Ethical Issues

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Ethical Issues

Autonomy – The ideal of self-determination is the basis for autonomy. It is important that a patient be allowed to decide what should be done to his or her own body. In other words, nobody else has the right to assert their power over another. Likewise, a physician should be allowed to decide not to perform a procedure if doing so would conflict with his or her values. In the Cruzan case, Nancy’s autonomy by way of her parents’ substituted judgment was overridden in favor of the State of Missouri’s policy to preserve life. Although the Supreme Court did not deny that Nancy had the right to refuse nutrition/hydration, there was not enough clear and convincing evidence to know that refusal was what Nancy truly wanted. Also, the autonomy of the hospital staff was taken into consideration because they did not feel it was right to withdraw treatment without a court’s consent. At first glance, it may seem that Nancy’s autonomy was not taken into consideration because her parents had to wait so long for the courts to agree to withdraw nutrition/hydration. However, the courts were actually erring on the side of caution because there was no advance directive indicating refusal of treatment as an option. Once Nancy’s parents found three more witnesses to attest to her wishes, the Supreme Court agreed that Nancy would have wanted refusal of treatment.

Beneficence/nonmalificence – Physicians strive to do what is good for the patient while avoiding doing harm in the process. In the Cruzan case, the definition of good may be debatable. Some may see preserving life as doing good, while others may argue that using life-sustaining interventions that have little or no benefit is doing more harm than good. Moreover, there is a question of who is to decide what is considered “good” for a patient when the patient is incompetent. Is it the physician, the family, State, or Supreme Court? The physician has medical knowledge of what will sustain life while the family has knowledge of the patient's wishes. The State of Missouri has a policy emphasizing preservation of life that intends to protect the citizens of that State, while the Supreme Court has a duty to do what is good according to the Constitution in order to protect the rights of American citizens. In the end, the decision to withdraw nutrition/hydration could be seen as an act th...

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...dgment as to how that very patient would act if he or she was competent. The surrogates in the Cruzan case were Nancy’s parents. The surrogate, whether he or she has received written documentation, oral communication, or no communication at all by the patient, gives or declines consent to recommendations for treatment from the physician. If the patient has documented or orally communicated his or her wishes for treatment prior to the onset of incompetence, the surrogate should use substituted judgment. In the Cruzan case, the state of Missouri (like many other states) required clear and convincing evidence concerning Nancy’s feelings about consenting to treatment. The state required clear and convincing evidence because they did not want to impinge on Nancy’s autonomy; they also believed that in considering her autonomy it would be better to err and keep her alive than err and end her life. A surrogate decision maker is needed in place of an incompetent patient to accept or refuse consent to treatment in end-of-life issues, but they are only efficient in using substituted judgment when clear and convincing evidence exists concerning the wishes of the once competent patient.

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