Case 8.1 “Don’t Let My Mother Die”

Background:

Mrs. Jones is an 81-year old, deeply religious Jamaican native. Although we are not informed as to what type of religion Mrs. Jones’ practices, one might assume that it is a some sort of mix of Christianity and Myalism. Myalism is a religion deeply rooted in African tradition, adopted by Jamaican slaves to recreate their past. In the late 18^th century, the beliefs and practices of Myalism began to be mixed with Christian traditions to form a religion that is still practiced by many Jamaicans today (Morrish 45-47). Having identified closely with her homeland’s traditions, she believes that her soul will be “condemned to wander the universe aimlessly for an eternity (Thomas and Waluchow 175)” if she dies in a foreign land, a belief consistent with Myalism. We are told that, at some point in time, Mrs. Jones moved to Edmonton, Canada with her son.  A “fair bit of time (Thomas and Waluchow 175)” later, Mrs. Jones’ health began to decline and her breathing muscles eventually became paralyzed, resulting in multiple cardio-respiratory arrests. Due to the paralysis of her breathing muscles, Mrs. Jones had to be placed on a respirator and was admitted to the Intensive Care Unit. Despite attempts to wean her off of the respirator, she was unable to regain the ability to breathe on her own and, we are told, likely never would. Additionally, Mrs. Jones has lapsed into semi-consciousness and is unaware of her surroundings. Before losing consciousness, Mrs. Jones placed a curse on her son should he not return her to Jamaica to die. Although the son wants to arrange her return, he lacks the financial means. The hospital is also unable to transport her back to her native land. The attending physicians, recognizing the likelihood of a future cardiac arrest, are trying to decide whether or not a Do-Not-Resuscitate order should be issued.

Dilemma:

The dilemma that the attending physicians face is three-fold. The first dilemma is whether or not it is moral to passively cause the death of Mrs. Jones. Is passively causing death a violation of the moral principle of non- maleficence? The second concerns how best to minimize harm and what types of harm they should minimize. More specifically, should they minimize biological harm to Mrs. Jones by not resuscitating? Or should they resuscitate in hopes of returning Mrs. Jones to Jamaica and thus minimizing spiritual harm to both Mrs. Jones and her son? This raises an interesting question about what rights someone has in choosing how they die (if they are to die in the first place). The second dilemma involves autonomy and whether or not surrogate autonomy should be awarded to Mrs. Jones’ son.

Analysis:

I believe that the attending physicians should grant Mrs. Jones’ son surrogate autonomy and thus allow him to make the decision as to whether or not Mrs. Jones should be resuscitated if she suffers another cardiac arrest. Additionally, I think that Mrs. Jones’ son should demand that the physicians attempt to resuscitate Mrs. Jones while arrangements for her return to Jamaica are being made.

According to Warren and Fletcher, a human life must have the following distinctive qualities to be worthy of protection: rationality, self-awareness, and autonomy. In Mrs. Jones’ semi-conscious state she is both unaware of her surroundings and unable to hold rational conversations. Due to this limited capacity, Mrs. Jones is regarded as a non-autonomous being and deemed incapable of giving informed consent by the attending physicians. One might conclude that, by Warren and Fletcher’s standards, Mrs. Jones’ life is no longer worthy of protection and that she should therefore not be resuscitated should she suffer another cardiac arrest. Although I recognize that Mrs. Jones’ quality of life in her present state is very low, I believe that protections should still be granted for her “afterlife” and that one should not only respect the sanctity of life, but the sanctity of death as well.

When looking at this case from a solely biomedical perspective, it is easy to dismiss Mrs. Jones and her son’s wishes concerning the fate of their souls. Along the same vein, it is easy to be critical of a Jehovah’s Witness who declines a life-saving blood transfusion. However, it is important to recognize that the experiences of health, illness, and death are not just biological, but cultural, religious and social. When considering non-maleficence, then, we must consider not only the harm done to the person physically, but socially, mentally, and spiritually as well.  Just as a Jehovah’s Witness would mourn the loss of their soul if they were to receive blood products, so too would Mrs. Jones’ son suffer if he was not able to return his mother to her native land to die. Along with extreme guilt, he would also likely feel paranoid about having a conditional curse put on him.

Additionally, it is important to consider that Mrs. Jones’ son is perfectly capable of assuming surrogate autonomy. Although his inability to pay for Mrs. Jones’ trip to Jamaica makes the return to her native land more complicated and less likely, this in no way inhibits his ability to make a decision about whether or not to resuscitate on his mother’s behalf.

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.