Case Study: Interpreting A Living Will After Stroke

One of the major areas of strength of the AMA Code of Ethics is the principle that outlines that the physician must “regard responsibility to the patient as paramount” (American Medical Association, n.d., par. 9). This principle outlines that importance of putting the patient first in all care aspects when working with a patient. Along with this, other principles set forth in the AMA Code of Ethics, while involving other aspects of care, state that the rights of the patient shall be acknowledged and followed during patient care. It is very important that healthcare codes of ethics are clear in defining that the patient needs to be considered first and foremost.

The practically speaking, the case of Nancy Cruzan highlights the fact that an individual cannot rely only on telling his would be decision maker what type of care is desired should that individual become incompetent. Such evidence may not be viewed as sufficient to refuse medical treatment as happened with Nancy Cruzan. It thereby becomes important to record exactly what type of treatment should be accepted or refused if one’s decision making capacity is lost. The most common way to do this is in the form of an advance directive. Such a document would declare not only who the patient wants a surrogate decision maker, but also relates the degree of treatment desired by the patient. The presence of an advance directive makes caring for incompetent patients much easier because confusion over the patient’s wishes is avoided. Had Nancy Cruzan made an advance directive, withdrawing the artificial nutrition

The appellant of the Cruzan v. Missouri case was the parents of Nancy Cruzan, Joe Cruzan and Joyce Cruzan. The Cruzans argued that when they made the decision to hook Nancy up to a feeding and hydration tube they were unaware that Nancy would be in the vegetative state permanently, they thought she would make it (Cruzan by Cruzan v. Director, Missouri Department of Health. (n.d.). Oyez. Retrieved December 8, 2015, from https://www.oyez.org/cases/1989/88-1503).

The patient has not taken his prescribe medication and his eating habits are also noncompliant. The patient is dealing with the death of his wife and the patient’s daughter believes he is acting this way on purpose and is unable to care for him properly. The daughter does not want to tell the doctor about the patient seeing a Curandero,but wants her father to be admitted into a nursing home in order for him to receive the proper care he needs.The nurse would need to consult with the Code of ethics book on the nursing floor to proceed with the best possible solution to the problem.The code of Ethic for Nurses is a guide for carrying out nursing responsibilities in a consistent manner with a certain quality in nursing care(American Nursing Association, 2001).There are ethical principles that a nurse should learn to apply to each situation that they feel an ethical decision will need to be made.

Judgment was passed on the 29th May 2003. The plaintiff, the Public Advocate of Victoria was a limited guardian of BWV, a woman aged 68 years old, who suffered from fatal and progressive dementia. The plaintiff was appointed the guardian of BWV to make medical decisions on her behalf, due to BWV’s unconsciousness with no brain activity or bodily functions for 3 years. BWV received fluid and nutrition required to keep her alive by percutaneous endoscopic gastrostomy (PEG). BWV’s brain stem functions normally but her cortex is damaged. She has no prospect of improvement, hence making PEG medical treatment pointless (as witnessed by 3 medical practitioners – Dr. Michael Ashby; Professor Malcolm Horne; Dr. Michael Woodward). Consulting medical professionals led to the conclusion that upon treatment cessation, BWV

Mr. B, the patient’s brother is Mr. E’s designee to make healthcare decisions in the event that he is unable to do so for himself. He is left to make these decisions without a code of ethics or without medical knowledge. He counts on the medical professionals to assist him. He has an ethical obligation to abide by his brothers wishes and directives. He is influenced by his own beliefs and his perceptions of what his brother would want. If he has the good faith belief that his brother did not understand the need for the ventilator or the outcome of refusing the treatment, then it is not unreasonable or unethical

An example of this Act is the very popular Nancy Cruzan Case. Although Nancy was left in a vegetative state resulting from a car accident, her parents were able to make the decision to have her removed from feeding tubes because Nancy expressed before the accident that she never wanted to be kept alive from breathing or feeding tubes. This Act really promotes Advanced Directives and hospitals, clinics and other providers that receive Medicare or Medicaid funds to provide patients with written information about their right and the information must clearly state the institutions policies on withholding or withdrawing life-sustaining treatment.

This scenario presents various ethical issues that could be argued several ways from HIPPA violations to whether or not this patient has/had the cognitive ability to understand the execution of an advanced directive and Power of Attorney. Advance Directives are put in place for this very reason. It eliminates the need for family members to make a choice in the heat of the moment and also respects the wishes of the person whom it affects directly. Although Mr. E’s hypoxia could affect his ability to think clearly one cannot assume that he has an altered level of consciousness nor the inability to execute an advance

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

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

Healthcare professionals will be faced with ethical dilemmas throughout their career, particularly in the hospital environment. Having an education regarding professional healthcare ethics will provide some direction in how to best address these dilemmas at a time when either the patient or their family is in need of making decisions for themselves or their family member. It can be difficult for healthcare professionals to weigh professional protocol against their own personal beliefs and ethical understandings when determining critical care for their patient.

Under Utilitarian ethics, actions that promote happiness are right while those that do not are deemed wrong. Because of this, Daniel should be intubated. That is, Daniel’s difficulty with eating and drinking would be resolved and Daniel’s (the present person at t2) desire to stay alive would be met. Consequently, intubation would yield the greatest amount of utility/happiness than the alternative of not inserting a feeding tube.

Living Wills, sometimes called Advanced Directives, are legal documents accepted in all 50 states. They clearly define a person’s wish to decline life-support or medical treatment in certain circumstances, usually when death is imminent. Generally, a living will takes effect when a person becomes terminally ill, permanently unconscious or conscious with irreversible brain damage.

As a doctor, to prepare myself to take on this case I would have to process a substantial amount of information and use my best judgment to conceive what the best plan of action regarding this case should be. Reviewing the four key principles in medical ethics: nonmaleficience, beneficence, respect for autonomy, and justice, would prove to be very helpful. After reviewing and consulting with my peers I would most likely conclude that the patient is the one receiving the service and is to be put first above all other factors contributing to the situation.

The advance directive, or living will, is one way of circumventing the ethical dilemma of Quinlan, as it is essentially a set of choices by the competent patient if faced with different hypothetical circumstances. Patients can thus feel comfortable knowing that their competent wishes have been documented and can be easily interpreted in case of catastrophe. However, the authority of advance directives is a topic hotly debated amongst medical ethicists (see Advance Directive Authority). Arguments against directives state that not all factors are considered by the person creating the advance order. Also, in some cases of severe dementia, it is argued that the personal identity of the author is no longer intact and therefore has no authority over the treatment of the “new” person. The debate on this topic is extremely complex, but many of today’s cases are decided on an individual basis, with the directive often being upheld.