important medications but did not take the time to review the list provided by the
pharmacological companies. One day he was told by the hospital pharmacy that he could only
obtain enough of an antineoplastic medication to treat one of several patients he was treating
with it. It would be several weeks to a month before a sufficient supply would be available to
treat more than one patient. He had started both Donald and Julie on the medication the month
before. The physician knew of several alternative medication that, although they were less
effect, could be used on both patient with limited side effects.
Donald was a 71-year-old patient whom had been treated for cancer several years
earlier, and who had since been in remission. Donald had recently come into the hospital after
experiencing progressive and severe back pain for several weeks. Tests revealed that his
cancer had metastasized to his spine. Now the aim of treatment was not to cure, but to lengthen
and improve the quality of his life. The treatment regimen with the medication that the physician
could no longer obtain could extend Donald’s life by a year or more. The alternative medication
would probably extend his life by only a few months.
Julie was in her early 60s and had recently been diagnosed with a primary cancer, but
was otherwise in good health. The physician believed that Julie had a very good chance of cure
with the original medication. The alternative medications were not as effective, were more
expensive, often more side effects and did not have any research that they were effective for
Julie’s type of cancer.
Catalano Page 2 of 2 Nursing Now 8e Ch04 Case Study
• Which patient should the physician use the scarce medication on? What ethical system
are you using in making this decision?
• If you were Donald, how would you feel about receiving a medication that would shorten
• Should Donald be told about the change in medication? How does the principle of
veracity enter into this decision?
• Does Donald have any legal recourse to force the physician to give him the scarce
• Are there any other alternatives the physician might select in resolving this dilemma?
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