Since the development of modern medicine, things such as euthanasia and physician-assisted suicide have frequently been the subject of media headlines and article titles, but furthermore this issue has been the focus of many medical, legal, and ethical discussions.  There are numerous reasons for this, but I argue that what attracts these cases to such extensive debates is the amount of ambiguity that complicates the dilemma, and this ambiguity is often filled in by personal belief or paternalistically skewed rationale.  But within these debates are the concepts or (a) sanctity vs. quality of life, (b) interests and consent, (c) the dying vs. non-dying, and  (d) active vs. passive measures (Thomas, Waluchow, & Gedge 210-213).  The two cases discussed in the book Well and Good serve as examples of the moral confusion that can arise from ambiguity in the obligatory duties for the physician, who is faced with the decision to either prolong the patient’s life or not, along with the countless considerations, both legally and ethically, to be made.

Carole is an 81-year-old woman on life support that makes it possible to sustain her semi-conscious state, where she is incapable of rational thought and communication.  The patient has no local family other than a son, who requests, despite the chronicity of his mother’s condition, that the doctors prolong her life by resuming life support treatment.  That is, until he can earn an unrealistic amount of money to fly his mother to Jamaica so she can pass away there or if someone is able to lift the curse that she put on him.  In other words, the physicians are faced with the decision to either continue providing the services and resources necessary to keep the woman at a state that straddles the line between life and death, or deny the woman of such needs as well as her son’s wishes to the doctor.  Obviously, as a healthcare professional, there is always an underlying obligation to preserve lives, but in many cases, perfectly exemplified by this scenario, it seems not only acceptable but right to discontinue the life, thereby reserving those resources for someone who could more genuinely benefit from the treatment, one of the points mentioned by Thomas et. al. (212).  What we ought to do if we were the physician can be determined by considering the situation from the angle of each of the four topics mentioned above that are outlined by Thomas et. al.

(a) Sanctity of life vs. Quality of life

People can say that every life is worth saving, but I think it would be tough to make an argument in cases such as this.  We can’t know for sure what is going on in Carole’s mind, but we can be confident in assuming she’s not having the best time of her life being connected to machines that she would die without.  There is no quality of life to evaluate for her and no real chance of her ever having a life of any true quality, so this life is not as sacred or valuable as a person with a chance of surviving/regaining a better quality of life.  Therefore, we can’t say that it would be reasonable or fair to turn away a patient who needs the same equipment and attention being given to Carole if it is likely that the treatment would have a greater impact on the new patient’s health and well-being.

(b) Interests and Consent

The patient in this case is clearly unable to make any rational decisions for herself, so the issue of consent is justly directed towards her immediate family, her son.  It is understandable for the son to want to prevent his mom’s death, but at one point or another, he will have to deal with the loss and its consequences.  It cannot be the physician’s responsibility to see to it that every patient’s dying wish is granted.  This is a situation where the amount of care and resources would outweigh the physician’s responsibility to maintain treatment, given the state of the patient and the unrealistic request by the son.

(c) Dying vs. Non-dying

The distinction made between patients who are dying or not dying is not necessarily applicable to this case.  It is more of a concern for those patients who are not dying but are requesting to die.  Clearly for Carole because of her incapacity to communicate, we can’t be sure what her desires are, but it is likely that discontinuing treatment would save her a good amount of suffering.

(d) Active vs. Passive measures

When assessing the moral correctness of a decision that involves the death of a patient, one of the primary details is whether the physician’s behavior reflected an active or passive effort in contributing to the patient’s survival.  Additionally, this idea is commonly associated with the killing vs. letting die debate.  In the particular case of Carole, however, the physician’s action of discontinuing life support is difficult to evaluate ethically because in order for the patient to die of “natural” causes, the plug would first need to be pulled.  So it seems that you could pin the doctor with killing the patient, although her services prolonged the life significantly.  I don’t think it is fair to judge the doctor’s actions in this way.

Overall, after analyzing the case and the details within it that pertain to the four principle dilemmas described above, I think it would be just to cease life support treatment for the patient if another patient requires the use of the same equipment.  This is a very economical way of viewing the situation, but it is suitable because it would be impossible to consider any input from the patient.

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. New York: Broadview, 2014.