August 3rd, 2009 by admin

I made up the following story to bring out a point.

A 59 year old man in prison for the past 14 years awaiting the death penalty for murdering his wife, 2 weeks ago suffered a fractured hip when he slipped and fell in his cell. He has been in a lot of pain and hasn’t been able to walk since the fracture. He has had some pain relief with pain meds given by the prison doctor but still is in much discomfort. His execution is scheduled to occur in 2 weeks unless he gets a delay based on a recent submission to the courts by his lawyer.

The issue posed to his doctor and the prison administrators is whether the prisoner should be now promptly scheduled for hip replacement surgery. The surgeons say such a surgery would definitely relieve his pain and discomfort and eventually allow him to walk normally. But with the execution scheduled within the near future is performing the surgery an ethical decision?

What is the point of this story? I think it highlights one of the issues that the government and public are debating regarding healthcare reform in the United States. The issue of this story comes down to whether the hip surgery should be looked upon as an ethical palliative, comfort procedure to finally relieve pain or because of his impending execution represents simply an unethical waste of scarce resources that could better be used in the care of others with a longer anticipated lifespan. In general healthcare reform terms, the issue is whether the costly tests, procedures and treatments which are being provided to the elderly are really all palliative in intent and result or do they too represent a waste of resources and health dollars in a patient with a more limited lifespan than others.

As with the prisoner in the story, we really don’t know if he will be executed in the 2 weeks. He may get a further delay in addition to his current 14 years of delay or may have the death sentence commuted to life imprisonment since the facts are that his wife had been a terminally ill cancer patient who was not receiving palliative care for her cancer pain and discomfort and he wanted to put her out of her misery. In that case, the hip surgery could be considered curative. Or would it? You tell me. ..Maurice.

Acknowledgment: The presentation of this ethical conflict and the story telling method was used by me from “Cases in Bioethics-Selections from The Hastings Center Report Story 59″, Third Edition, 1998 St. Martin Press, Inc. The current content of the story on this thread is my own.

Graphic: X-Ray of hip fracture which I digitally modified with ArtRage and Picasa3.