Entitlement to Treatment
Situation
D.C., a 35-yr-old English tourist, was in a hang-gliding accident while
touring the United States. She was taken to the regional trauma center
for treatment of internal injuries, blood loss, and severe pelvic
fractures. She has become septic, is now in renal failure, and has
ARDS. She has no health insurance. Despite a poor chance of
survival, her husband and parents want all possible measures to be
taken.
Ethical/Legal Points for Consideration
• Federal law requires hospitals receiving federal funds through
Medicare and Medicaid to provide emergency evaluation and
treatment to stabilize patients (Emergency Medical Treatment
and Active Labor Act [EMTALA]). Once the patient is stabilized,
they are under no obligation to continue treatment and may
transfer the patient to another facility.
• Discussions with the family must occur to clarify treatment goals
(e.g., recovery, survival, continued biologic existence,
nonabandonment of the patient) and what they mean by wanting
“everything done.” There is no legal or ethical obligation to
continue medical treatment when treatment goals cannot be met.
• Contact with the English consulate may result in collaboration to
stabilize the patient and transport her to England.
• Neither HCPs nor hospitals are required to provide medically
futile care (care that provides no benefit to the patient).
• Although her home country (England) offers universal health
care, D.C. assumed the risk when engaging in a potentially
dangerous activity and did not obtain international health
insurance coverage for her visit to a foreign country.
Discussion Questions
1. How can the nurse facilitate discussions with the family about
treatment goals for D.C.?
2. Are family members able to state D.C.’s wishes for her own care
in such a situation?
