Review the clinical scenario presented and respond to questions.

Discuss the ethical, financial, treatment, and additional issues that surround the following case. Relate the case to the principles of distributive justice. 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 believes that, because of her age and long history of coronary artery disease, Clara should be monitored and evaluated more closely. She has no private insurance but her care 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 for a few aging cousins in a distant state. She is taking several medications at home, including diltiazem (Cardizem) for her heart problems, ranitidine (Zantac) for a hiatal hernia, and papaverine (Pavabid) to increase her general circulation.

After a complete physical examination, including several tests and an electrocardiogram (ECG), she is scheduled for a cardiac catheterization. A significant block is seen in one of the major coronary arteries, and it is decided to perform angioplasty on the artery. She is admitted to the intensive care unit (ICU) 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 angioplasty, exceeds $15,000.