Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true patient care case. You vote on your decision in the case. And next week, we'll reveal how you all made the call. And stay tuned, bioethicist Jacob M. Appel, MD, JD, will weigh in next week with an ethical framework to help you learn and prepare.
The following case is adapted from Appel's 2019 book, :
Ellen is the single mother of a 4-year-old girl, Alice. After Alice's health deteriorates progressively over several months, the child is diagnosed with a rare degenerative disorder that requires a liver transplant. Without a transplant in six months to one year, Alice will die. Unfortunately, the waiting list for deceased-donor livers is extremely long; most patients die before a liver becomes available.
Fortunately, since 1989, some parents willing to serve as "living donors" have been able to give partial transplants to their children. The procedure poses a substantial danger to donors, however: about 0.17% to 0.5% die. Doctors are reluctant to perform such a risky operation on a healthy person, but will do so when the donor is a close family member with a deep commitment to the child. Ellen researches this procedure and decides that she wants to donate part of her liver to Alice.
During the preliminary workup, doctors discover that Ellen was born with an unusual configuration of the blood vessels in her abdomen. They estimate that her risk of death with the procedure is closer to 25%. This does not deter Ellen, but her surgeons are reluctant to go forward.
See the results and what an ethics expert has to say.
Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at the Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College.
And check out some of our past Ethics Consult cases: