Dilemma
A son’s mother, Carole, has been in the ICU for several weeks, is semi-conscious, and is now almost completely unaware of her surroundings. All of Carole’s attending physicians agree that her breathing muscles are irreparable and that she will suffer more cardiac arrests. Thus, since she is completely dependent on a machine in order to continue surviving and is no longer able to return to a life outside of the confining walls of the ICU, I believe her attending physicians are justified in issuing a “do not resuscitate” (DNR) order.
Analysis
Over the course of the past several weeks, her attending physicians have had sufficient time to carefully and properly assess her condition and consult with each other. The decision is not being made hastily, in an emergency room setting. Nor is the decision being made by a sole attending physician.
One opposing argument I foresee considers the religious and cultural concerns of this case. The healthcare team must be cautious of respecting the religious and cultural identity of a patient and a patient’s immediate family. But to what extent? The son argues that his mother’s soul is at stake if she passes away in a foreign land. Additionally, he will be cursed if he cannot return his mother to her homeland prior to her death. In their religious and cultural context, both of these concerns are valid. However, the son is (realistically) unable to fulfill his mother’s and his own personal wish in a timely manner, because he is “penniless and unemployed”. In this situation, the healthcare team must balance these different factors and determine what course of action is in the best interests of the patient’s health, especially since she can no longer provide her informed consent. (Apparently, she can no longer even carry out a rational conversation.)
Her health will deteriorate even more with additional cardiac arrests, while prolonging her stay in the ICU will increase her dependency on the machines. It seems that Carole’s quality of life is decreasing. Since both the son and his mother are deeply religious, I wonder whether the healthcare team could have a holistic conversation with the son, together with a trusted religious figure, about his mother’s realistic health outcomes, her suffering, and her quality of life. This approach could help the son think beyond the threat of a curse and consider an alternative decision.
Works Cited
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 think you make a great point of bringing up the religion of the family in this situation. This case is one that warrants a lot of care simply because of the sanctity of life, but what about respect for the patient’s values? In a lot of ways, it’s not practical to take religious concerns into consideration, but to be quite frank, when is taking religion into consideration ever really practical? It’s not a question of practicality. It’s a matter of autonomy and values. This to me brings up the relationship between morality and practicality. In a lot of cases (arguably most cases) morality antagonizes practicality. If we were to act practically without moral considerations, then hospitals would cease to exist on the grounds that it’s not practical to maintain the life of someone who is ill. The reason we discuss morals, then, is because we know and understand that there needs to be a balance that is struck between moral and practical considerations.
For this I case I believe there is a question of competence on the sons side. I would call into question is he thinking straight when he is asking for the request to keep his mother alive. One he is facing the imminent death of a loved one and thus would want to keep her alive as long as he can. He is also currently unable to fulfill his promise of moving her as he has no money. Thus he is not in a position to make a rational decision involving the matter of transporting his mother. Combined with his belief that he will be cursed his request to keep his mother alive can be seen as unreasonable. The second factor we must address is does he truly understand the situation his mother is in and that he himself is in. People who are grieving often are irrational and it is unclear to the degree that he understands how bad his mother situation is and is hoping to move her to Canada to get better treatment. Lastly there is the idea of non-maleficence. While letting her die would obviously cause her physical harm, her current situation is not a good situation to be in as she is in a coma and unlikely to recover. Prolonging her suffering to me would be a worse act of harm. Thus I agree with your decision to issue the DNR order.
In this case, I agree with Beatrice that the most prevalent matter is regarding the patient’s religion. On the one hand, allowing Carole to die would cause a rift between her and her family’s religion. On the other hand, prolonging her life goes against the ethical principle of nonmaleficence, as she will experience more cardiac arrests. Agreeing with Beatrice, the most ideal situation in moving forward would be to have a holistic conversation with Carole’s healthcare team, her son, and a trusted religious figure. This conversation should determine what the right decision would be and could potentially ease the son’s mind in regards to religious penalties.