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Life and Death in the War Zone

Classroom Activity

Materials | Procedure | Activity Answer | Links & Books | Standards  Print this Teacher's Guide (PDF, 4 pages)

Objective
To determine criteria for selecting an organ transplant recipient.

• copy of the "You Be the Judge" student handout (PDF or HTML)

1. The medical personnel at the Combat Support Hospital in Iraq used specific criteria to consider which injured Iraqis to treat. In this activity, students will consider what criteria they might use when selecting an organ transplant recipient in this country.

2. Organize students into four Transplant Review Board teams and distribute the student handout to each team member. After each team has chosen its lung recipient, discuss the following:

   • What criteria did each team use to select a lung recipient?

   • How did team members decide which criteria were most important?

   • How did students weigh patients who have knowingly abused their bodies, such as cigarette smokers or alcoholics, against individuals who have not engaged in risky behavior? Should this be a guiding factor? Why or why not?

   • Why or why not should the ability to pay—through insurance, Medicaid, or personal funds—affect which patients are selected?

3. To conclude, review the American Medical Association's guidelines for allocation of limited resources in cases such as organ transplantation (see Activity Answer). What do the students think about the AMA's recommendations?

4. As an extension, have students research and report on guidelines that have been set for allocation of limited resources in other situations, such as food or medical distribution in areas of need.

Students should sort through each case history to determine which facts are relevant in deciding which of the four patients should be chosen to receive the lung transplant.

According to the American Medical Association's Code of Ethics, decisions regarding the allocation of limited medical resources should only be based on ethically appropriate criteria. These criteria include:

• likelihood of benefit
• urgency of need
• change in quality of life
• duration of benefit

In some cases, the amount of resources required for successful treatment is also considered. In terms of judging quality of life, the AMA notes, patients should first be prioritized so that death or extremely poor outcomes are avoided, followed by prioritization according to change in quality of life. In order for these criteria to be ethically relevant, substantial differences among patients must exist; the greater those differences are, the more justified the use of the criteria.

According to AMA guidelines, the individuality of patients and the particulars of individual cases should be respected as much as possible in the decision-making process. In cases where substantial differences do not exist among potential recipients based on defined criteria, some other equal-opportunity method should be used to make final allocation decisions, such as a first-come-first-served approach.

Non-medical criteria that should not be considered when making allocation decisions include

• ability to pay
• age
• social worth
• perceived obstacles to treatment
• patient contribution to illness
• past use of resources

Find the full text of the AMA's Code of Ethics regarding allocation of limited medical resources at www.ama-assn.org/ama/pub/category/8388.html

Web Sites

NOVA Web Site—Life and Death in the War Zone
www.pbs.org/nova/combatdocs/
In this companion Web site to the NOVA program, find out how combat doctors decide whom to treat, learn what it was like to make this film, read experiences from five combat hospital doctors and nurses, view photos taken during the film's production, and try to interpret military medical photographs through time.

Combat Medic Competition Challenges, Motivates Soldiers
www.defendamerica.mil/articles/nov2003/a112503e.html
Provides a look at the Combat Medic Challenge, a competition in which teams from eight Northern Iraq medical units square off to test battlefield medical tactics.

Combat Medicine
www.pbs.org/newshour/bb/health/jan-june03/combat-medicine_3-29.html
Features an article on advances in civilian medicine and lessons learned from earlier conflicts and explores how these factors are transforming medics' methods of treating soldiers in Iraq.

Principles of Medical Ethics
www.ama-assn.org/ama/pub/category/8292.html
Includes the American Medical Association's standards of conduct.

Books

Kaplan, Jonathan. The Dressing Station: A Surgeon's Chronicle of War and Medicine. New York: Grove Press, 2001.
Details a combat surgeon's personal experiences in war trauma centers in several countries, including Iraq.

Pence, Gregory E. Classic Works in Medical Ethics: Core Philosophical Readings. Boston, MA: McGraw-Hill, 1998.
Explores several broad philosophical issues, including terminating the lives of dying patients and allocating scarce medical resources.

The "You Be the Judge" activity aligns with the following National Science Education Standards.

Grades 5-8

	Science Standard G: History and Nature of Science

Science as a human endeavor:

• Science requires different abilities, depending on such factors as the field of study and type of inquiry. Science is very much a human endeavor, and the work of science relies on basic human qualities, such as reasoning, insight, energy, skill, and creativity—as well as on scientific habits of mind, such as intellectual honesty, tolerance of ambiguity, skepticism, and openness to new ideas.

Grades 9-12

	Science Standard G: History and Nature of Science

Science as a human endeavor:

• Scientists are influenced by societal, cultural, and personal beliefs and ways of viewing the world. Science is not separate from society but rather science is a part of society.

Classroom Activity Author

This classroom activity originally appeared in the companion Teacher's Guide for NOVA's "Dying to Breathe" program.