PHI-FPX3200_ThompsonNia_Assessment3-1
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Should We Withhold Life Support?
Nia B. Thompson
PHI-FPX3200
Ginger Raya
May 09, 2023
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Should We Withhold Life Support?
Sometimes when patients are diagnosed with a chronic or terminal illness, their first thought is about their ability to maintain a normal life doing the things they enjoy. This is often something that they can’t attain. Some patients will then look into active or passive euthanasia. Active euthanasia is also known as assisted suicide and passive euthanasia is removing or refusing treatment or procedures that would be used to sustain or save an individual’s life. When
an individual chooses one of these options, it often gives the patients the choice to enjoy the remaining time they have left on their own terms. In this assessment, I’ll be addressing patient directives, the individual’s right to choose, and quality of life. I’ll also touch on what ethical concepts there may be when it comes to making this moral decision as well as what moral issues there could be when the decision is made to withhold life support.
Patient Directive Mr. Martinez
Mr. Martinez is 75 years old with chronic obstructive pulmonary disease
; he and his wife have stated that they do not wish for CPR to be performed should he need it. As such a “do not resuscitate” order was issued. This order is often stated in a patient’s chart as a DNR. A DNR “is a legal order signed by a physician that specifies you do not want to be resuscitated in an emergency” (Anaebere, 2022). Most often when a patient has a DNR in place, they also have an advance directive on file. Advance directives serves as a legal document that discusses the wishes of the patient when it comes to instructions on their medical care. This typically goes into effect when the patient is no longer able to communicate. Quality of Life with COPD – Mr. Martinez
Mr. Martinez has chronic obstructive pulmonary disease, also known as COPD. While the symptoms of COPD vary for each patient, the most common symptoms are shortness of breath,
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coughing up mucus or phlegm, and tightness in the chest area. A lot of individuals live normal lives with COPD, however, 1/3 of the mortality rate of people with COPD is due to respiratory failure. The dilemma that the hospital staff, Mr. Martinez, and his wife are being faced with is that the reason for his respiratory failure is due to his oxygen being accidentally turned up. This lead to him gasping for air and in emotional distress. If they chose to overlook his DNR on file and place Mr. Martinez on a ventilator, it is possible that he wouldn’t be weaned off and would then be placed in a long-term care facility. It would also go against his and his family’s wishes. The question they would then be faced with it is if they perform life saving measures on Mr. Martinez, what would his quality of life look like? Quality of Life is “based on your own perception of how you’re doing, your goals, your expectations” (Brody, 2022). Patients with COPD often have an impaired quality of life and it gets worse as the disease progresses. They experience trouble enjoying the simple things in life such as engaging in social
events. It can even limit some individuals of their ability to enjoy their favorite hobbies. When it comes to measuring quality of life, some examples of what to consider are the following:
Social interactions
Natural living environment
Overall ability to experience life
These are a few examples of some things to consider when assessing how Mr. Martinez’s quality
of life will be affected should the hospital staff perform life-saving measures.
Moral and Ethical Issues and other considerations
Healthcare workers are educated and trained professionally, and there is also an oath that is taken when medical students become doctors. This oath is known as the Hippocratic Oath. The first thing that most people think of when they think of this oath is the phrase “first, do no harm”.
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This oath is taken when most physicians graduate from medical school. Healthcare providers also get trained in providing patients with the best care to improve their overall health. This includes, but isn’t limited to respiratory care, surgical procedures, and experimental treatment and drugs if needed. Many providers support patient directive and feel strongly that patients should be given the option to discontinue treatment if they feel treatment won’t improve their quality of life. However, some physicians may feel this is morally and ethically wrong especially when they take into account the Hippocratic Oath. Morally, it is acceptable to respect a terminally ill patient’s decision to forego life-saving measures. Especially when it will bring them considerably more harm than good. An ethical consideration regarding Mr. Martinez’s decision is the respect to his autonomy to decide what is best for himself. When he decided, along with his wife, that he didn’t want CPR performed, he made it apparent that he felt this was the best course of action for him. The Principle of Respect for Autonomy is the ethical principle that supports the patient’s right to withhold life support. It essentially states that a person should respect a decision made by an individual when it concerns their own life. “Autonomy is the ability to allow one to make their own decisions, as well as to respect the decisions they make” (Gracyk, 2012). Mr. Martinez has exercised a right that everyone has, the right to choose what type of healthcare will be best for them. This includes the right to refuse life-saving measures or any other type of medical intervention. Some healthcare providers may have difficulty understanding this course of action especially when they are trained to save lives and “do no harm.” However, sometimes the best method in caring for a patient is to respect what their
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wishes are. Providing life-saving measures may cause him more harm than good. In this case, for Mr. Martinez, it would be best to attempt to stabilize his condition with respect to his wishes. Decision
In this scenario, the best course of action s to respect the Mr. Martinez’s decision regarding his care. Do not resuscitate is not the same thing as do not treat. Mr. Martinez is in distress and there should be action taken to prove him some relief, short of CPR and placing him on a ventilator. Honoring the patients’ DNR in place is showing the respect for his legal right to make the best decision for his care in the event of an emergency.
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References
Brody, B. (January 04, 2022). What Quality of Life Really Means When You Have Chronic Illness?
https://creakyjoints.org/support/quality-of-life-chronic-illness/
Advance Care Planning: Advance Directives for Health Care
https://www.nia.nih.gov/health/advance-care-planning-advance-directives-health-
care#:~:text=called%20advance%20directives.-,What%20are%20advance%20directives
%3F,of%20attorney%20for%20health%20care
.
COPD Symptoms & Diagnosis
https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/symptoms-
diagnosis
Anaebere, T.C. (January 04, 2022). When and Why do People use Do-Not-Resuscitate Orders?
https://www.goodrx.com/health-topic/end-of-life/dnr-order-do-not-resuscitate
Shmerling, R.H. (June 22, 2020). First, do no harm.
https://www.health.harvard.edu/blog/first-do-no-harm-201510138421
Zamzam, M., Azab, N., Wahsh, R., Ragab, A., & Allam, E. (October 2012). Quality of Life in COPD patients
https://www.sciencedirect.com/science/article/pii/S0422763812000635#:~:text=Quality
%20of%20life%20is%20impaired,symptoms%20and%20impact%20of%20disease
.
Quality of life indicators – measuring quality of life
https://ec.europa.eu/eurostat/statistics-explained/index.php?
title=Quality_of_life_indicators_-
_measuring_quality_of_life#Framework_for_measuring_quality_of_life
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Gracyk, T. (2012). Four fundamental ethical principles (a very simple introduction).
http://web.mnstate.edu/gracyk/courses/phil%20115/Four_Basic_princples.htm