January 10th, 2018
Ethics case study – Mr. P’s ethical dilemma
Mr. P’s case presents an ethical dilemma, a choice between resuscitating and not resuscitating Mr. P who suffers a terminal and painful illness. Mr. P’s family advocates for resuscitation with their Orthodox Jewish religion influencing their decision greatly since it advances life to be invaluable hence should be prolonged to the longest possible extent. Mr. P’s condition is however grave and initial attempts to treat his condition have proven futile. The doctors and other members of the healthcare team at Academia Hospital attending to Mr. P agree that therapy for Mr. P should be aimed only at keeping him comfortable rather than making further diagnostic and therapeutic measures. Being a member of the Academia Hospital Ethics Committee considering Mr. P’s case, I consider it ethical to listen to the medical team and allow Mr. P to enjoy his remaining lifetime without having to undergo further discomforting diagnostic and therapeutic procedures.
First, Mr. P is in a medically futile condition of constant and unbearable pain that cannot be alleviated, owing to his serious illness. Besides, his conditions are progressively deteriorating and any efforts to rehabilitate him have been fruitless. The physicians explains that the most appropriate therapy is to keep the patient comfortable with fluids, and, if needed, narcotics, and to withhold all further diagnostic and therapeutic measures. Although the son is a pulmonary physician and offers an alternative strategy in managing Mr. P’s conditions, all physician agreed that the alternative will not produce any significant improvement on the condition. This means that the patient will continue to perceive the severe pain. Their calls are founded largely on religious grounds not on medical grounds. Respecting the will of the family is unethical because it will increase Mr. P’s suffering and will siphon scarce resources away from other pressing medical needs. Letting Mr. P live the remainder of his time without bothering him with excruciating medical procedures will save him from severe interminable suffering. Secondly, such an action will respect his autonomy as a patient. Given his age and conditions, it would be in the patient’s best interest that he is saved from further intolerable suffering. For the last five years, Mr. P has lived in a home for the aged; apparently, his daughter and the family that has come out now was not caring for him in any way even through his worsening healthy condition. To some extent, they should not wholly determine the fate of a person they did not care about when he was in the nursing home.
Arguments could be advanced that effective treatments could be available at some point later that could help treat Mr. P’s condition. However, given his advanced age and the nature of his illness – multiple and progressive – Mr. P may not live long enough to benefit from such medical innovations. For many individuals, the fight for life is a correct professional view. Many believe that the forces of medicine should always be committed to using innovative ways of prolonging life for the individual. However this cannot be the only approach to caring for the terminally ill such as Mr. P. Certain moral questions regarding the extent to which physicians engaged in heroic efforts to prolong life must be addressed if the individual’s rights are to be preserved. The aim of those charged with patient care ought not exclusively be to extend life for as long as conceivable through the extensive use of drugs, operations, chemotherapies, and the like, but rather to offer a rational “value of life” for every patient. As a personal view, I believe the quality of Mr. P’s life is sufficiently compromised that complicating it further with additional therapeutic procedures is detrimental.
The other reason why I support the medical team’s recommendation over that of the family is due to “mercy”. The principle of mercy requires not just refraining from causing pain or suffering, which the principle of non-maleficence would require, but also acting to relive pain or suffering as the principle of beneficence would require. The medical team is faced with a patient they cannot save from disease he suffers, and it is out of their mercy that they save him from at least the pain of disease from which he longs to be freed. The real business of medicine is to provide care in whatever way best serves the patient’s interest. When an exhaustive analysis of a patient’s condition fails to find beneficial outcome for the patient’s ailment, and the patient has suffered a lot out of such ailment, I believe that a do-not-resuscitate approach would be the right approach.