Mr. Smith
Mr. Smith is a 54-year-old homeless man admitted to the hospital after he was found
unconscious near the Dallas Farmer’s Market. He has been slowly bleeding into his bowel
because of complications of his liver cirrhosis, which in turn is due to his lifelong heavy drinking
of alcoholic beverages. The bleeding can be stopped temporarily, but cannot be fixed with either
medicine or surgery. He has already had 10 blood transfusions, and will need more as long as he
survives. The doctors believe that his bleeding has caused serious brain damage which has
caused a persistent coma, or state of unconsciousness. While the doctors cannot be sure if he will
wake up from coma, they doubt that he will wake up before he dies of other problems. He is
likely to die from his liver disease, but the timing of his death is hard to estimate - it could be a
few days to a few weeks.
Despite sustained effort, the social worker has been unable to find any family members or even
someone who knows him. He has no medical record. He has no advance directive (guidance to
doctors about what to do in the case the patient cannot direct his own treatment). He has no
insurance, which means that the County’s taxpayers will pay for his treatment.
Questions:
Should the patient be allowed to die? Why, or why not?
Why are the multiple transfusions of blood an important consideration in this ethics case?
Who should decide if, and when, life-sustaining treatment is stopped?
If Mr. Smith had medical insurance, would that change your responses to the questions
above?
Student Responses
10-26-2012
1. Yes, because the tax payers are paying for a man’s treatment when the treatment is going to
only fix the disease temporarily.
2. The man is still going to die from the disease no matter how many blood transfusions he gets.
3. If the patient does not have an advance directive then the head doctor should make the
decision.
4. Even if Mr. Smith had medical insurance my answer wouldn’t change.
C.Z., Byron Nelson High School
10-26-2012
1. The patient should be kept alive as long as quality of life has not declined to an unrecoverable
level.
2. Multiple blood transfusions are an important consideration because the patient has already had
several transfusions and will need many more until he dies because of internal bleeding.
3. The physician or the patient’s family (if contacted) should decide when life sustaining
treatment should be stopped.
4. If the patient had medical insurance, treatment could be sustained longer, but answers above
would not have changed.
T.D., Byron Nelson High School
10-26-2012
1. No the patient should not be allowed to die because Mr. Smith is still a human being with
rights. Although the taxpayers will have to pay, the physician needs to help Mr. Smith because as
a physician he or she is required to help the patient.
2. It’s important to consider multiple blood transfusions because this will be expensive to use
every time but Mr. Smith may need this. The tax payers would not like this.
3. The doctor will decide because Mr. Smith does not have a medical record or advance
directive. However, the doctor should continue this treatment because Mr. Smith might have a
family member that shows up all of a sudden.
4. No because Mr. Smith is still a human being and should be treated like one. With or without
insurance this man needs help and hopefully others can understand that.
M.M., Byron Nelson High School
10-29-2012
1. Mr. Smith's doctor should do everything he can to make sure his patient stays alive. Although
the symptoms of Mr. Smith are bad, he should be given care even though he has no insurance. If
they decide there is nothing more to be done, Mr. Smith should pass away as painlessly as
possible. He should not suffer and he should be given the best care possible until he does pass.
Even though Mr. Smith is homeless, he has a right to his care.
2. The doctor has determined that Mr. Smith can only survive through blood transfusions. Even
with the transfusions, Mr. Smith only has a few more weeks to live. The doctor must decide
whether or not he should "waste" blood on Mr. Smith even though he is going to die soon
anyway. They have done everything they can, including surgery, but there is no way to stop the
bleeding because of Mr. Smith's old habits. The blood used for Mr. Smith could be given to
another person who has a better chance of living.
3. Since no one in his family can be reached, the doctor, along with the hospital board, should
decide when life-sustaining treatment is no longer necessary or helpful. The doctor may have to
go through court so that he can't be held liable. No one can make the decision for Mr. Smith,
therefore, it is in his best interest that the doctor be given the responsibility to do so.
4. I wouldn't change my answers to any of the questions before. Mr. Smith should receive the
same care without insurance that he would if he had insurance. Mr. Smith was homeless and
shouldn't be denied care because of this fact. Medical insurance would be helpful, and possibly
allow the hospital to contact the family, but it should not determine whether someone lives or
dies. As taxpayers, it is nice to realize that our money is going to help the people that don't have
insurance. There are many people that are employed, however, they do not have insurance just
like Mr. Smith. They deserve to receive the same care as people that do have insurance.
E.S., Byron Nelson High School
11-11-2012
1. I don’t think the patient should be allowed to die. I mean, yes, his constant drinking is what
lead to his current state, but maybe he drank to cope with economic and social poverty. He
doesn’t have a single friend in the world and maybe alcohol was his outlet to happiness. Also, if
this man was treated, who knows if he could become an example for people in a similar
situation. He’s a human being, and although the chances are slim, he has the potential to offer
something to the world if doctors were to keep him alive.
2. Multiple blood transfusions is something very costly. Because of the fact that Mr. Smith’s
treatment is being provided for by the tax payers, it is made into a more conflicting ethics case.
3. Mr. Smith doesn’t have any advanced directives or family to look after him so I think that it
would be up to doctor to decide when to stop life- support.
4. Even if he had medical insurance the doctors should still try to save him because you never
know, he may have money but no family to look after him. Medical insurance is an unnecessary
factor in my opinion; if a person has good morals, good intentions, and a reason to live, they
should be given treatment despite their economic status.
K.H., Med High
11-11-2012
The health care provider should make sure he/her does everything in their power to keep Mr.
Smith alive. Although his symptoms are pretty bad, he should be given the right to the best care
possible. If there is nothing else that can be done for Mr. Smith then they shout let him die
without much pain. Even though he is homeless, he has a right to his care.
With transfusions, Mr. Smith may only have a few weeks to live. The doctor must determine
whether or not he should "waste" blood on Mr. Smith even if he may die soon. The blood used
for transfusions on Mr. Smith could be given to another person who has a better possibility of
living.
Because nobody in his family can be reached, the doctor and hospital board should determine
when treatment is no longer essential or useful. No one can make the decision for Mr. Smith, so,
it is best if the doctor is given the obligation to make the decision.
I wouldn't change my answers to any of the questions. Mr. Smith should receive the same care
without insurance than if he did have insurance. Even though Mr. Smith is homeless he should
not be deprived of care. Medical insurance would be beneficial, but it should not decide whether
someone lives or die. Many people do not have insurance, and they ought to obtain the same care
as people that have insurance.
AB South Texas High School for Health Professions
11-11-2012
1. Under the Hippocratic Oath, a physician pledges to do all in his or her power to save or sustain
the life of a patient, so absolutely not.
2. Treating a patient with Liver Cirrhosis, which is the final phase of chronic liver disease,
through heavy dosage blood transfusions could engender additional complications. The possible
implications include a much greater rate of graft failure, or a more common occurrence of sepsis.
These consequences will harm the patient and hinder his recovery, albeit the physician’s
intentions are to do whatever is necessary to keep him alive.
3. The AMA policy on Provision of Life-Sustaining Medical Treatment states that in
circumstances where the patient is incapable of participating in the decision process, and there is
also no advance directive, it is not banal for physicians to come to an agreement, adjudication of
dispute by court is appropriate.
4. No, because the medical decisions are not being based off of the patient’s financial state or
incapacity to pay for treatments, they are based off of the physician’s ethical codes. It is not the
job of the physicians to decide whether or not to deny the patient treatment, it is his or her job to
do all they can to help the patient.
E.G., Med-High
11-11-2012
1. Although this might sound of as harsh, I believe that Mr. Smith should be allowed to die, this
would end his suffering from dying of another cause.
2. They are important because he will continue needing more and more transfusions, which will
be paid by the tax payers.
3. The doctor should decide after taking a considerate amount of time to wait and see if a family
member shows up.
4. Yes, it would change my answers because if Mr. Smith had medical insurance then that would
mean that he would be employed, therefore have a brighter future ahead of him.
N.S. South Texas for Health Professions High School
11-12-2012
Yes, I believe Mr. Smith should die because the doctors are wasting necessary resources that
could be used for other patients. They are also sustaining a life that will more than likely die
either way, and I think it's best to end the suffering of Mr. Smith.
The number of transfusions is important because it indicates how many transfusions have been
done with no avail. This shows Mr. Smith is more than likely long gone, and anymore
transfusions done on Mr. Smith won't have any effect, and they could be used for other patients.
The person who should decide is the head doctor, or a doctor of high authority.
My answer wouldn't change even if Mr. Smith had medical insurance, because either
way, the attempts done by the doctors are having no effect on Mr. Smith.
C.E, South Texas High School for Health Professions
11-12-2012
Mr. Smith should be allowed to die (once all treatments prove futile) because he has too many
ailments and is virtually incurable at this point.
In this case, the multiple blood transfusions are insignificant because the transfusions are only
stalling the problem, not solving it. It is a waste of blood.
The doctor should decide if, and when, life-sustaining treatment is stopped because Mr. Smith
has no family or advanced directives.
If Mr. Smith had medical insurance, the above responses would not change because insurance
doesn't change the severity of his health problems.
H.O., Med High
11-12-2012
He should be allowed to die because he is in a permanent coma, there is no use in keeping him
alive. Not just this, but he has no family members around, so who will it affect?
He has already taken up a large amount of blood, for transfusions, that could be used on other
patients as well.
The head physician should get to make the decision, considering that there is no one else to do it.
Even if he had medical insurance, the answers above would remain unchanged.
D.S., Med High
11-12-2012
Unfortunately, Mr. Smith is going to die soon anyway due to the complications brought about by
his excessive alcohol consumption. He is in a coma and can not survive on his own. He has
already had ten blood transfusions without any success. Since he obviously can't make the
decision on his own, the choice would normally go to friends or family members. But since he
has none, it's up to the doctors to choose. And because he has no insurance, the taxpayers' dollars
could go to a patient who has a chance of survival. It seems cruel to let a man die, but poor Mr.
Smith has little chance of living much longer.
C.S., Midway High School
11-12-2012
1. The patient will not recover from his illness, and so will die no matter what the doctors do.
The best that can be done for Mr. Smith is to make his passing as comfortable as possible.
The doctors are using blood transfusions to keep Mr. Smith alive longer; that blood could be
better used to treat patients who have higher chances of surviving.
Unless a family member shows up, Mr. Smith's doctor should determine when the treatment is
no longer necessary.
No. Regardless of insurance, Mr. Smith's last days should be as comfortable as possible.
K.M., Midway High School
11-12-2012
I don't believe he should be left to die. I mean, he has no one who can speak for him anyways,
and since he is in a coma we don't know what he wants. It's best to give him the best chance he
has, even though he will be suffering if he wakes up.
It is important to keep Mr. Smith as healthy as possible for as long as possible, but like the
doctor said, these blood transfusions will only work temporarily. These transfusions won't help
for long.
If the patient has no one who can speak for him, it is no one’s call to make. If the patient passes
away during the coma with proper treatment then that is a misfortune. But he should be given the
best chance as anyone else who had a voice.
No. It's nice to know my money would be helping to contribute health to someone who
desperately needed it. Just because someone made a bad choice in life to drink alcohol doesn't
mean he had it coming and/or doesn't mean we shouldn't help him. We are all human and make
bad choices and should be grateful if strangers helped us survive.
J.C., Midway High School
11-12-2012
Yes, because he caused his own problem by drinking heavily and if he has no known family then
he probably lost everything he had because of his alcoholism.
The man needs to continue to get the transfusions just to live and will continue to need them
throughout his life.
The doctors or the head doctor should decide if he cannot be saved.
Not really, because if he is homeless how can he pay for his medical insurance to begin with?
L.C., Midway High School
11-12-2012
1. Mr. Smith should be allowed to die as humanely as possible. The doctors have determined that
there is no hope for his recovery, and although it is harsh, he is taking up much needed resources
by staying at the hospital. He is in a coma and it is presumed he can feel no pain.
Mr. Smith's use of blood transfusions is an important consideration because of the value of
donated blood to hospitals. There is always need for people to donate blood, and this patient is
regrettably using up valuable supplies. His death is inevitable in a very short amount of timeusing these supplies on him is not the most efficient use of resources.
As Mr. Smith appears to have no next of kin, his physician is the only one qualified to make the
decision to take him off of life support. Legal considerations to protect the doctor and his/her
assistants should be taken.
If the patient had insurance, it would change my responses. If Mr. Smith paid for insurance and
was eligible, then he has a right to treatment even though he only has a few days to live. This
also saves the taxpayers from paying for whatever treatment he is given.
S.G., Midway High School
11-12-2012
The patient should be taken off the blood transfusions because the doctors have already
determined that the probability of finding a permanent solution to the man's illness is unlikely so
he using up resources, such as the blood transfusions and money, that could be used on other
patients with a known cure.
It is important to consider the fact that he has used multiple blood transfusions already, and he is
still going need many more throughout the rest of his life, that can be used by other patients
without a terminal mystery illness when determining what the outcome of Mr. Smith.
The final decision should be made by the head doctor after hearing the advice of his staff.
Even if Mr. Smith had medical insurance, my above answers would not change because he is still
utilizing resources that could be better used on a patient that has a known diagnosis and a known
cure.
A.M., Midway High School
11-12-2012
The doctors should make a judgement call based on the situation. He is a person just like
everyone else and it is the doctor's responsibility to do all that is possible to help him, even if that
means making him as comfortable in his passing.
The blood transfusions are an ethics case because the blood is being given to a person who may
die is a few days. It might be considered wasted blood because it could be given to someone who
needs it just as much that will survive.
The doctor should make that decision since there are no family members.
No, insurance or not he should be helped.
M.L., Midway High School
11-12-2012
This question with Mr. Smith is in its self a dilemma, it has no easy answer. However when it
comes to making decisions on life and death, it must be made with a logical and level head rather
than by emotional decision. It seems imprudent to allocate resources to a man unable to recover
when they may instead be used toward a child fighting a curable disease. I would say that when a
consensus of doctors agree that recovery is impossible, Mr. Smith may be comforted, but the
inevitable should not be delayed.
H.M., Midway High School
11-12-2012
1. The patient should be allowed to die. After many medical procedures and attempts to save the
patient, the patient is still dying with no way of recovery. It is better to end his suffering.
2. For this particular case, Mr. Smith is already dying and the only way of staying alive
physically is through blood transfusions. However, because he only has a few weeks to survive,
at most, the blood transfusions would benefit other patients more than Mr. Smith. Also, the
expenses of the blood transfusions would not be wasted.
3. If the patient has no family members or friends in contact, the doctors should decide if lifesustaining treatment should be stopped, which is when the patient stops responding to treatment
and still is dying.
4. If Mr. Smith has medical insurance, that means he would have been able to afford to treat his
medical problems earlier. Therefore, this does not change any of my responses above.
T.D., Midway High School
11-12-2012
1. Mr. Smith should be allowed to live for at least a week, so that should any family member turn
up they could take action whether to keep him alive or not.
2. The multiple blood transfusions could be going towards a worthier patient with a higher
chance of survival rather than to keeping someone who isn't making any contributions to society
currently whereas that other person may be a great asset should they get the medical attention
they need.
3. The court should decide whether or not this life has any value to society or not.
4. Yes, if he had insurance he should be allowed to live as long as the insurance company would
fund his medical expenses.
M.N., Midway High School
11-12-2012
1. No one can technically "allow" a person to die. Instead, the question is rather should doctors
be allowed to lose hope for a patient and stop treatment. In my opinion, the doctors have already
determined that the patient will not recover from his sickness and will die. Therefore, the doctors
have the right to change the method of treatment for the patient to focus on easing him in to
death painlessly instead of prolonging the inevitable. However, I only feel this way if the doctors
are absolutely sure that the patient can not recover.
2. The multiple blood transfusions are considered because these transfusions can be used for
many different patients. If there is no way of saving Mr. Smith, the transfusions may serve a
better purpose for a patient who will recover and be saved by this.
3. Because the patient has no known family or relations, the head doctor should make the
decision.
4. If the patient had insurance, my answer would not change. The patient's health should be the
priority, not the taxpayer's money.
C.C., Midway High School
11-12-2012
1. Mr. Smith should be kept alive. It is the doctor’s duty to do everything he possibly can to keep
this patient alive. When they have done everything they can to keep him alive, and his condition
is not getting better, then they can let him go.
2. No matter how many blood transfusions he gets, he will die and it would be like a waste of
blood on him. It also is very expensive, and since he has no insurance the tax payers are going to
be paying for this.
3. Since there is no medical record, family member or person that knows him, and advance
directive the doctor should decide whether or not to keep this man alive.
4. Every patient should be treated equally even if they do not have medical insurance or they do.
My answers would not change.
M.B.S., South Texas High School for Health Professions
11-12-2012
1, As a living being with certain rights, Mr. Smith should be treated like any other patient until
his systems fail naturally. If Mr. Smith was a celebrity figure in society, no questions would be
asked on continuing his treatments. The staff at the hospital should feel obligated to care for each
and every patient until nothing else can be done. Also, who knows what may happen if a miracle
pulls through and Mr. Smith survives. It does not sound likely in this scenario, but such
situations have occurred and must be taken into consideration.
2. Mr. Smith's primary treatment at the moment is blood transfusions. If he continues treatment,
then the more transfusions he will need and thus the medical expenses will increase. Also, those
blood transfusions may be used on other patients that have a more likely chance of surviving.
3. Since Mr. Smith has no known family members, the doctors and staff at the hospital
are responsible for making decisions for their patients. Taxpayers may feel obligated to
determine his fate, but the doctors should be in charge of taking everything into consideration for
making informed decisions.
4. No, Mr. Smith's rights remain the same regardless of money. Modern society may run on
money, but the characters and rights underscore the foundations of the same society.
N.B., Midway High School
11-13-2012
Mr. Smith should be allowed to die, after all he is taking up space and time, as well as money,
that could go to someone that has a better chance of living. He is going to die whether it be a few
days or a few weeks, why prolong the dilemma. After all no amount of surgery or medicine will
help him, that’s already been established. The money from taxpayers could go to help pay for
others who are better off.
The blood transfusions are a huge part to take into consideration, because that blood could go to
someone that has an actual chance of getting better. If Mr. Smith is kept alive, he will continue to
need transfusions that in the end will not keep him from reaching the same end.
Even if Mr. Smith had insurance, it would not change the way I answered the previous questions.
Insurance would take the payments away from the money of taxpayers, buts it’s not like that
would change the sitution as he would still die and would still use up those blood transfusions.
C.G., G.B. Trimble Technical High School
11-16-2012
The patient should not be allowed to live because he will die in a short time with treatment and
will not be able to take care of himself. The multiple transfusions of blood are important in this
case, because the quantity and quality of the patient’s life with treatment is still poor. Instead of
the blood transfusions going to this patient, they should be going to somebody that will have a
better quantity and quality of life with treatment. The head doctor should decide when the life
sustaining treatment should be stopped. Unless, family or friend is contacted. If Mr. Smith had
medical insurance it would not have changed our response.
Students from Coldspring Oakhurst High School