The New York Times - January 23, 1984

An alcoholic has come to the hospital with internal bleeding. He is given numerous blood transfusions and will bleed to death if not given more. But on this particular day, the blood supply at the hospital is so dangerously low that other patients may have to go without. At what point should the hospital stop giving this particular patient blood so that others might live?

Dr. Macklin said a key factor in this analysis was doctor attitude. Is the physician's impulse to deny this patient blood because the illness is self- induced?

All patients have the right to be treated whether their condition is self-induced or not, Dr. Macklin says. If other patients are waiting for blood, how acute is their risk? Is their risk as great as that of the alcoholic?

On this occasion, the alcoholic was given blood. Questions about treating him, however, led to discussions about what should be done in similar situations.

The hospital decided not to alter its practice, which continues, that unless the shortage of blood is so severe that other needy patients will definitely have to go without, the director of the hospital's blood bank must provide transfusions upon need - no matter its origin.

Two children afflicted with AIDS have been abandoned by their drug- addicted parents. Should they be placed for adoption - given the lack of knowledge about their chances for long-term survival and unknown risks of contagion?

Here the analysis focused on the rights of these children as well as the rights of their prospective adoptive parents. What alternatives would exist for these children if they were not placed for adoption? Would they get adequate upbringing in a hospital? What long-term psychological impact might this have on the children? How could adoptive parents be adequately informed of all potential risks? What responsibility must the hospital assume for referring these youngsters for adoption?

After approaching the parents, the hospital sent one of the children home with its mother. The other child is still at the hospital, and social workers are exploring the possibility of foster care. There is still hope, however, that as the mother's situation changes, this child will be able to go home with her as well. In the interim, the hospital is working on developing a policy toward other children afflicted with AIDS and is exploring the possibility of restricting foster care for these youngsters to medically trained personnel such as nurses.

An unwed 14-year-old recently gave birth to a diabetic daughter. The mother had consistently demonstrated an inability to take care of herself and was therefore deemed incapable of caring for her daughter. Should she be allowed to take her daughter home?

The analysis had to balance the mother's right to raise her daughter against the potential danger to the child. What other options are there, given the mother's desire to take the child home? Is it possible that the experience of motherhood itself would give this teen-ager a greater sense of responsibility and ultimately enhance her ability to tend to her daughter's needs?

Amid great concern, the hospital finally decided to send the infant home with her mother because there were insufficient grounds to deprive the mother of her rights.

Social workers tried to encourage the young woman to come back to the hospital regularly. In that way, the staff could monitor the infant's condition and if there were signs of deterioration, take appropriate steps.

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