Question

Kitty, 34, has recently been diagnosed with terminal brain cancer. She is expected to live for only one to two more months. As her cancer progresses it will affect different parts of her body causing issues from muscle weakness to organ failure. Her ability to communicate will also become compromised, eventually requiring her wife, Brittany, to make decisions on her behalf. Although Kitty has been thinking about various end-of-life options and has written up an advance directive, she has trouble talking to her wife about her condition and eventual death. Because Brittany keeps promising to “talk about this when the time is right,” Kitty has not yet informed Brittany of the advance directive, and they haven’t discussed what to do once Kitty starts to decline further. Brittany has been urging Kitty to try one last round of chemotherapy in hopes that it will prolong Kitty’s life. Having tried chemotherapy in the past, Kitty feels that the severe side-effects aren’t worth the few extra weeks that the treatment could possibly provide. Although Kitty has explained this to her wife, Brittany is so distraught at the thought of losing Kitty that she continues to insist on chemo. The palliative care team has also been called to assist with Kitty’s case. Palliative services assist patients with pain management, relief of physical and psychological symptoms, as well as providing social support.

Kitty has fallen into a coma. Brittany still does not know about Kitty’s advance directive and acknowledges that they never had a conversation about Kitty’s specific end-of-life wishes. After much deliberation, Brittany consents for Kitty to receive artificial hydration and nutrition. Which of the following describes this action?

1. Involuntary

2. Paternalism

3. Voluntary

4. Non-voluntary

Answer 1

An advance healthcare directive, is a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity. If decisions were made according to kitty's healthcare directive, it would be voluntary. But, so is not the case.

Involuntary treatment refers to medical treatment undertaken without the consent of the person being treated.

Paternalism is an action performed with the intent of promoting another's good but occurring against the other's will or without the other's consent. But, herein, there is more Ill effects than good of the pateint as the future holds more adverse scenarios, which kitty clearly doesn't want to undergo.

Nonvoluntary treatment suggests that the patient exists in an intermediate domain of decision-making capacity and voluntariness. But there is no intermediate domain of decision making as the person is in coma. So it is not involuntary.

Hence, according to me, this case is involuntary.