CLINICAL CASE FOR DISCUSSION
Bobby C.
Lawrence P. Ulrich, Ph.D.
Lawrence.Ulrich@notes.udayton.edu

Some issues raised:


Bobby C. is now six months old. He was born prematurely with a birth weight of 800 grams and had multiple problems from the beginning. Bobby developed hyaline membrane disease due to his underdeveloped lungs and the need for a respirator. He also developed rickets. A CAT scan revealed some calcium deposits in the brain that might or might not compromise his mental functions. Within the first month, Bobby developed thrombocytopenia (low platelet count) for which he was given transfusions. He now suffers from a depression of his immunological system, perhaps AIDS related to the transfusions. He shows little interest in eating, and all attempts to bottle-feed him have failed after a couple of days. His healthcare costs are being supported by Medicaid, and they are estimated to be in the neighborhood of $850,000 for his six months of hospitalization. Now the healthcare staff, the attending physician, and his parents are considering the possibility of a bone marrow transplant to deal with the thrombocytopenia and the immunosuppression. The chances of success in an infant this small are minimal, and the procedure is largely experimental in infants having this condition. If the transplant is successful, it will only alleviate one of his many problems. The parents want to authorize the transplant because they think his condition is a punishment from God because they were seriously considering aborting Bobby early in Ms. C.'s pregnancy.

Some Discussion Questions:

1. Do the parents have enough information in this case?
2. Are the parents beliefs about "punishment" exercising a coercive influence on their consent?
3. Could the bone marrow transplant in this case be considered "futile?"
4. How much of a role should the medical uncertainties play in the communication with the parents?
5. Should decisions in this case be based upon the calculation of medical probabilities?
6. Are there limits to aggressive interventions when caring for newborns?
7. Should resource allocation be considered in this case?