Okay, a rescue van picks up a 85 year old nun and a 24 year old prostitute. The latter is dying of AIDs, and is shot in a vital spot. The nun is also shot in the same spot, same wound. They both arrive at the same time, but there is only the people to treat one (hypotical, so bear with the question alright?)

Who should be treated and why?

Lol, it's like my medical interviews all over again.....

Personally I'd treat the 24 year old

Wingfoot

Why is she entitled to better care?
(And I'm looking forward to taking Medical Ethics class. My girlfriend is taking one starting soon)

The slut. It's called triage, you treat the people who need the most help. Who are you to say that the nun deserves more help then the prostitute?

They both have exactly the same wound, and exactly the same chance to live though. No one needs "more help", the situations are exactly the same. The fact that one has AIDs, somthing that is always fatal and incureable doesn't normally get one higher on any list into a hospital, in fact it can people denied for many things.

Toss a coin because it doesn't matter.

Nope. It does matter, it matters quite a bit for the person who loses the coin toss.

You can't make a decision just based on those facts. Other circumstances come into the equation like if any other people are dependent on either of these 2 etc etc. More factors could come into it to sway the decision in either of their directions.

Wingfoot

You don't have the time. You don't know anything about these people, they where just picked up after some sort of shooting. Its an emergency situation.

Again, who do you treat and why?

You don't know anything bout them...though conveniently know their age, profession and any other relevant medical details....OK

Still stick by my prostitute answer

Wingfoot

The age is told by how they look, and you know prositutes and nuns both have uniforms......of sorts....
But you said who, and not why.

No more than if they weren't picked some other way.

Based on the information you've given, there's not enough information to make a "good" decision, both are equally deserving (or undeserving) of treatment.

As long as we say it's better for one of them to be treated at the expense of the other (as opposed to letting both die), then a randomized choice is acceptable.

You'll so fail a medical ethics class man.


Or would you...... :rolleyes:

Why the prostitute?

I guess the over-riding factor in my mind was her age. Though my reasoning does look silly now I've written it down.

I had a question like this at Nottingham Med School, though it was a 3-way arguement. I'll try and dig out the interview questions I was handed afterwards.

Wingfoot

what a terribly intriguing question. Personally, I would go with the nun. The fact that the prostitute has AIDs greatly reduces the time she has left before dying, likely something close to the amount of time the nun had before dying of old age. To me that negates the age factor. So now I'm looking at a situation where I have to decide whether to save a nun or a prostitute. Because nuns contribute to society, while prostitutes corrupt the moral fabric of society, the nun would be a easy choice.

Though it probably breaks every rule in "medical ethics", thats my logic.

I haven't the slightest as to who I would pick.
Both wouldn't have much time left because of the AIDs and the age.
It's really a toss-up...
I would think that, following the teachings of Christ, the nun would want the prostitute to be the one to live, but you can't know how someone else would feel short of them telling you.
I would think that neither has much family. Actually, no wait.. the nun wouldn't have any family because of celibacy vows.. and her parents would be dead, too. But since the 24 year-old became a prostitute, I assume that she was outcast from her family (causing her to sell herself to begin with). So who knows.
I would go with the prostitute because of the off chance that she has family. Though it wouldn't be long before the AIDs kills her, she would at least have the chance to say goodbye to whatever family she has.

Quick question, though. How would you know she has AIDs without access to her other records?

Lol, standard assumption, every prostitute has AIDS.

And she may not have neccesarily been extrodited from her family, for all we know maybe her family doesn't know that's her job?

Wingfoot

She is wearing a sticker saying that she has AIDs.

Again, the situation is hypothetical.

The person who is needs care most urgently gets it.

So, who would that be, Intifada?

Judging by the information you have given, I would say the prostitute needs the treatment.

And why?

I enjoy reading how "additional information" isn't available, but when people get into making their choices and asking questions, these little tidbits about "AIDS" stickers or bracelets, occupation, etc. prove otherwise.

It's almost impossible to have two women, different ages and lifestyles to come into the exact same hospital, have the exact same wound and be admitted at the exact same time.

The decision befalls someone that is likely NOT performing the operation, either the senior doctor present or the hospital administrator if they are available. Still, it comes down to the doctor/surgeon to determine who they will try to save. Technically, if both of them are fatally wounded, it should be first come-first serve. You're situation hypothetically says they were both wheeled in at the same time, etc.

There is no right or wrong answer. The doctor/surgeon has to operate on the one nearest to them if they KNOW there isn't a patient in need of more critical care. That definately falls within their responsibility of determination; even if that information is relayed by other staff.

As to recovery chances, no one in the hospital should go under the assumption that one has a better chance than the other. They've been proven wrong time and again for doing so. The will to live often becomes a factor.

As a lawyer for the hospital, if I had the call, it would be the nun:
1.) Less risk to the staff and other patients for the spread of AIDS (i.e. liability)
2.) There is a chance this hypothetical hospital is tied to the Roman Catholic church (especially if titled Mother Frances, St. Frances, etc.)
3.) The nun is more likely to have medical insurance or to have their expenses covered by the RC church.
4.) If the media is going to trash the reputation of the staff and/or the facility, it's better to save the nun versus the prostitute, it plays better in the press for the former. Admit it and sadly so, the public generally cares less about a prostitute.

It is an impossible situation, but it isn't meant to be answered in a clearly factual way. As such, you are right, there is no right or wrong answer, its a hypothecial ethics question, which leads to more realistic questions later on.

And the best answer for this when it came up in class was by me, and I said (as you did) whoever have the best insurance.

Though in the UK insurance wouldn't come into it as the surgery would be paid for by the NHS. Then what?

Wingfoot

Hey, you aren't going to get an answer out of me. I merely pose the question.

The prostitute.

I mean it's a nun, she knows she's going to heaven anyway...right?

Heh, I suppose that is one way of looking at it.

To me, the point of the question is not whether or not such a situation could actually occur in a hospital setting. Rather, the whole "hospital" hypothetical is posed to get to the real point: who is of more value to society?

While ideally, I'd say that they are both of equal "value," I would say that we ought to save the prostitute. AIDS is at a point wherein it is no longer an inevitable killer (with all the medications), and a young, reformed prostitute living with AIDS could lead by quite a powerful example to other people.

Exactly

And have more of an affect than a Nun would?

Yeah, I think so.

I feel like disturbed youth would be more likely to listen to a 24 yr old prostitute and hear her story than an 85 year old nun.

Okay, lets carry this a step further.

How far do we go when judeing a person's benifit to society and how that relates to medical care? How do we know when to stop?

That has to be one of the strangest scenarios I’ve ever heard.

The nun at that age could have a chance of dying quicker right there, simply because of age.

The prostitute…I don’t think having AID’s gives her much less time than the 85 year old nun who just got shot… (I’d laugh at that, but it’s too grim)

They’ll both die sooner or later, in fact, we all will.

Why a nun? Dang. I don’t know, but I’d probably try to save the nun because her age might speed her death.

I’m guessing the prostitute got shot by her pimp or another person she surrounded herself with who intended to shoot her. The nun being shot was most likely an accident.

You aren't supposed to judge the injury itself. Assume its the same injury gotten the same way.

Still the nun for the last reason:

It's not a great reason.

I guess I'm also judging on the character of the people. If I had to choose (and both had equal chances) I'd pick the one I respected more. If the difference wasn't as drastic as nun/prostitute I don't know what I would do.

Hospital triage is much like war triage. If the wounds & damages are identical, you give care to the one most likely to survive. With both present there is time to stabilize both and examine/learn more. Under this scenario, the older nun might voice a preference to save the younger prostitute. Might refuse care until she is taken care of first. People do stuff like that in such situations. I've seen it. Under such circumstances, in the real world an ambulance with two take both to hospital which could care for both. This is an unlikely scenario. It also mentions a disease without reference to how advanced or controlled. The 85 year old could be on coumadin & suffered more bleeding. Whose vital signs are more stable? Are other infections already present in the 24 year old? Not much is taken in consideration to the means of living of the person, age is taken into consideration, but so are other factors. If this is absolutely all there is to go by, since you said AIDS and not HIV infected (which the nun could also have by the way) I would go by the 85 year old nun, since she apparently lacks a disease bettering the odds, than someone with multiple infections, who undergoes surgery which is treatment of a gun shot wound.

All this time and I still havn't seen an ethical arguement (as this is an ethics question) that has swayed me either way :no:.

Lots of ideas though, pretty interesting.

Well in terms of medical ethics it boils down to who is more likely to survive treatment. AIDS is a state of multiple infection greatly decreasing odds of surviving surgery. Infection has a larger influence than age.

What good is giving care if they don't survive, if one could have?

It's not just the immediate situation, how will people react later retelling the story?

People ask, who did you help?
a- a nun
b- a prostitute

You let the nun die?! :o

*sigh* This question seems to have been lost on most people here. Zarik seems to get it, but yeah.

Forget the medical aspect of the proceedure, they will both come out the exact same if they are given care, except one will be near death and one will have AIDs.

Ethics question.