Marguerite M., an 89-year-old widow, is admitted into the cardiac intensive care unit in Chicago's Memorial Hospital at 3:00 A.M. on a Sunday morning with a massive heart attack (myocardial infarction). Her internist, Dr. K., who is also a close family friend, has ordered an angiogram to determine the status of Marguerite's infarction (heart attack). Dr. K. knows that the angiogram and resulting treatment need to be done within the first six hours after an infarction in order to be effective. Therefore, the procedure is going to be done as soon as the on-call surgical team can set up the angiography room. The radiologist, who lives thirty minutes from the hospital, must also be in the hospital before the procedure can begin. At 4:30 A.M. the team is ready to have Marguerite, who is barely conscious, transferred from the intensive care unit (ICU) to the surgical suite. Coincidentally, at 4:30 A.M. Sarah W., an unconscious 45-year-old woman, is brought in by ambulance with a massive heart attack. The emergency room (ER) physicians, after conferring with her physician by phone, conclude that she will need a balloon angiography (dilating an obstructed blood vessel by threading a balloon-tipped catheter into the vessel) to save her life. When they call the surgical department to have the on-call angiography team brought in, they are told that the room is already set up for Dr. K.'s patient. They do not have another team or surgical room for Sarah. A decision is made that because Sarah needs the balloon angiography in order to survive, they will use the angiography team for her. Dr. K. is called at home and told that his patient, Marguerite, will not be able to have the angiogram. The hospital is going to use the angiography team for Sarah, because she is younger than Marguerite and has a greater chance for recovery. Unfortunately, it took longer than expected to stabilize Sarah before and after the procedure and the six-hour "window" when the procedure could be performed on Marguerite passed. Marguerite expired

1. Do you believe that this case presents a legal or an ethical problem, or both?

2. What do you believe should be the criteria for a physician to use when having to choose a solution that will benefit one patient at the expense of another?

3. How can Dr. K. justify this decision when speaking to the family of Marguerite M.?

4. What options does a member of the angiography team or a caregiver for Marguerite have if he or she disagrees with this decision?