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. 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.

2. 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

Answer 1

1.Here a combination of principles and values are used in this decision. Which includes ethical principles of Autonomy, beneficence, non malefience and principle of justice. Autonomy implies that it is the right of mentally competent patient to accept or refuse medical care it must be respected here patient already communicated to physician regarding that. Principles of beneficence requires that medical knowledge and skills should be intended to benefit the patient. Principle of malefience prohibit physicians to harm patients deliberately. Principle of justice implies provide justice to patient during treatment. Here the combination of these principles used , they physician respected his autonomy of patient, he used beneficence and skill. Provided justice to the patient because with out a prognosis delaying his death is injustice. Delaying his death is a harm to him during the terminal stages so principles of malefience also used. Delaying death will lead to unwanted procedures and interventions all these will cause endless suffering to patient. So physician used ethical principles effectively and have proper communication with family also.

2.Short term consequences is demise of a dear one, that is a sad feeling for family and family members. He is a lose to society and his related individuals. It will make everyone sad. It will take sometime to overcome the grief.  His gap will be there in family and society however, comparing to long term consequences short term consequences are less because if patient is on long term on respirator his suffering will be higher , he have to undergo many unwanted procedures. He will be a burden to family and society. So while comparing the long term and short term consequences of the alternative the long term consequence overrides the short term consequences.