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How would you answer this question:You have one dialysis machine to share between three patients with equal medical need. One is a 17-year-old drug addict who has just overdosed, one is a 40-year old woman with terminal breast cancer and only 6 months of life expectancy, the third one is a 70-year old marathon runner. Who gets the machine?
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S.G.
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(Original post by Student user)
How would you answer this question:You have one dialysis machine to share between three patients with equal medical need. One is a 17-year-old drug addict who has just overdosed, one is a 40-year old woman with terminal breast cancer and only 6 months of life expectancy, the third one is a 70-year old marathon runner. Who gets the machine?
This is a trick question. NHS can’t afford dialysis machines.

On a serious note, go through each case weighing up why you should and why you shouldn’t give them the machine.

There’s not really a right or wrong answer in these questions.

Just make sure you explore most of the situation.

For example, yes for 17 year old because he’s young but also no because he put himself at risk with the drug overdose and could’ve avoided it etc.
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Rvellani
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(Original post by Student user)
How would you answer this question:You have one dialysis machine to share between three patients with equal medical need. One is a 17-year-old drug addict who has just overdosed, one is a 40-year old woman with terminal breast cancer and only 6 months of life expectancy, the third one is a 70-year old marathon runner. Who gets the machine?
Well, how would you answer it? It would be much more helpful to have a go first, then we can work through it on here.
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Magendie
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Daisy chain all three circulations to one dialysis machine?
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Future_Surgeon
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(Original post by Student user)
How would you answer this question:You have one dialysis machine to share between three patients with equal medical need. One is a 17-year-old drug addict who has just overdosed, one is a 40-year old woman with terminal breast cancer and only 6 months of life expectancy, the third one is a 70-year old marathon runner. Who gets the machine?
Each scenario needs to be balanced up:

The 17 year old is young and his condition isn't stated to be terminal. He has the best chance of coping and surviving, based on his age. However, his physical health is likely poor. Yes he has just overdosed but it is not for us to judge and discriminate based on actions of the past. The overdose could have been prevented by a change in his behaviour, but it's over now and future outcomes are all that's important.

The 40 year old woman has terminal breast cancer but that does not mean she should automatically be denied treatment if she needs and seeks it. Her condition is terminal but we don't know if her kidney failure is due to metastasis/chemotherapy, or is something completely unrealted. She is also in her mid 40s and we don't know if she has dependents or if her cancer is terminal in the sense that death is imminent.

The 70 year old marathon runner is much older in age than the other two but is most likely very physically fit if he's still running marathons. Based on this assumption, he is the most likely to react well to treatment because of his current physical condition.

I would give dialysis to the 70 year old marathon runner based on the fact that he is most likely the patient in the best physical condition, and is most likely to react well to treatment now and, in my opinion, would be the one who would best adapt to the lifestyle that is associated with regular dialysis sessions.
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ecolier
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(Original post by Student user)
How would you answer this question:You have one dialysis machine to share between three patients with equal medical need. One is a 17-year-old drug addict who has just overdosed, one is a 40-year old woman with terminal breast cancer and only 6 months of life expectancy, the third one is a 70-year old marathon runner. Who gets the machine?
Use the 4 pillars of ethics - autonomy, nonmaleficence, beneficence and justice and analyse it that way. If it's an interview setting you wouldn't have the time to argue the ins and outs anyway. There is no right answer and you are certainly not expected to choose. In fact choosing one could potentially be detrimental to your chances.

(Original post by Future_Surgeon)
...
Well done, I have started changing my opinion of you - that was a good analysis (albeit as I said above, you are probably not supposed to choose).
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Future_Surgeon
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(Original post by ecolier)
Use the 4 pillars of ethics - autonomy, nonmaleficence, beneficence and justice and analyse it that way. If it's an interview setting you wouldn't have the time to argue the ins and outs anyway. There is no right answer and you are certainly not expected to choose. In fact choosing one could potentially be detrimental to your chances.



Well done, I have started changing my opinion of you - that was a good analysis (albeit as I said above, you are probably not supposed to choose).
Thanks, I know, I'm great. But in an interview, how would you end your answer if you are not supposed to choose?
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ecolier
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(Original post by Future_Surgeon)
Thanks, I know, I'm great. But in an interview, how would you end your answer if you are not supposed to choose?
I wouldn't go that far (yet)

Say that your decision would be guided by the 4 pillars, you will need to consult with your senior colleagues and will need to seek further information before deciding. The information given is simply to provoke your thinking - there may well be much more important background such as their past medical history (for all the patients listed above).
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Future_Surgeon
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(Original post by ecolier)
I wouldn't go that far (yet)

Say that your decision would be guided by the 4 pillars, you will need to consult with your senior colleagues and will need to seek further information before deciding. The information given is simply to provoke your thinking - there may well be much more important background such as their past medical history (for all the patients listed above).
Thanks mate, I'll make sure to give you an extra big Christmas bonus when you're working for me
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ecolier
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(Original post by Future_Surgeon)
Thanks mate, I'll make sure to give you an extra big Christmas bonus when you're working for me
Oh dear!
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Asklepios
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(Original post by Magendie)
Daisy chain all three circulations to one dialysis machine?
Nice thought, but they all just died from ABO-incompatibility transfusion reaction and DIC.
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Magendie
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(Original post by Asklepios)
Nice thought, but they all just died from ABO-incompatibility transfusion reaction and DIC.
I'm clearly not serious.
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HateOCR
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(Original post by Magendie)
Daisy chain all three circulations to one dialysis machine?
This isnt a PC man 😂😂😂
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applesforme
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(Original post by Future_Surgeon)
Thanks mate, I'll make sure to give you an extra big Christmas bonus when you're working for me
the other guy gave you a lot of interesting help. 4 pillars of ethic sounds very interesting. and all you can do is a slap in the face about him working for you? seems you've got the arrogance and hubris to make a calalmity out of this - like a shakespearean tragic hero, you seem to have the fatal flaw that will drive you but also bring it all crashing down. better watch out.
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ecolier
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(Original post by applesforme)
the other guy gave you a lot of interesting help. 4 pillars of ethic sounds very interesting. and all you can do is a slap in the face about him working for you? seems you've got the arrogance and hubris to make a calalmity out of this - like a shakespearean tragic hero, you seem to have the fatal flaw that will drive you but also bring it all crashing down. better watch out.
Thank you, I have learnt to ignore his snide remarks. After all I am nearly half way in my registrar training, and he is yet to enter A-Levels. I will be near retirement as a consultant before he is even an FY1.

If you want any more useful information, do ask - candidates are expected to know the 4 pillars for your medical interviews, and if I interview I will literally ask the candidates what are the 4 pillars of ethics.
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nexttime
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Not sure why people use dialysis in these scenarios. Dialysis machines are not in short supply. Organs for transplant, however, very much are, and in that context these exact decisions are made every day!

IRL the 17 year old would 100% get it though...
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Hammad(214508)
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the boy
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