A Friday evening ethical dilemma, because I’m curious and like ethical dilemmas. The following story is mostly true, but feel free to consider it apocryphal.

A local homeless man has been brought into the emergency room several times the past year, at least once a month, with massive GI bleeding. Each time he’s brought in, he needs six to eight units of blood to stabilise him, which is a heck of a lot, and blood, as you know, is always short. He is bleeding because of his alcoholism, but the bleeding could be fixed by a relatively simple and safe operation, no more dangerous than removing an appendix. He would then have no more bleeding issues, and no longer be brought in and need massive reperfusion.

However, when the man recovers, he always refuses the operation, and discharges himself as soon as possible. He has no family that can help persuade him or take charge of his medical decisions, and the hospital psychiatrists declare him competent. He also will not be persuaded to accept the operation, no matter who tries. So he returns to the street, only to return within a month needing another six to eight units of blood.

Now what?