Powerpoint presentation for Ethics in Healthcare course.

1. Seven-Step Decision Model for Young
Child Needing Heart Transplant
Martha A. Campbell
Berkeley College, HEA 203, Legal and Ethical Issues in Healthcare

2. Abstract
• The purpose of this paper is to resolve a medical issue using the
seven-step decision model.
• The seven-step decision model is a problem solving tool geared to
making decisions based on following an established approach.
• My assignment is on two young parents who have a child with a
significant cardiac defect. There are no available infant hearts at this
time and the baby might die waiting for a donor heart. A cross-
species transplantation using a baboon heart is a possibility.

3. Step 1 - Determine the Facts
• In Step 1, the problem must be clearly defined. Irrelevant information
should be disregarded and only look at what decisions need to be made.
• It is known that the patient is an infant with significant cardiac failure, thus needing a
new heart.
• Also known is, there are currently no available infant hearts in the donor heart pool.
However, there is a baboon heart available because the doctor has already offered
the parents the simian heart for the infant.
• Transplantation of an animal organ into a human is known as xenotransplantation.
Those involved in the situation are the parents of the infant and the doctors who are
treating the child, the surgeon(s), the hospital and myself.
• The decision must be made soon, because the child’s heart situation would be dire.

4. Step 2 - Determine the Ethical Issue
• In Step 2, it must be determined what the ethical issue might be in
this situation. There are several ethical issues with regards to this
medical issue.
• Given that xenotransplantation is still experimental, there is the issue of
whether to take a chance on it.
• The chance of the infant dying while waiting for a human heart must be
weighed against the chance that the baboon heart might be rejected by the
infant’s body.

5. Step 3 - Identify Major Principles, Rules
and Values
• Step 3 is about identifying what the major principles, rules and values are.
Is this an issue of morality or individual rights?
• The moral issue is whether to take a chance on an experimental surgical procedure
that has not been proven to be successful. Xenotransplantation is an unproven and
largely an unsuccessful procedure.
• The individual rights come into play because the infant has a right to life and if there
is a procedure that can save them, then they have the right to try.
• There is an issue of bias to consider, with the doctors and hospital, because they
could be pushing the xenotransplantation in order to get medical notoriety and
prestige should the transplantation be successful.
• In the majority of cases, the parents would make any medical decisions for their
child. This leads to another factor, which is making sure the parents are made
completely informed of all the risks of this surgery.

6. Step 4 - Specify Alternatives
• In Step 4, the decision must be made as to whether there are
alternatives to the xenotransplantation. There are several choices
here.
• One is to leave the infant on the transplantation list and hope that a donor
heart will become available in time
• Another alternative would be to do nothing and allow the child to go home
and spend their last days with their family.
• And a third alternative is to seek out any alternative treatments or procedures
that may be out there that have not yet been considered, such as corrective
surgery.

7. Step 5 - Compare Values and Alternatives
• In Step 5, a comparison must be made between the values of Step 3
and the alternatives of Step 4:
Wait for human donor heart
It is under the parental rights for turning down
the xenotransplantation, however it will take a
medical decision as to whether the child is still a
viable candidate for a human donor heart.
Allow the child to go home with the result most
likely being the child will die soon.
This would be completely the parent’s decision to
make but they must be completely informed of
what to expect.
Seek out alternative treatments and procedures.
This is the parental right to ask for consideration
of this but will take cooperation of medical team
as to whether any alternative treatment or
procedure is available.

8. Step 6 - Access the Consequences
• For Step 6, the consequences must be assessed.
• The consequences for the infant is pretty much black and white.
• With any type of surgery, there are risks. With the simian transplant, there is
a higher possibility that the child will either die. Without the surgery, the
child will die.
• The only gray and unknown area is if alternative treatments or procedures
can be assessed and recommended.

9. Step 7 - Make a Decision
• In Step 7, the final decision must be made.
• The final decision rests in the hands of the parents.
• I do not foresee any reason for the medical community to become involved
with attempting to take the parental decision rights away from the parents.
• I think the recommendation should be to seek alternative treatments or
procedures.