Background
There are two very important cases presented in Well and Good titled “Don’t Let My Mother Die” and “Please Let Me Die.” I will be focusing on the latter. In this case you have a 26-year-old man named John who has been suffering with a neurological disease commonly known as “the elephant man’s disease” for 20 years now. Ultimately, over the course of his life he has had over 100 operations to remove tumors, which have lead to total deafness, partial blindness, total paralysis except for some movement in his right shoulder and total impairment of his breathing muscles. So John would be stuck on a respirator for the rest of his life and consequently, after everything, John does not want any more surgeries and he wants to die.
Dilemma
This case raises multiple concerns. One would be addressing the difference between letting someone die and killing them. However, the main moral issue here is whether to respect the patient’s autonomy or act out of nonmaleficence. Up to this point in John’s life it had been easy for the physicians to do both, considering that John agreed to his past procedures and by doing so the physicians were acting nonmaleficently. However, now John’s wishes would require the physicians to go against the principle of nonmaleficence because John now wishes to die. So what do you do here? Do you respect John’s decision and act based on his autonomy? Or do you act out of nonmaleficence and go against your patient’s wishes?
Analysis
Personally, I believe that the physicians must respect John’s decision and take him off of the respirator. There are many reasons behind my view. First of all, I believe that John has the right to make this decision and that he autonomy should be respected because of certain factors. The first factor being that John has been dealing with this disease for nearly all of his life, he has been dealing with it for 20 years. So when John finally decides that he would like to die, it is not like he has had this disease for one or two years and decides then that he doesn’t want to live anymore, he has been dealing with this for basically all his life, and since 20 years have gone by and the physicians know and tell him that there is no chance for remission, John’s decision is plausible. Moreover, respect for autonomy goes hand in hand with a competent, autonomous patient, and John was proven by his medical staff and social workers to be “fully alert, conscious, and in control of his mental faculties; he is able to make rational decisions and choices.” So where is the confusion? John’s decision must be upheld.
Furthermore, there is great controversy in the distinction between “letting die” and “killing.” Beeauchamp and Childress address this problem. They say that “letting die” is “prima facie acceptable in medicine under one of two conditions,” the condition relevant in this case is the second one stating that “patients or their authorized surrogates validly refused a medical technology.” That is, if the patient’s refusal of treatment is valid, then letting that patient die is acceptable, and in the above paragraph it is shown that John’s refusal is definitely valid.
Now some may want to argue that since John’s family was at first against letting him die, but after several counseling session finally came around to his decision, their decision was not their own but rather one they were most likely persuaded into. But even so, if they are truly trying to act in the best interest of John then they would respect his wishes. We have to look at John’s life in the long run. The physicians have told him that there is no chance of remission, and John has been living a paralyzed and physically disabled life for 20 years now. Even though John can continue to live he is severely depressed and will not live a happy or fulfilling life is he is to continue with the respirator and surgeries. So his family wanting him to live is a selfish desire, and they aren’t acting out of beneficence for John, but rather what would make them happy. So ultimately, I strongly believe that John’s autonomy must be respected in this case and his medical team is entirely morally justified in disconnecting his respirator.
Works Cited
Beauchamp, Tom L., James F. Childress. Principles of Biomedical Ethics. 7th ed. N.p.: Oxford University Press, 2012. Print.
Thomas, John E., and Wilfrid J. Waluchow. Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. Toronto: Broadview, 2014. Print.
I definitely agree with your argument that John should be taken off the respirator. Another argument that I would make, with respect to nonmaleficence, is that the doctor is causing the patient harm, to a certain extent, with either decision. The choice to take him off the respirator is more obvious since John would die, so that is clearly harming him. However, I believe that by keeping John live and convincing him to undergo yet another surgery would also be harming him since he clearly does not want to suffer any more, and as you mentioned, is clearly competent. I do not think this is a scenario where the options are harming or not harming the patient. Thus, I would argue that, in this situation, there should be nothing stopping the doctor from taking John off the respirator other than the family’s desire to keep John alive despite his wishes.
I agree that in this case, it would be best to listen to John and to take him off the respirator. As you said, the case mentioned that John was deemed fully competent mentally to make decisions about his own health. Additionally, his family now agrees with John’s decision, so any concerns they had about taking John off the respirator are not issues anymore. I feel like even if his family had been opposed to the decision, John’s wishes to be taken off the respirator should be considered over the family’s opposition, as he is a fully competent adult. Acting against John would obviously violate his autonomy, but might also arguably go against nonmaleficence in the opinion of John and his family, as it would force him to continue to live in agony.
I agree with you Mikaila that John’s decision to be taken off the respirator should be respected. John does not wish further treatment since he has suffered so much in the past years and will never get better from his disease. John is also considered fully competent and understands that if taken off the respirator, he would die. This situation can be compared to cancer patients going through chemotherapy treatments. A patient’s decision not to have chemotherapy should be respected even though they know they would die earlier. Some patients may choose quality of life for a shorter period over extending their life and feeling sick from the constant chemotherapy.