It is accepted that the advances in resuscitation techniques, initiated and influenced the evolution of bioethics by bringing to the fore the questions of:
(i) just allocation of scarce medical resource, health care
(ii) the nature of “being”, and
(iii) the proper purpose of medicine.
The main issues that caused the emergence, or the study and introduction of bioethics was the introduction of modern technology in medicine in the form of respirators and artificial heart machines. The media attention to the Karen Ann Quinlan case made the issues public. The Karen Ann Quinlan case serves as a perfect example of these new issues. She was diagnosed with a persistent vegetative state, and her life was sustained with a respirator and feeding tubes. Her parents wanted to remove the respirator. Many issues were brought forward during the deliberation; all of them dealing with issues pertinent to ethical medical practices:
(i) What is the difference between ordinary and extraordinary care in treatment?
(ii) Does an individual have the, “right to die”?
(iii) What is informed consent?
(iv) Who has the right to be a surrogate in the absence of consciousness in an individual?
(v) Who has the patient’s best interests at heart?
(vi) Is it important to have a “living will”, an advance directive, that formally states our wishes regarding medical treatment in the case of an unforeseen catastrophic illness?
Due to the use of resuscitation machines breath was no longer the sign of real life. This impelled the development of a new way of identifying death…brain death. ‘Brain death’, - the bodily condition of showing no response to external stimuli, no spontaneous movements, no breath, no reflexes, and a flat reading on a machine that...
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...coined from the Harvard Medical School in 1968. Death was now seen to be a destruction of the brain, and not the termination of breathing. Karen Quinlan was not completely ‘brain dead’.
II) The, ‘Right to die’.
Can someone demand to be allowed to die? In most cases, the rational adult has the right to refuse treatment. This is sometimes ignored when the refusal will lead to death. However, at the same time there is never a right to invade the privacy of a patient by forcing treatment on them.
III) What is the extent of the doctor’s duty to his patient?
Individuals are inflexible in their opinions on these issues, especially in regards to life and death. The Karen Ann Quinlan case led society to see that a difference is made only when the issues are openly discussed. Bioethics seeks to provide the framework for such discussions to take place.
There are many ethical paradigms through which humans find guidance and justification for their own actions. In the case of contractarianism, citizens of a state are entitled to human rights, considered to be unalienable, and legal rights, which are both protected by the state. As Spinello says, “The problem with most rights-based theories is that they do not provide adequate criteria for resolving practical disputes when rights are in conflict” (14). One case that supports Spinello is the case of Marlise Munoz, a brain-dead, pregnant thirty-three year old, who was wrongly kept on life support for nearly two months at John Peter Smith Hospital in Fort Worth, Texas. Misinterpretation of the Texas Advance Directives Act by John Peter Smith Hospital led to the violation of the contractarian paradigm.
Barbara Huttman’s “A Crime of Compassion” has many warrants yet the thesis is not qualified. This is a story that explains the struggles of being a nurse and having to make split-second decisions, whether they are right or wrong. Barbara was a nurse who was taking care of a cancer patient named Mac. Mac had wasted away to a 60-pound skeleton (95). When he walked into the hospital, he was a macho police officer who believed he could single-handedly protect the whole city (95). His condition worsened every day until it got so bad that he had to be resuscitated two or three times a day. Barbara eventually gave into his wishes to be let go. Do you believe we should have the right to die?
Levine, Carol. Taking Sides: Clashing Views on Controversial Bioethical Issues. 7th ed. Guilford: McGraw-Hill, 1997.
As we get older and delve into the real world, it is important to start thinking about end-of-life care and advance directives. Although it is something no one wants to imagine, there is an absolute necessity for living wills and a power of attorney. Learning about the Patient Self-Determination Act and the different legal basis in where you live is important because it will help people understand why advance care directives are so important. Although there are several barriers in implementing advance care directives, there are also several actions that healthcare professionals can take to overcome these obstacles. These are also important to know about, especially for someone going into the medical field.
Tom Harpur, in his 1990 article in the Toronto Star - "Human dignity must figure in decisions to prolong life" - presents numerous arguments in support of his thesis that the use of advanced medical technology to prolong life is often immoral and unethical, and does not take into consideration the wishes of the patient or their human dignity. However, it must be noted that the opening one-third of the article is devoted to a particular "human interest" story which the author uses to illustrate his broader argument, as well as to arouse pity among readers to support his view that human life should not always be prolonged by medical technology. This opening section suggests that a critical analysis of Harpur 's arguments may find widespread use of logical fallacies in support of the article 's thesis. In this essay I will argue that, given how greatly
Before, there were no breakthroughs with the opportunity of saving lives. Innovations in medical technology made contributions to correct abnormal heartbeats and save lives by using a defibrillator and modern respirator. Who would know that the rapid discoveries would include successfully giving patients surgical transplants? Furthermore, President Lyndon Johnson implemented an executive policy requiring the usage of medical response trauma teams. Since 1976, this executive order has allowed the widespread use of CPR, and organizations like the American Red Cross and the American Heart Association were founded. “About 6.4 million people now survive angina chest pain each year, while an additional 700,000 people survive a heart attack each year (pg. 15 of Last Rights) Despite these remarkable breakthroughs that help those badly injured, the law becomes vague and allows more opportunities for misinterpretation on defining death. As a result, this could be advantageously used against the best interest of others and the government. “This ten-year mishmash of laws is what led the previously mentioned President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, established by an act of Congress in 1978 , to tackle the first task of defining death.” (pg. 81). The President’s Commission forced the U.S Supreme Court and
There is great debate in this country and worldwide over whether or not terminally ill patients who are experiencing great suffering should have the right to choose death. A deep divide amongst the American public exists on the issue. It is extremely important to reach an ethical decision on whether or not terminally ill patients have this right to choose death, since many may be needlessly suffering, if an ethical solution exists.
While navigating the abundant and sometimes confusing legal language of advance directives can be time consuming, it would benefit every person to consider their end of life wishes and have some form of written statement available for their doctor and family to understand those wishes. Doing this in advance can prevent emotional anguish, suffering and expensive litigation. In the end, clearly and when possible, written, documentation of a medical directive, a living will, or a chosen health care power of attorney will lessen the burden for the medical professionals and family of a dying or incapacitated person.
This can be seen in the case study as ethical and legal arise in resuscitation settings, as every situation will have its differences it is essential that the paramedic has knowledge in the areas of health ethics and laws relating to providing health care. The laws can be interpreted differently and direction by state guidelines may be required. Paramedics face ethical decisions that they will be required to interpret themselves and act in a way that they believe is right. Obstacles arise such as families’ wishes for the patients’ outcome, communicating with the key stakeholders is imperative in making informed and good health practice decision. It could be argued that the paramedics in the case study acted in the best interest of the patient as there was no formal directive and they did not have enough information regarding the patients’ wishes in relation to the current situation. More consultation with the key stakeholders may have provided a better approach in reducing the stress and understanding of why the resuscitation was happening. Overall, ethically it could be argued that commencing resuscitation and terminating once appropriate information was available is the right thing to do for the
The concept between life and death cannot simply exist without one another, where the topic is widely discussed throughout “When Breath Becomes Air” by Paul Kalanithi. This memoir explores Paul’s definition of death as he passes through the distinct “stages” of his life. As Paul progresses through each stage, he views death differently as he transformed from a student to a neurosurgeon, neurosurgeon to a patient, and eventually becoming a father, where he needed to take full responsibility as an adult.
In an effort to provide the standard of care for such a patient the treating physicians placed Ms. Quinlan on mechanical ventilation preserving her basic life function. Ms. Quinlan’s condition persisted in a vegetative state for an extended period of time creating the ethical dilemma of quality of life, the right to choose, the right to privacy, and the end of life decision. The Quilan family believed they had their daughter’s best interests and her own personal wishes with regard to end of life treatment. The case became complicated with regard to Karen’s long-term care from the perspective of the attending physicians, the medical community, the legal community local/state/federal case law and the catholic hospital tenants. The attending physicians believed their obligation was to preserve life but feared legal action both criminal and malpractice if they instituted end of life procedures. There was prior case law to provide guidance for legal resolution of this case. The catholic hospital in New Jersey, St. Clare’s, and Vatican stated this was going down a slippery slope to legalization of euthanasia. The case continued for 11 years and 2 months with gaining national attention. The resolution was obtained following Karen’s father being granted guardianship and ultimately made decisions on Karen’s behalf regarding future medical
Mohr, M., & Kettler, D. (1997). Ethical aspects of resuscitation. British Journal of Anaesthesia, 253.
The case of Dr. Lowell and Mrs. Jackson revolves around a conflict between the doctor, who advocates the implementation of a particular treatment and the patient who disagrees with the doctor and wishes to do things her own way. The doctor feels that the suggested course of action is disastrous and threatens to have the patient declared mentally incompetent. The question now is whether or not the doctor is morally justified in taking action against the patient in order to implement the course of treatment she feels would be most effective. Is this an infringement on the autonomy of the patient or is the doctor morally obliged to do everything that he/she can possible do in order to restore the patient’s health even if that includes to go so far as to take this decision out of the hands of the patient?
At the core of this project lies a fundamental challenge; determining the worth of a human life. Even though no human should have such power, the premises of this project required that we do just that. Naturally, when such power was given to us, instantaneously moral conflict began to arise. People would argue that certain questions were unfair, unnecessary, or even discriminatory and without fail, someone always had a dissenting opinion. Due to the relatively wide range of opinions and demographics, it was very hard to compile a strong, complete list of questions to ask the prospective patients. In the end, we only asked the candidates approximately thirteen questions to which the answers would determine life and death.
President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Defining Death: A Report on the Medical, Legal and Ethical Issues in the Determination of Death. Washington, D.C.: U.S. Government Printing Office, 1981.