The case of M.C. is challenging because it confronts us with injustices that exist in the American healthcare system. One issue at the center of this debate and at the core of this case is the just distribution of limited medical resources. Health care professionals recognize the importance of this issue, but few are willing to discuss it openly as it applies to treatment decisions for patients. As medical resources continue to be stretched to their limits and hospitals continue to incur large financial losses, distributive justice must be an integral part of the decision-making process for patients and health care professionals.

In this case, health care professionals are responsible for the present dilemma. It was not only medically but ethically and legally obligatory to admit M.C. when she came to the emergency room. However, after diagnosing her condition and stabilizing her, M.C. should have been referred to her home country for further treatment. Arguably, the initial reinduction chemotherapy was appropriate, but no other medical treatment should have been initiated without first taking into consideration the family’s financial situation and residency status. Clearly, this family could not afford medical treatment.  They came to the United States with the intention of gaining free access to this hospital because of a precedent set on a fellow foreign national. One cannot blame M.C.’s parents for wanting to do everything possible to save their daughter’s life, but when that precedent was set, the hospital’s financial circumstances may have been different. Today, this hospital is suffering large financial losses. To continue to incur these losses would jeopardize the health, safety, and well-being of others to whom the hospital is responsible.

The hospital generated its dilemma by not only initiating treatment but giving the patient and her family hope of receiving a Bone Marrow Transplant (BMT). When the family rejected the possibility of receiving a new regime of chemotherapy at home, with the drugs provided free of charge, the physicians might at that point reasonably have terminated discussion of additional treatment options, a decision that would have been justified given that the child has no health insurance and is not an American citizen. Instead, they decided to continue to treat, giving the impression that a bone marrow transplant was still an option. The result is that the hospital is now confronted with a public relations nightmare. Either course of action—refusing to give M.C. further treatment or moving forward with a bone marrow transplant—could jeopardize the hospital’s ability to sustain its ongoing mission.

Thus the situation comes down to the question of distributive justice, namely, whether treating M.C. is a fair and equitable distribution of this hospital’s limited medical resources. In a situation of scarcity, the issue of determining how to distribute benefits and burdens becomes a major concern.  The hospital has apparently acted in good faith to provide the best possible care for M.C., but it does not have a moral obligation to provide a bone marrow transplant if this would generate large financial losses and jeopardize the safety and quality of care available to other patients and to the community as a whole. There is an ethical obligation to continue medical treatment once it has been initiated and determined to be beneficial, but the extenuating circumstances in this case limit that obligation. Besides the financial and medical benefit losses, there is also the question whether, if M.C. received the transplant, she would be able to receive the necessary follow-up care in her home country.

Under the circumstances, I do not believe the hospital has an obligation to give M.C. a bone marrow transplant. No one can be obliged to do what is impossible to do. It is certainly unjust that all people do not have equal access to health care resources; however, this is the reality of our present situation. As a matter of justice, we have an obligation to distribute the medical resources available in a manner that will bring about a reasonable balance of benefits and burdens. No hospital can be obligated to act in a manner that would threaten its ability to sustain its mission of providing health care for the good of society. To compromise this basic obligation would be a grave injustice.