Carrie James Ethical Dilemmas

Dr. Carrie James is a pediatric cardiologist at Riley Hospital for Children. She completed her undergraduate degree and medical degree at Loyola University in Chicago. Then, she went on to complete her pediatrics internship, residency, and fellowship at Indiana School of Medicine in Indianapolis. Dr. James joined the team at Riley Hospital for Children in 1999, and has been practicing there since. She specializes in fetal echocardiography and transthoracic and transabdominal children.

The American Medical Association developed a Principles of Medical Ethics to define the essentials of honorable behavior for a physician. Upon review of these principles with Dr. James, she found many of the principles to be straightforward. However, there

James provided multiple examples. Because Dr. James works with children who are unable to consent for themselves, the concept of autonomy can be especially difficult. For example, Dr. James had an eight-year-old patient with a heart rhythm abnormality. The patient was on medicine that kept him stable but had to take the medicine three times a day without fail. Dr. James approached the family about completing an ablation, a procedure that can be done in a catheter lab, that would normalize the heart rhythm. The patient was ecstatic about the idea of not taking medicine anymore. Additionally, Dr. James stated that most kids do not have the same sense of mortality as adults do; they feel invincible. The parents, however, were incredibly nervous and given their son’s stability with medicine, they did not think the added benefits outweighed the risks. Because Dr. James’ patient wanted to go through with the surgery, she said that she felt it was her responsibility to convince the parents by informing

James frequently encounters is transplant distribution. Because of the low donor pool and incredibly high need pool, the concept of justice comes in to play, and someone must decide how to distribute the organs. One criterion that has been implemented for children is a social evaluation in which social workers assess a family’s ability to provide the care and resources that a transplant patient requires. In one situation that Dr. James could recall, a twelve-year old needed a heart transplant. The grandparents were the guardians because the parents were both in jail. The evaluation determined that the grandparents were too old and could not fully provide for the child’s needs post-operation, and the boy was not listed. Outraged, Dr. James could not accept this answer and fought for the boy’s placement with a foster family. Eventually, they did find a foster family that was willing to take on the responsibilities and the boy received a heart. He is alive today. Dr. James groaned that while she can intellectually understand the need for these guidelines, when dealing with real patients, this issue is the hardest for her to ethically