Life or Death Who has the Right to Make the Choice This paper will introduce a case study that results in an ethical dilemma. The ethical dilemma will be clearly stated including obligations and conflicts. Using the Contemporary Utilitarianism theory I will analyze the ethical dilemma. Finally I will analyze the same case using an Egoistic approach as an alternative course of action. Case Study An apparent 19 year old male is brought to the emergency room by ambulance in respiratory failure related to end stage cystic fibrosis.
The patient is accompanied by his girlfriend who states that the patient has a do not resuscitate (DNR) order. As the emergency room physician tries to contact the patients primary care physician he finds that the patient is under the care of a pediatrician which makes him suspicious of the DNR request. He confronts the girlfriend about the patients age because the patient is unable to communicate due to his respiratory condition. The girlfriend breaks down and admits that the patient is actually 17 years old. The physician immediately intubates the patient in an effort to stabilize his respiratory condition.
The patients respiratory condition is stabilized after a short time and he is extubated. The patient relates to his nurse that he does not want to be intubated again or placed on a respirator. The nurse relays this information to the ph! ysician who at this point does nothing. The patients mother arrives at the emergency department and the physician explains the patients condition and his request for a DNR order. His mother refuses to sign a DNR order and this information is explained to the patient by the physician with the mother present. A discussion insues between the mother and her son and she reluctantly agrees to sign the DNR order. The physician is informed of her decision and assists the mother in signing the appropriate paperwork.
The patient soon confronts the physician and makes him promise to stick to the DNR order no matter what his condition, the physician agrees. Shortly after the DNR is completed and all other appropriate paperwork are in order, the patient goes into respiratory arrest. All the parties involved in this situation are present when the respiratory arrest occurs. The physician stands by will all intentions of honoring the DNR but within 30 seconds of the arrest, the mother orders the physician to intubate. The physician looks to the patient as he shakes his head indicating that he does not want to be intubated, the physician also is aware that the patient will be 18 years old in three weeks. Ethical Dilemma Initially it appears as if the dilemma revolves around what the physicians next move should be. When actually the real dilemma is who owns the rights to make this life or death decision.
It is clear what the patient wants for his course of treatment. It is equally clear what his mother will allow his treatment to be. Each have equally selfish reasons for wanting their decision to be upheld. The mother does not want to lose her son and will at all costs keep him alive. She feels he is romanticizing death and has no real concept of what dying means. Her son lived with cystic fibrosis since age four and has seen many of his friends placed on ventilators only to later die.
He does not want that quality of life in his final days. The physician is supportive of the patients request but is placed in an awkward legal position if he abides by the patients request. The nurse who has acted as an intermediary throughout this entire process continues to acts as a patient advocate an ensur! e the patients rights are observed and that his wishes are acknowledged. Ethical Analysis of Dilemma Contemporary Utilitarianism is divided in to four basic principles, each principle will be used to analyze this dilemma. The first principle considers which action will provide the greatest happiness for the greatest number.
As we look at the action in this case the patient should not be allowed to discontinue treatment because his mother and girlfriend do not wish fort him dye. This action does not provide the greatest good and it appears that the patient looses by a vote of two to one. The second principle is based on what the consequences of this action are, not what or how its done but how the chosen action effects the majority. Again we find that the patients requested action of no medical treatment and death is not the consequence that the majority wants. So the chosen action in a bottom line analysis would not be considered good. The third and fourth principles appear to get more egoistic in nature by definition, but remember the basis of this theory is the greatest good for the greatest number.
The final principles are centered around human happiness and minimizing suffering. It is known that what would make our patient happy is to be left to die with no further medical attention. The question of suffering in his mind, would be reality if he was placed on a ventilator. This suffering would not be so much a physical pain, but a suffering of his quality of life. To provide happiness to the majority would mean complete medical intervention. As we attend to their happiness issue, we have also addressed and alleviated the issue of their suffering (Ufema, 1995) by prolonging the life of their loved one. Alternative Course of Action As an alternative to Contemporary Utilitarianism we can apply a purely Egoistic approach to the same ethical dilemma. Egoism is very self centered and is concerned only with what benefits the individual.
This individualistic approach takes no one elses thoughts or feelings into consideration. From this perspective it is completely within the patients legal and moral rights (Gostin, 1993) to request that no further medical treatment be given. The patient knows first hand that if medical treatment were to continue that his quality of life until his death (Halliburton, Manning, and Olney, 1996) would greatly diminish. The physician and nurse are supportive of the patients decision (Lyndaker, 1996) but have reservations about letting someone so young die. Both the patients mother and girlfriend are against the discontinuance of treatment.
The consequences of the patients actions will result in his death a right that he feels is his decision. His mother and girlfriend will grieve and continue to feel his decision was selfish and wrong. As a final course of action the Egoistic approach is essentially the action that will be taken. If the mother refuses to comply with her sons wishes it will only be three weeks until he can take control of his own destiny. The right to refuse treatment (Halliburton et al., 1996) is a personal and individual choice of every human being.
We have the innate right to choose what care we receive or do not receive. The age of this patient since so close to the legal age of consent is merely semantically both morally and legally. His desires are based on his quality of life. An issue that can only be addressed on an individual basis. No one can or has the right to determine what the best quality of life is for another.
Cases of chronic terminal illness are heart breaking for all concerned, but until one actually lives with that illness the final outcome should be left to the afflicted individual. References Gostin, L. O. (1993). Drawing a line between killing and letting die: The law, and reform, on medically assisted dying. Journal of Law, Medicine & Ethics 21 (1), 94-101 Halliburton C.
S., Manning D. M., Olney R. S. (1996). Cystic fibrosis deaths in the united states from 1979 through 1991: An analysis using the multiple-cause mortality data.
Archives of Pediatrics & Adolescent Medicine 150 (11), 1181-1199 Lydaker, C. Z. (1996). Identifying ethical values conflicts in nursing education. NursingConnections, 9 (1), 28-33 Ufema, J.
(1995). Insights on death and dying. Nursing, 25 (1), 72-73.