Consider the following case study. Be prepared to participate in a class or online discussion to be scheduled by your instructor.

Clara, 108 years old, is admitted through the hospital emergency room (ER) for nonspecific complaints of chest pain and dizziness. This is the third time she has come into the hospital with this complaint in the last month and, although previous examinations and tests showed no acute disease process, the ER physician believed that, because of her age and long history of coronary artery disease, she should be monitored and evaluated more closely. She has no private insurance but is covered under Medicare parts A and B with a supplement from a small insurance company in her state.

Despite her age, Clara is mentally alert and competent, lives by herself in a small apartment, and manages basic daily care, including shopping and cleaning with only minimal assistance from friends. She has no living family members except a few aging cousins in a distant state. She is taking several medications, including diltiazem (Cardizem) for her heart problems, ranitidine (Zantac) for a hiatal hernia, and papaverine (Pavabid) to increase her general circulation.

After a comple physical examination, including several tests and an electrocardiogram, she is scheduled for a cardia catherization. A significant block is seen in one of the major arteries, and it is decided to perform angioplasty on the artery. She is admitted to the intensive care unit after the procedure where she also receives two units of blood for an anemia problem. She recovers without incident and is discharged 5 days after her admission. Total cost for her hospitalization, including tests and agnioplasty, is in excess of $15,000.

Discuss the ethical, financail, treatment, and additional issues that surround her case.

Relate the case to the principles of distributive justice.