A Family 's Tough Choice : Life Or Death

This problem first began to surface in the 1980s when the court had to face Cruzan v. Director, Missouri Department of Health. In this case the court had to decide by “clear and convincing evidence” that the comatose patient’s (Nancy Beth Cruzan) desire to terminate her life before the courts would allow her family’s wish of disconnecting her feeding tube be carried out. Unfortunately eight of nine judges said no to the proposition and concluded that the right

Autonomy can override beneficence when life-support is withdrawn (Prozgar, 2010). In addition, when a physician takes the position of withdrawing life-supporting equipment, the principle of non-maleficence is severed. Since helping patients die violates the physician’s virtue of duty to save lives,” distributed justice is served by releasing a room in the intensive care unit for a patient who has a higher chance of resolving their medical problems (Pozgar, G. 2010). There are so many inflict fuzzy gray areas and ideas about conflicting DNR policies that political disputes had to go to the courts to sort out the issues legally.

When a patient is unable to make decisions for himself or herself, their caregivers and those who know them are appointed to make the decisions based on what the patient would have wanted. This is called surrogate decision making. According to the article Terri Schiavo and End-of-Life Decisions “when surrogate decision makers and caregivers cannot agree upon what that choice would have been, they may turn to the courts to determine either what the now-incapacitated patient would have chosen or who is best suited to choose as the patient would have” (Mathes, 2005)

In the case of Jani McMath, her parents, family, the court, as well as the medical staff, are all faced with the ethical dilemma of whether or not to pull the plug. Who has her best interest in mind? How do we know? We would assume her family because they are the closest ones to her, but the truth is that McMath is incapable of making the decision for herself; therefore, whether her life is preserved or not is left in the hands of others. She could have wanted the plugged pulled; then again, she could have wanted her family to be strong and continue to fight for her life.

Aiding the death of infants is a much disputed controversy in healthcare. H. Tristram Engelhardt Jr. provides an ethical view that there is a moral duty not to treat an impaired infant when this will only prolong a painful life or would only lead to a painful death. It is these individuals, like Engelhardt, who must defend this position against groups who consider that we have the ability to prolong the lives of impaired infants, thus we are obligated to do so.

“One of the obligations for nursing staff and everyone is to take care of the dead body whose perfused organs are being maintained by machines”, a panelist interjected. Many hospitals have policies whereby if one is hired by the hospital and has a personal, moral, or religious objection to certain things, then every effort will be made for someone else to participate – termination of pregnancy serves as an example, he continued. Furthermore, he emphasized that there does not have to be a conscientious objection on the part of the doctors or nurses based on spiritual, philosophical, or religious grounds; it’s solely based on not being required to give treatments that one believes are futile. As another member put it succinctly, “You can recuse yourself from performing such duties”. Moreover, the idea of futility is a vague idea, mentioned a panelist; he stressed that in this particular instance, regarding the woman’s brain-death state, this is totally futile. The whole idea behind a religious exemption is, as he put it: “You are not dead based on spiritual grounds. The family believes that it is not actual death – it is not cardiopulmonary death”. In addition, the doctor emphasized that many health practitioners also hold the same religious ideals and would conclude that the person is not dead.

In the CRUZAN v. DIRECTOR, MISSOURI DEPARTMENT OF HEALTH 497 U.S. 261 (1990) case that was presented to the Supreme Court in 1990 was about a woman named Nancy Beth Cruzan and her right to die. The According to thesciencewritinblog.com, “On January 11, 1983 Nancy Beth Cruzan’s car overturned when she was driving home from her job at a cheese factory. She was found face down in a ditch, and although paramedics restarted her heart, 15 minutes without oxygen left her with severe brain damage (Science and Law).” Cruzan stayed in a diligent vegetative state in which she showed no intellectual capacity, yet had reflexes after waking up from her 3 week coma. Cruzan parents wanted take off life support but the hospital refused to do so without a court order because there was no living will so there was no evidence to support that Nancy would have wanted that for herself.

The ethical principles for nurses to practice with beneficence and no maleficence. This legal battle between Terri Schiavo’s husband and her family was an ethical debate between continuing artificial life or remove her feeding tube by the request of her husband. Using the theories of utilitarianism and deontology can be applied or considered in making the most ethically correct resolution. The cases are very complex and raise many moral and ethical issues. The cases have brought awareness to society of “the importance of discussing end-of-life issues with family members and underscores how an advance directive, a living will and/or durable power of attorney for health care, are a healthcare proxy clarifies and provides evidence of the wishes of an individual regarding end-of-life decisions. Terri Schiavo should impress upon laypersons and professionals alike the uncertainty of the context in which issues of continuation and termination are argued ethically. Nobody knows what Mrs. Schiavo would have wanted. She left no advance directive and in its absence her husband says one thing and her parents

“An ethical dilemma exists when a choice has to be made in which the consequences may have a potential positive or negative outcome.”("Topic 4: Contemporary Ethical Dilemmas (How do managers evaluate beginning-of-life dilemmas?). ", n.d.) The given scenario presents a patient named Jamilah Shah, who is of Turkish descent, 90 years old and collapsed at the side of her bed in the extended care facility in which she resides. The patient suffers from Chronic Pulmonary disease and diabetes mellitus. The patient was rushed to the ER were the EKG and lab tests revealed she suffered a heart attack and she was started on anticoagulants. The patient has no advance directives and a communication barrier exists, the ER department contacts the emergency contact, one of the patient 's sons Bashir. The patient 's family arrives at the hospital and her son states that he makes the decisions and the wants a do not resuscitate order for his mother and no medical intervention other than comfort care. The social worker handling Jamilahs case is concerned by her family 's lack of support and that the family 's wishes are at odds with the patient 's request for help and her expressed desire to live. Furthermore if the patient does not receive a cardiac catheterization or is considered for a coronary bypass, she will surely die.

The principles of justice, nonmaleficence, and beneficence must be considered in this situation as the patient herself has neither voice nor living will expressing her desires. An ethical theory that applies to this situation is rule utilitarianism. This theory is a hybrid of deontological and utilitarian approaches (Purtilo & Doherty, 2012). Terri’s husband feels that he is legally honoring her wishes by allowing Terri to die as the natural consequence of her unfortunate medical condition. Using the utilitarian theory removing her feeding tube justifies the end goal of death. For her family, they feel a duty to Terri and having her feeding tube removed betrays their sense of duty and right. Conflict resolution, in this case, must consider promoting the person’s good or prevention of further harm to the patient. Ethical theories and principles can guide the best

The current health situation should be explained in a non-technical way so the patient (if possible) family, and or valid surrogate can understand every aspect. The physician should also help them understand when there is no hope for recovery. Most often the organs are no longer functioning, or there is little to no brain activity; at this point suffering potentially outweighs the probability of recovery. Medical teams most often realize that the focus should be on comfort, rather than extending a dying life. This decision comes with a great deal of uncertainty, and will always be hard, no matter what age of the patient, or the circumstances. Kathryn Kosh, MD explains that, “Ready access to advanced modern technology has changed death from an event to a process… Defying death requires payment [in the form of] pain and discomfort or in an unacceptable decline in the quality of life.” Often times physicians will not prescribe treatment in the first place knowing that this option will not benefit the patient, prolong suffering; and will likely end in termination anyway. Therefore, allowing the nature of the illness or injury to take its own course of action. Another point of interest regarding this topic is that medical teams realize in most cases, that providing an ethical and dignified death can be just as rewarding as administering aggressive measures to save a

In end-of-life scenarios, where the patient may not be able to communicate their wishes, decisions must be made either by the healthcare professional(s) or family member(s). However, who gets to decide or where the line should be drawn are not always clear. Consequently, not all decisions may be ethically permissible. To illustrate, I will discuss a scenario in which physicians and family are not in agreement. Upon proving a brief summary and explaining the ethical dilemma, I will provide moral reasons for two ethically permissible choices from which, by referencing the principle of autonomy and Utilitarianism, will determine which course of action ought to be carried out.

Everyday, healthcare professionals are faced with ethical dilemmas in their workplace. These ethical dilemmas need to be addressed in order to provide the best care for the patient. Healthcare professionals have to weigh their own personal beliefs, professional beliefs, ethical understandings, and several other factors to decide what the best care for their patient might be. This is illustrated in Mrs. Smith’s case. Mrs. Smith is an 85 year old who has suffered from a large stroke that extends to both of her brains hemispheres which has left her unconscious. She only has some brain stem reflexes and requires a ventilator for support. She is unable to communicate how she wishes to proceed with her healthcare. Mrs. Smith’s children, Sara and Frank have different views regarding their mother’s plan of care. The decision that needs to be made is whether to prolong Mrs. Smith’s life, as Sara would like to do, or stop all treatments and care, as Frank feels his mother would want. In the healthcare field, there are situations similar to this case that happen daily where moral and ethical judgment is necessary to guide the decision that would be best for the patient. The purpose of this paper is to explore and discuss, compare and contrast the personal and professional values, ethical principles, and legal issues regarding Mrs. Smith’s quality of life and further plan of care.

As an administrator I would need to take into consideration the patient’s autonomy, autonomy is recognizing an individual’s right to make his/her own decisions about what is best for them regarding their health care (Pozgar, 2012). The patient’s rights always should be considered before any decisions are made by any other family members. In this scenario it is clear that the patient is unable to make any decisions, the patient has suffered a serious brain damage, and although it is not complete brain death, we must determine how to proceed.

The autonomy of a competent patient is an issue not often debated in medical ethics. Refusal of unwanted treatment is a basic right, likened to the common law of battery, available to all people capable of a competent choice. These fundamental rules of medical ethics entered a completely new forum as medical technology developed highly effective life-sustaining care during the 20th century. Several watershed cases elucidated these emerging issues in the 1960’s and 70’s, none more effectively than that of Karen Ann Quinlan. Fundamentally, this case established that a once-competent patient without the possibility of recovery could have their autonomy exercised by a surrogate in regard to the