PHI-FPX3200_ArkettAndrew_Assesment3-1

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Should We Withhold Life Support? The Martinez Case Andrew W Arkett Capella University PHI-FPX3200: Ethics in Healthcare Dr. Ginger Raya

Analyzing Moral Issues Associated With Limiting Life Support and Identifying Assumptions Based On The Analysis In analyzing the moral issues associated with limiting life support, one may ponder on the aspect of assisted suicide. If life support is limited, are you complicit in ending the patient’s life? In the case of Mr. Martinez, a mistake or accident happened when his oxygen was turned up. Therefore, I believe that negates the DNR that he had in place. I believe he should be placed in intensive care and brought to the point he was before the respiratory distress happened. Because of someone’s negligence, he is experiencing undue circumstances which could have legal implications. The first thing would be to discuss the situation with the family. To kill someone (including oneself) is to take a definite action to end his or her life (e.g., administering a lethal injection). To allow someone to die, by contrast, is to take no steps to prolong that person’s life when those steps seem called for. Failing to give a needed injection of antibiotics, for example. Active euthanasia, then, is direct killing and is an act of commission. Passive euthanasia is an act of omission. (Munson, R. (2013). The moral issue is letting Mr. Martinez die even though he has a DNR place. The extenuating circumstances exacerbated his current state. Demonstrating Sound Ethical Thinking and Relevant Ethical Principles While Considering Limiting Life Support Control over our body has been taken to be central to the interpretation of autonomy. In the context of end-of-life care, the right to refuse treatment places a recognized limit on interventions by doctors, who must respect refusals even against their best clinical judgment and even if a patient’s life is at risk. As a result, patients may thus insist that treatment not be given or be withdrawn, and doctors may be expected to comply. (Gedge et al., 2007) This theory of

autonomy is definitely in play while examining Mr. Martinez’s situation. In law, the principle of autonomy is taken to bestow a negative right, a right to non-interference. (Gedge et al., 2007) Respect for patient autonomy need not be seen entirely in negative terms (i.e., the patient’s right to refuse treatment) but may be understood as the provision of options for enhanced choice and the resources to make such choices, a view that is consistent with the current priority given to informed consent. This is not possible without increased attention to communication with family members and other proxies. (Gedge et al., 2007) As I stated above, there needs to be a conversation with the family. Even though there is an advance directive to follow the DNR and the patient’s request not to administer CPR, the family needs to be aware of what happened and needs to be informed of all the facts of what has transpired with Mr. Martinez. After those issues have been addressed, I believe that a mutual decision can be reached. Patients had to rely on their doctors to educate them and to tell them the truth. Doctors and patients were seen to be partners working together to do what was in the best interest of the patient. This requires transparency on the part of both patient and doctor. The patient shouldn’t hide anything from her doctor, because the doctor needs reliable information to make a diagnosis and decide what to recommend as the best course of treatment. The doctor shouldn’t hide anything from his patient because the patient needs reliable information to exercise her autonomy and make a decision about what treatments she is willing to accept. Both effective medical practice and informed consent require trust and openness. (Munson, R. (2013). In this case, respecting Mr. Martinez’s autonomy and reaching a mutual decision with his family respecting his wishes. Explaining Important Considerations That Arise When Contemplating Limiting Life Support

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There are some considerations that arise while contemplating limiting life support. The fact that Mr. Martinez has a DNR in place factors into his care and how he would like end-of-life measures to be carried out on his behalf. However, in Mr. Martinez’s case, there was an act of negligence involved by someone who adjusted his oxygen and sent him into respiratory distress. I believe this provides a unique circumstance and requires further conversations and decision- making rather than just following the DNR as it is written. “Can a DNR be revoked by family?” This question can come up from family members who are concerned for their loved one and feel as though a DNR should not be in place. This could happen if they don’t agree with the physician’s recommendation or fear that an error has been made. According to the National Library of Medicine, medical error is the third-leading cause of death in the U.S., so such a fear is not always off-base. However, only a physical, the patient, or the patient’s healthcare agent can revoke a DNR. The only instance in which a family member can revoke a DNR is when that same family member is also the patient’s healthcare agent. If the patient authorized that family member to serve as their agent through their Medical Power of Attorney document, then that family member does have the power to cancel the DNR. However, they are ethically bound to complying with the patient’s end-of-life wishes. (Can a DNR be Revoked by Family? (n.d.). Trust & Will.) All considerations should be made while contemplating limiting life support. Each case is different. Even though a patient’s orders may be specific, extenuating circumstances may arise that change the course of a DNR. If we are acting in the best interest of the patient, then there needs to be a conversation with the patient before the DNR is drafted about the possibility of extenuating circumstances that may arise. I believe that this would alleviate confusion, and everyone involved in the patient’s care would have a clear, concise directive.

References Gedge, E., Giacomini, M., & Cook, D. (2007). Withholding and withdrawing life support in critical care settings: Ethical issues concerning consent. Journal of Medical Ethics, 33 (4), 215. https://10.1136/jme.2006.017038 Source type: Scholarly Journals; Object type: Article; Object type: Feature; Copyright: Copyright: 2007 Copyright 2007 by the Journal of Medical Ethics; DOCID: 4022756061; PCID: 103973522; PMID: 270539; CODEN: JMETDR; ProvJournalCode: JDTH; DOI: 10.1136/jme.2006.017038; PublisherXID: BMPG_JDTH_v33n4d20070401_101136JME2006017038 Munson, R. (2013). intervention and reflection: Basic issues in bioethics, concise edition. cengage limited. https://Capella.vitalsource.com/books/9781337015332. Munson, R. (2013). Intervention and Reflection: Basic Issues in Bioethics, Concise Edition. Cengage Limited. https://capella.vitalsource.com/books/9781337015332 Can a DNR be revoked by family? https://trustandwill.com/learn/can-a-dnr-be-revoked- by-family

PHI-FPX3200_ArkettAndrew_Assesment3-1

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