Question

David, who has suffered from ALS for twenty years, is now hospitalized in a private religious hospital on a respirator. He spoke with his physician before he became incapacitated and asked that he be allowed to die if the suffering became too much for him. The physician agreed that, while he would not give David any drugs to assist a suicide, he would discontinue David’s respirator if asked to do so. David has now indicated through a prearranged code of blinking eye movements that he wants the respirator discontinued. David had signed his living will before he became ill, indicating that he did not want extraordinary means keeping him alive. The nursing staff has alerted the hospital administrator about the impending discontinuation of the respirator. The administrator tells the physician that this is against the hospital’s policy. She states that once a patient is placed on a respirator, the family must seek a court order to have him or her removed from this type of life support. In addition, it is against hospital policy to have any staff members present during such a procedure. After consulting with the family, the physician orders an ambulance to transport the patient back to his home, where the physician discontinues the life support.

1. Define the precise ethical issue. For example, is it a matter of fairness, justice, morality, or individual rights?

2. Identify the major principles, rules, and values. For example, is this a matter of integrity, quality, respect for others, or profit?

3. List the major alternative courses of action, including those that represent some form of compromise. This may be a choice between simply doing or not doing something.

Answer 1

1. Define the precise ethical issue. For example, is it a matter of fairness, justice, morality, or individual rights?

Ethical issues means when a decision, scenario or activity creates a conflict with a society's moral principles. These conflicts are sometimes legally dangerous.

Here in the above scenario the ethical issue is individual rights.
According to American nurses association, the health and well-being of patients is developed because of collaborative effort between patient and physician in a mutually respectful alliance. Patients have the right to seek care and to be candid with their physicians.

2. Identify the major principles, rules, and values. For example, is this a matter of integrity, quality, respect for others, or profit?

According to American nurses association the patient have the right to make decisions about the care the physician recommends and to have those decisions respected. A patient who has decision-making capacity may accept or refuse any recommended medical intervention.

So in the given scenario patient has the right to refuse the treatment. But at the same time the physician has the right to give best treatment for the patient. It creates an ethical dilemma. For the patient the only option is euthanasia. But it have some reasons and proper indication for doing. So the physician can perform euthanasia legally with the permission of court. That also need written consent of patient and family members. Other practices are not doing and ethically prohibited.

3. List the major alternative courses of action, including those that represent some form of compromise. This may be a choice between simply doing or not doing something.

Give counseling to the patient and family members regarding active and passive euthanasia. Its legal implications also. If the patient and family strongly wants, get legal consent from the patient and family. Then plan for medical euthanasia as per procedure from court. Other methods like take off respirator without written consent are oppose to ethical principle.