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Medicine

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Apr 3, 2024

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docx

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The following document serves as a reference to complex decision making regarding the continuation of life-sustaining care for patients in coma or persistent vegetative states, focusing on legal proceedings and religious principles. Legal Cases: 1) Karen Quinlan 1975 a) Synopsis : She was in a coma post-overdose and put on artificial nutrition and a ventilator in a Catholic hospital, and a year later was in a persistent vegetative state (Hampson and Emanuel, pg. 1). Her father then requested the removal of the ventilator , which was denied by the hospital, due to Catholic principles (O’ Keefe, 4/10/23) b) Ruling : The New Jersey Supreme Court ruled in favor of Quinlan’s removal from the ventilator (O’ Keefe, 4/10/23) c) Explanation : In presence of an adequate surrogate , one that acts in the “ best interest ” of the patient, the state cannot force invasive healthcare , as the “ right to privacy ” outweighs the state’s interest in the preservation of life (O’ Keefe, 4/10/23). 2) Cruzan v. Director, Missouri Department of Health 1990 a) Synopsis : Nancy Cruzan suffered extensive brain damage after a car accident, and post-resuscitation was in a coma , eventually being diagnosed as in a vegetative state and given artificial nutrition and hydration via a feeding tube. The parents sought the removal of the feeding tube but were denied by the state of Missouri (O’ Keefe, 4/10/23). b) Ruling : The Supreme Court ruled in favor of the state , keeping Cruzan on artificial nutrition and hydration (O’ Keefe, 4/10/23). c) Reasoning : In reference to the due process clause of the 5th and 14th amendment stating, “deprive any person of life, liberty, or property, without due process of law”, a lack of “clear and convincing evidence ” regarding the patient’s wishes, means that the state must act to preserve life, to stay in accordance with the “due process of law” (O’ Keefe, 4/10/23). Abrahamic religions and principles regarding life-sustaining care: 1) Catholicism:
a) Authority for ethical decision making : Pope (O’Keefe, 4/12/2023). b) Pope John Paul II was against the term “vegetative ” as he thought it took away the patient's “human dignity” (address of John Paul II, pg. 2). c) Believe that we do not possess “absolute power” over our lives and have a moral obligation to preserve the life bestowed upon us by God (O’Keefe 4/12/23). d) A person must use “ordinary of proportionate means” to sustain life. This includes care that does not impose an unnecessary burden and has “reasonable hope” of helping the person (From USCCB as cited in O’Keefe 4/12/23). e) However, life-sustaining care may not be necessary if is “extraordinary or disproportionate”, that is causation of unnecessary burden on a patient or treatment that would cause “significant physical discomfort, and no “reasonable hope” of recovery (From USCCB as cited in O’Keefe 4/12/23). 2) Judaism: a) As a part of the covenant, one must follow or obey the law, Halakah , which is described in the Torah , and is the basis for ethical decision-making (O’Keefe, 4/14/2023). b) No overall consensus on any topic as arguing is considered a “Mitzvah” or a good deed, leading to significant gray areas (O’Keefe, 4/12/2023). c) One can stop something that is the sole hurdle between life and death, and there is no moral obligation to continue care if the prognosis is poor . However, life- sustaining care like artificial nutrition and hydration lies in a gray area , depending on its classification as medical care or food (O’Keefe, 4/12/2023). 3) Islam: a) Ethics and law are intertwined. i) The Shari’a: draws from the word of God, the Quran , and the Sunnah , the conduct of the prophet. (O’Keefe, 4/14/2023). ii) The Fiqh : application of Shari ’a to daily life. (O’Keefe, 4/14/2023). iii) Jurists use the above law to make decisions, but a person is not compelled to follow the opinion and is allowed to scrutinize the decision, similar to Judaism (O’Keefe, 4/14/2023).
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