Debate Team 1

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Baker College, Owosso *

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2110

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Medicine

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Feb 20, 2024

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docx

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Questions: 1. What are the ethical issues that can relate to your assigned position in this case study? What different ethical conflicts are present here? (Rochonda) An ethical issue is when there is an issue in the process of making a decision between two options. The issue can be related to moral principles, society, values, or beliefs of one person. Prior to starting her pregnancy journey Melinda appointed her husband as her surrogate, completed an advance directive, as well as appointed a durable power of attorney for healthcare purposes. Melinda put these things into place, as she was aware that there was a possibility that she would not be able to experience a normal pregnancy and delivery due to past health conditions. This scenario is different from normal scenarios, as Melinda took action prior to her pregnancy to ensure that her wishes would be granted in case of an emergency. As Melinda’s condition worsens, the doctors and her family have a dilemma about honoring the wishes of Melinda that were stated in her advance directive. Seeing that Melinda has been in critical condition for over 5 weeks and unable to breathe on her own, her family is losing hope but has not made the decision to stop all treatments. 2. Using the clash of values that includes her family's desire to honor Melinda's advanced directive, give the best argument you can develop to uphold that position. Think about some of the topics we’ve talked about during the semester, including ethical principles, ethics theories, the moral community, and others. (Alex) An advanced directive is a legal document that details medical decisions to be made in the event a person is not able to speak for themselves, making this particular situation difficult for all parties involved. One argument that can be made is that Melinda’s case is that her advanced directive supports autonomy, in which she is able to make her own medical decisions (Furlong, 2019), her condition has not improved in any way shape or form but has instead become significantly worse with chances of her survival decreasing significantly each day. While her advanced directive stated that if there were any chance she would be able to hold her new born baby to be kept alive, however from a medical standpoint the chances of that being a possibility are practically impossible. Melinda being in the ICU for five weeks following her labor as well as being placed on a mechanical ventilator, one could argue whether or not Matt is overestimating or underestimating the toll of keeping Melinda alive is taking on him and her family. Another argument could be what is physically and medically best for Melinda given her current state of health, determining if she would want to be kept alive in this condition with the possibility of holding her newborn child. 3. Respect for persons must include respect for their autonomy. Melinda made a decisive choice to have treatment continued. What situational factors can be used to support your position in this case? (Katelyn)

Defining respect for autonomy would be self determination (Jahn, 2011). Respecting a person's wishes who have decision making capacity. There are three elements considered with autonomy, agency, independence, and rationality. Agency, the awareness of oneself and their desires. Independence, the absence of being influenced. Rationality, defining if the situation is logical. I believe her autonomy has been respected. She wanted the chance at life and that is what the health care team has given her. A tracheotomy, ventilation support, and has had weeks within the ICU (Antig, 2022). Melinda’s wishes have been respected but her condition has not improved. The rational or logical in me is doubting that she will recover and be able to hold her baby boy. However, during her third trimester she made an advance directive (Antig, 2022). She was of sane mind, and made an independent decision at any cost she wanted that possibility for survival. 4. What weaknesses are found in your argument that would enable someone from the opposite perspective to argue against you? (Courtney) The weaknesses that can be discussed are even though Melinda made an advance directive. The opposing side can say that at the time Melinda was not thinking of her family or at the cost that the advance directive would have regarding Melinda's life or her family's life. The fact that doctors can and have override advance directives is something that Melinda didnt think about. “ Health professionals have been known to override patients' advance directives. The most ethically problematic instances involve a directive explicitly forbidding the administration of some life-prolonging treatment like resuscitation or intubation with artificial ventilation.”(Banja & Sumler,2022) With the ethics regarding advance directives that becomes a gray area. Advance directives are all about what the patient wants, not what the family wants. Is it truly ethical for someone to state that they want all the bells and whistles even though it's putting the patient's quality of life to diminish. 5. Respect for persons must include respect for their autonomy. Is autonomy supported in your team’s position given that Melinda made a decisive choice to have treatment continued? What situational factors can be used in support of your team’s position? (Erika) Autonomy is defined as “In healthcare ethics, the ability to act independently and to make decisions about actions, treatment, and health practices.” (Furlong, 2018). Yes, autonomy was supported thus far in my team’s position given that Melinda made a decisive choice to have treatment continued. The situational factors that can be used in support of my team’s position is that she was resuscitated and intubated, has received a tracheotomy and ventilation support, along with nutrition and hydration. 6. Each team needs to make its strongest argument to support its position using information from the text and course materials. (Ashley) Also responsible for the opening statement for withholding treatment.

Antig, R. (2022, July 6). The Case of Melinda and Matt: Ethical Indicators of Futility in Critically Ill New Mother - Center for Practical Bioethics . Center for Practical Bioethics. https://www.practicalbioethics.org/shared-decision-making-and- advance-care-planning/end-of-life-ethics/the-case-of-melinda-and-matt-ethical- indicators-of-futility-in-critically-ill-new-mother/ Jahn, W. T. (2011). The 4 basic ethical principles that apply to forensic activities are respect for autonomy, beneficence, nonmaleficence, and justice. Journal of Chiropractic Medicine, 10(3), 225–226. https://doi.org/10.1016/j.jcm.2011.08.004 Banja, J., & Sumler, M. (n.d.). Overriding advance directives: A 20-year legal and Ethical Overview . Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management. Retrieved March 1, 2023, from https://pubmed.ncbi.nlm.nih.gov/31433120/ Furlong, E.E.M.A. B. (2018). Health Care Ethics: Critical Issues for the 21st Century (4th ed.). Jones & Bartlett Learning. https://reader.yuzu.com/books/9781284164664

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Debate Team 1

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