Presenting Ethical Dilemma: The Resident of MICU asks for an Ethics Committee Consult to help decide if 80 yr old chronic alcoholic with recurring GI bleed should be given more than 20 units of blood.
Medical Indications: The patient has been in MICU numerous times in the last few years for GI bleeds due to alcoholism. He had a stroke two years ago, with partial paralysis, but cares for himself in a single hotel room where he lives along on a coal miner’s pension. He is a poor surgery risk. He has been given 18 units of blood so far. He is being treated with crushed ice.
Patient Preference: He stated that he wanted to live, but did not want surgery. He is competent and has the capacity to decide and is a compliant patient. He has been through several alcohol treatment programs and stays sober for up to a year after these programs.
Quality of Life: Stroke was treated successfully (90%) enough that he left the nursing home in which he had been recovering, and returned to his hotel and life alone. He has some malnutrition.
Contextual Issues: The Resident believes this patient should not receive more than 20 units of his blood type. More would deplete the hospital’s supply. He believes the patient’s quality of life as a chronic alcoholic patient with residual paralysis is too poor to warrant further utilization of the valuable resource of blood supply.