old unknown patient also needs it, equally ill. Ethical Question: Who should get the dose?

A. The celebrity, to avoid legal trouble.
B. The unknown patient, to ensure fairness.
C. Use a medical need assessment.
D. Split the dose if possible.

Limited Rehab Beds Case Description: A rehab facility has one bed, needed by a 20-year-old accident victim and a 60-year-old stroke patient, both with good recovery potential. Ethical Question: Who should get the bed?

A. The younger patient, due to age.
B. The older patient, due to equal need.
C. Use a random draw.
D. Assess functional outcome potential.

Disaster Resource Allocation Case Description: After an earthquake, a field hospital has one surgeon. A 30-year-old with a crushed leg and a 50-year-old with internal bleeding need surgery. Ethical Question: Who should the surgeon operate on first?

A. The internal bleeding patient, due to urgency.
B. The leg injury patient, due to younger age.
C. Whoever is closer to the OR.
D. Follow a triage system.

Insurance-Based Allocation Case Description: A hospital has one slot for a costly procedure, needed by an insured 50-year-old and an uninsured 30-year-old, both equally ill. Ethical Question: Who should get the procedure?

A. The insured patient, due to funding.
B. The uninsured patient, for equity.
C. Use a medical priority score.
D. Delay until funding is resolved.

Age-Based Allocation Case Description: A 15-year-old and a 75-year-old both need the last ventilator during a shortage, with equal medical severity. Ethical Question: Should age determine allocation?

A. Yes, give it to the younger patient.
B. No, treat them equally.
C. Use a random selection method.
D. Follow hospital policy.

Resource Allocation in Chronic Care Case Description: A clinic has one specialist slot for chronic disease management, needed by a 40-year-old with diabetes and a 60-year-old with COPD, both uncontrolled. Ethical Question: Who should get the slot?

A. The diabetic, due to younger age.
B. The COPD patient, due to equal need.
C. Use a first-come, first-served rule.
D. Assess disease severity.

Global Health Resource Disparity Case Description: A charity has one shipment of HIV drugs, enough for a small village in Africa or a larger city clinic elsewhere, both with high need. Ethical Question: Where should the drugs go?

A. The village, for greater relative impact.
B. The city, for more patients served.
C. Split the shipment between them.
D. Use a needs-based assessment.