Question

David, who has suffered from ALS for 20 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.

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

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

IV. Specify the alternatives. 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.

V. Compare values and alternatives. Determine if there is one principle or value, or a combination of principles and values, that is so compelling that the proper alternative is clear.

VI. Assess the consequences. Identify short-term, long-term, positive, and negative consequences for the major alternatives. The short-term gain or loss is often overridden when long-term consequences are considered. This step often reveals an unanticipated result of major importance.

VII. Make a decision. The consequences are balanced against one’s primary principles or values. Always double-check your decision.

Answer 1

ALS : Amyotrophic Lateral Sclerosis

A chronic progressive disease charecterised by degeneration of Central nervous system and the loss of voluntary muscle control.

ii) Ethical issue:

An ethical issue is an issue related to the accepted principles of right and wrong. Here the ethical issue is related to 'Individual rights'. David already signed an 'Advanced living will' of not wanting the life support measures at the end of life. The physician has the right to work according to the Living will, but the Hospital policy is against to it. I'm this scenario both Patient and physician rights are getting questioned.  

iii) The case scenario is not a matter of profit or quality , but is a matter of respect for others and integrity. If the patient's wish in the 'Living will ' is not met , it may indicate the loss of respect on patient and Same time it questions the Doctor's Integrity towards fulfilling the Living will of patient and the Etical principle of ' "Do good to the patient ".

iv) Alternatives:

* As there is a living will, signed by the patient, there isn't a need of Court order to stop the respirator,  instead an immediate family member can agree for removing the life support, as there is already a Living will.

* Family can obtain a court order , as it is the hospital policy, to stop the life support or assistive suicide as it was/ is the patient's wish.

v) The major ethical values are Beneficience ( Do good ) , nonmaleficence ( Do no harm ) , justice , Autonomy ( respect individuals decision) etc.

* When the physician and hospital continue with the Patient's will , the value of autonomy is getting respected. But the value of Beneficience and Nonmaleficence may get questioned in this alternative, as the life support is withdrawing and the action can  cause patient's death.

* Obtaining a court order may make the values silent as the court order is based on fairness or justice. If the court orders for withdrawing the life support , then it might fulfil patient's wish and hospital policy. If the court rejects the option of Withdrawing life support,patient's wish may not fulfil, but the Hospital people may not undergo questioning.

vi) Consequences:

* If the physician follows the Patient wish , and ask the family to give a consent for removing the life support, Hospital may not support him and no nursing staff may support him. As there is a 'Living will' , he may nit get caught by law and order.

* In case of obtaining a court order, family has to run around for it and it is not sure , that the court may provide it. In that case patient's wish may not fulfil.  

Vii) Decision : Ask the family to obtain a court order to withdraw life support measures from the patient, as it was his wish that not to use any life saving measures.  

In this decision, Hospital may support physician and Nursing staff in their duty of Care.