On July 5, a Monday afternoon, two trauma victims, both group O-negative, arrive in the same hospital emergency room. Both patients have massive injuries requiring largevolume RBC transfusions. Because of the time of year, the hospital transfusion service is low on O-negative RBCs. As the requests for RBCs rise, units crossmatched for tomorrow’s elective surgery are taken to be used for the trauma patients. The transfusion medicine physician (TMP) contacts the department of surgery to cancel elective surgery cases for Tuesday, July 6. The transfusion service manager (TSM) puts in an emergency call to the regional blood center. The blood center informs the TSM that it, too, is short of O-negative RBCs but that it will canvas the neighboring hospitals and put in an emergency request to the blood exchange network.
As several hours pass, during which the trauma surgeons and OR team work diligently to correct the injuries and restore vital organs, it is clear that there will be sufficient RBCs available to adequately support only one patient. The chair of the hospital ethics committee is consulted for assistance in determining how to proceed.
Additional information available includes this: One patient is a 55-year-old bank president who is the sole financial support for his spouse, two college-age children, and widowed mother; the other is a 28-year-old gas service attendant who is unmarried. Both patients are critically injured, but with adequate transfusion support, both are deemed likely to recover by their treating physician.
1. Which ethical principle is being emphasized?
2. How will a decision favoring one patient over the other be viewed ethically? Legally?