Case 1:
The ethical issue is whether Mr. P should be discharged from the hospital. My initial thought was that he should not be discharged because he nearly died at home. However, here is a more reasoned response. There are no ethical standards to help decide what to do in this situation. The insurance company says that they will not pay for the hospitalization. Mr. P does not may the money to pay for it. The consequences of hospitalization are that Mr. P would not be able to support himself later. However, he would be safer because the hospital staff would be able to monitor his seizures. These are serious and likely consequences. The consequence of not hospitalizing Mr. P is death. This is a serious, irreversible, and likely consequence.
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The cheaper prosthesis is as good as the more expensive, however it is more likely to fail after 10 years. There is no clear ethical or legal consensus. The consequences of providing a cheaper prosthetic would be the hospital would save costs and the surgeons would profit (because of “gain sharing.”) The consequence to the patient would be the patient would receive the same quality prosthesis. However, if the patient lives over 90 years, the patient would have a failing prosthesis, which would negatively affect their lifestyle. At the age of 90 years, the patient may not be a candidate for another hip replacement surgery, and the patient would have to live with the prosthesis. The consequence of using a more expensive prosthesis would be that the number of surgeries would have to be reduced and some patient may be denied a prosthesis. Also, it seems as if there is a potential loss of income for the surgeon. The patients do not have the decision-making right to request a procedure, and so they cannot decide which prosthetic they want. The virtue of compassion could support the more expensive prosthesis, because it would prevent potential pain when the prosthetic started failing. It would also support the cheaper prosthesis, because patients who need hip replacement surgeries may often be in pain if they