Question

Sarah is a 17-year-old undocumented immigrant who has been followed at a regional pediatric heart center since age six for single-ventricle Fontan physiology. She lives with her parents and three siblings in a rural community, where her parents struggle to avoid deportation and support their four children by working as agricultural laborers. Although Sarah and two of her siblings immigrated in childhood and are eligible for the Deferred Action for Childhood Arrivals program (DACA), Sarah’s youngest sibling was born in the United States and is an American citizen.

Sarah’s heart condition is now complicated by protein-losing enteropathy, tricuspid regurgitation, and decreased cardiac function. Her cardiologists have diagnosed her with end-stage heart disease and believe she will require a cardiac transplant to survive to adulthood. Due to her anatomy, Sarah is at a higher risk of a poor outcome if transplantation is pursued, and this risk will increase as she gets sicker. She is not a candidate for a ventricular assist device. After a discussion of the risks and benefits of a transplant, Sarah and her parents have indicated that they would like to pursue heart transplantation.

The cardiac transplantation team considers Sarah an acceptable candidate for transplantation despite her increased risk, but it has raised concerns about whether her status as an undocumented immigrant will adversely affect her ability to obtain the health care and medications required to maintain her long-term health following the transplant. In addition, there is a child who is a citizen that also needs a heart transplant on the same floor Sarah is hospitalized in. Her first surgery was performed in Mexico, but subsequent surgeries have been performed at the regional pediatric institution. The regional children’s hospital has committed to providing care and medications until Sarah reaches age 21, but the team has expressed concern about whether she would be able to afford the necessary care and medications after that point.

How does the principle of nonmaleficence apply to this scenario?

Answer 1

Principles of nonmaleficence indicate that not to do harm for others. good effect to be intended and it must outweigh the bad. it is considered to be negligence if your action is careless that causes risk and harm others not and in future. As medical professionals our duty should benefit the patient. we must take always positive steps to prevent the harm.
Sarah is at high risk of poor outcomes if transplantation is done. it increased her risk if she gets sicker. To do good to the Sarah as a cardiologist they should find some other way to improve her heart function. that avoid risk due to transplantation, consciously if we do some wrong to the patient that is negligence act and it violate the ethical pricinpe. Team must think of her future she could afford to receive necessary care or not in the future, this negligence act violate the principles of nonmaleficence.