A Case of Mecial Ethical Dilemma
An elderly woman, age 91, named T.B was found unresponsive. Emergency services was called and for approximately 45 minutes, attempts were made to revive her and to regain a heartbeat. Although she regained a heartbeat, she did suffer an anoxic injury to her brain because of the extended period without oxygen to her brain. She is now on life support and is developing pressure sores because of being bed bound for so long and is also developing pneumonia because of using a ventilator for a long period of time. T.B has three children who are adults, and concerned about their mothers future. The doctors explain to them that their mother has no quality of life, her prognosis is poor, she is very advanced in age and her neurological status is not getting better. Taking into consideration all this, the doctors recommend putting a do not resuscitate (DNR) order into her chart and taking her off life support. Naturally, this has stirred up many different emotions in T. Bs children and has caused them to be divided as to what to do. This case is very delicate because it deals with human life and whether it would be ethical to keep her on life support or not. Careful deliberation will have to be made to make the best decision possible.
The patients medical problem is an anoxic brain injury. The article Evoked potentials not just to confirm hopelessness in anoxic brain injury states, Complete cerebral circulatory arrest and oxygen deprivation cause unconsciousness within seconds (Kreiger, 1998, p.1). The brain can survive only a few minutes without oxygen so making a full recovery from this is very rare. T. Bs prognosis is very poor, and her case is terminal. As stated in Legal and Ethical Issues for Health Professionals Although there may be a duty to provide life-sustaining equipment there is no duty to continue its use after it has become futile and ineffective to do so in the opinion of qualified medical personnel (Pozgar, 2016, p. 125). Even if T. Bs neurological status did improve and she did make a recovery, the damage she sustained is already severe and the quality of life she would lead would be poor. Given T.Bs advanced age. the possibility of recovery is little to none and medical and nursing care would be of little help to her if she made a recovery, because she is now permanently disabled.
T. B has not been made aware of the risks and benefits of being on life support or the termination of life support. The patient is unresponsive and currently does not have the mental capacity to grasp the intensity of her situation and she has not stated what she would like done incase a situation like this should occur. She does have three adult children capable of making decisions for her. Although they are divided on what the best decision is to make, they each want to do what is best for their mother. The patient is not unwilling or being uncooperative or denying medical treatment.
Quality of Life
Without the patient being on life support, there would be little chance of a normal life because the patient would not survive. With the patient being on the treatment, there is also little chance of having a normal life because T. B would be bedbound. The doctors can judge her quality of life because having a patient that suffered an anoxic brain injury, medical personnel would know that there is little to no chance of having a normal life. An article called Euthanasia statesthe motive is to relieve comatoseness, physical suffering, anxiety or a serious sense of burdensomeness to self and others (Frederich & Tischauser, 2013). Taking T. B off life support would be reliving her of any physical suffering she might have to endure or might have to live with. It would also relieve the children of the trauma of seeing their mother with a disability and ultimately dying. The ethics of euthanasia are highly debatable; some agree with it and think that you are saving that person from a life of pain. Others disagree and according to the article Top Ten Reasons Euthanasia Should be Illegal, Euthanasia is the conscious act of ending a life by withholding necessary treatment (passive euthanasia) (Anderson, 2015). In the article, Anderson goes on to say that euthanasia can be viewed as murder by some. Many would disagree with this because although euthanasia is debatable, there are many benefits to it.
There are no professional, business interests or interprofessional interests that might create conflicts in the clinical treatment of the patient. There are not any other parties interested in this case except the family members and the doctors. There are also no known religious or monetary issues that would prevent them from making a decision. However, there are health issues that would affect the decision; the patient is developing bed sores from being bedbound for a long time and pneumonia because of prolonged use of the treatment. On top of dealing with a permanent disability, if she gets well, she would also have to deal with pneumonia and bed ulcers; at her age, this could be life threatening. There are not conflicts within hospitals that may affect the patients welfare and clinical decisions.
The correct decision must be made in this situation. Taking T. B off life support would be the best situation in this case. In the article Active and Passive Physician-Assisted Dying and the Terminal Disease Requirement, Varelius statesa patients disease is terminal when it leads to her death within a given period, usually that of six months (2016. P. 2) T. B did suffer a terminal injury and her chances of living and prognosis is not good. In this case, removal of life support would be the best decision.
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