Debate Team 1
Shanice Moore, Staci Swartz, Megan Sanders, Brandi Hurd, Genna Paquette
Ethics for Health Professionals
HSC 4210: C1
Dr. Glenn Croxton
May 4, 2022
Debate Team 1 Posting
Introduction:
As an ethics committee we are presented with a case that needs resolution. This case study is a reflection of the ethical dilemmas that occur within the healthcare field and the merits of which decisions should be made based on moral justifications. The ethics committee will present why the position should not be upheld to withdraw treatment based on the ethical principles, theories and moral community. The discussion of ethical issues and differing ethical conflicts as it relates to the withdrawal of treatment, arguments that can be developed to uphold the position of not withdrawing treatment, the respect for a person’s autonomy and the situational factors that supports the position, as well as weaknesses that can be found within the argument will be reflected within this debate team paper.
Case Study Summary:
Melinda Roberts, was an 31-year-old educated African American woman who, at the age of 17 was diagnosed with Myasthenia Gravis (MG) which made her seriously ill causing her to spend four weeks in an intensive care unit before her symptoms subsided. Since that time, Melinda had no further major health issues and began family planning with her husband Matthew, who she discussed her illness with. Knowing the history of her illness, Melinda completed an advance directive for her healthcare decisions and appointed Matthew as her durable power of attorney. In the event something should happen to her, Melinda directed that “treatment not be discontinued.” With the notion that she could have a normal pregnancy after speaking with her obstetrician Melinda became pregnant.
During her final trimester Melinda began experiencing difficulty breathing and extreme weakness in her lower extremities, and was admitted to the hospital in the intensive care unit. After discussing the likelihood of the possibilities of a recurrent episode of MG with her physician, Dr. Ryan, she reminded him of her advance directive indicating her wishes remained the same concerning continuous treatment stating “if there is any chance she could see and hold her child” she directed “treatment should not be discontinued, keep her alive.” Her health immediately began to deteriorate. Despite receiving a tracheostomy and ventilation five weeks post-delivery, Melinda remained unable to breath on her own, her kidneys began shutting down and the outlook for her situation was poor even after receiving nutrition and hydration. Matt, who was under considerable stress caring for the new baby, spending time with Melinda, and keeping his job on hold, felt he was beginning to lose faith that doing more things to Melinda was really the best thing for her. Matt and her physicians began discussing withdrawing from treatment as they felt her situation was futile. Melinda’s family who had been by her side night and day were insistent about honoring her wishes in accordance with her advance directive, however Matt who was desperate and depressed asked Dr. Ryan and others on the team for assistance.
Ethical Issues- Staci Swartz
One ethical issue related to leaving Melinda on life support is that removing her from life support would go against her advanced directive and wishes, that if there is any chance that she can see and hold her baby, she would like to be given that chance. If she were to be taken off life support, it would violate her autonomy, as before she became comatose, she was competent enough to make the decision herself without coercion. While her condition is grave, the medical professionals have not said that it’s impossible she will recover (Morrison & Furlong, 2019). Another ethical issue that could be related to the position is nonmaleficence. Nonmaleficence is ensuring that no harm is done to patients, and that only good is provided. If she was taken off the ventilator at this stage when there still is a chance she could regain consciousness, it would be harming her chances and ensuring that she isn’t able to meet her son. Deontologists define harm as that which prevents us from carrying out our duty. Her duty is to see and hold her child; taking her off life support would prevent her from this, thus not in accordance with acting with nonmaleficence (Morrison & Furlong, 2019).
Differing Ethical Conflicts- Staci Swartz
There are a number of differing ethical conflicts present. One of the ethical conflicts present is that her durable power of attorney for health, her husband, is displaying conflicting wishes than her advanced directive. Studies have shown that surrogates’ predictions of patient preference often align with their own preferences. Due to this fact, clinicians encourage patients to select surrogates with similar views. It’s unknown if her surrogate had similar views to her own when she appointed him, but even if he had, he is in a compromised and stressed position currently and might not make a decision that would have aligned with the views he had when he was appointed. Due to this, he might not make a choice that is aligned with the patient’s best interests. According to an article by Talebreza and Widera, some surrogates’ emotions can be so strong that they are unable to place the patient’s best interest above their own. As her husband is stressed with spreading his time, it might appear that his best interest is letting her go so he can focus on his other needs. However, this doesn’t align with her best interest and the fact that if there was a chance to see her baby, she wanted to be kept alive. In instances that the surrogate’s interest doesn’t align with the patient’s best interest, Matthew’s emotions and stress need to be addressed first before he can determine what would be in Melinda’s best interest (Talebreza & Widera, 2015).
Another ethical conflict relating to the conflicting views of her husband and her advance directive is that surrogacy leeway for decision making is not outlined. Some advance directives enable a patient to outline if they want their directive to be followed strictly or if leeway is available for the surrogate to use as a general guide. According to the article by Talebreza and Widera, if leeway is not indicated, and there is not a compelling reason to modify directive, the patient’s goals should continue to be followed according to her wishes; she should be left on life support as long as there continues to be a chance of recovery (Talebreza & Widera, 2015).
Arguments that can be developed to uphold the position- Shanice Moore
Melinda’s husband Matthew has become overwhelmed and stressed with the decision on whether continuing treatment was really the best thing for her, which is not following the guidelines of her power of attorney. Melinda’s family on the other hand; her only sister, and parents want to honor her wishes to follow the advance directive which is the right thing to do, and according to Microethics an individual view of what is right and wrong is based on personal life experiences, which only her family would have a greater understanding of. Since the decision is left in the hands of her appointed surrogate (her husband Matt) his moral judgment should be based on the principles of ethics that are universal to the rule of conduct, derived from ethical theories that provide practical basis for identifying what kind of actions, intentions, and motives are valued. Even when considering religion, and social values the relevance to a patient’s autonomy, beneficence, nonmaleficence, and justice should also be considered. An argument could be made that if Melinda is taken off of life support aside from her wishes, her family may file suit against the hospital and her husband as her power of attorney. The courts often point to the common law in the case of Schloendorff v. Society of New York Hospital that would support the families beliefs in right to self-determination. The courts argued that every human being of adult years and sound mind has the right to determine what shall be done with his or her body, any physician who performs an operation and fails to conduct respect for persons autonomy, commits assault and can be liable for damages (Mary E. Schloendorff v. the Society of the New York Hospital,, 1914, slip op. at 1).
Autonomy and the situational factors
Genna Paquette-
Situational Factors (also known as external factors) are influences that do not occur from within the individual but from elsewhere like the environment and others around you. Examples of situational factors are your environment, work and school, and the people around you. A huge situational factor in this case is when Melinda stated the following “During the discussion with Dr. Ryan, she reminded him of her advance directive and stated that her wishes concerning continuing treatment remain the same with the impending birth of their first child. “If there is any chance that I can ever see and hold my child,” she directed, “I want to have that chance. So, you keep me alive.” Her and Matt discussed her health concerns before they started having a family just in case if a situation like this happened, they would be prepared. The environment around Melinda knew and supported her decision on having a child and she made the executive decision that if there is any chance of her ever seeing her baby, she is going to take extreme measures to do so.
Shanice Moore-
In the event of one’s inability to make decisions, the principles of autonomy sets forth the right to protection for those with diminished autonomy. Recognized by the Fourteenth Amendment to the Constitution of the United States, the law upholds that an individual has the right to make his or her own healthcare decisions (George D. Pozgar, 2018). Autonomy is supported in the committee’s position because it is morally unjust to impose withdrawal of treatment when Melinda has a written directive inplace and has expressed her wishes verbally to Dr. Ryan. Melinda’s advance directive is strong evidence and significant in determining what she would want for substituted judgment, using Matt (her husband) as a surrogate decision maker to ensure “treatment should not be discontinued.” Melinda’s decisive choice to have treatment continued is her freedom to choose which is the main objective autonomy applies. According to Autonomy and the Kantian Deontological Tradition it is the duty of the physician to treat people’s illnesses, not to judge them for why they are ill (Furlong, 2018). This includes telling the truth and keeping promises, not withdrawing treatment would support Melinda’s autonomous decision and would follow the duty-base approach; an obligation in the sense that a person who follows the ethical paradigm believes the highest virtue comes from doing what you are supposed to do and what you agreed to do (George D. Pozgar, 2018).
There are many situational factors that could support the committee’s position not to withdraw treatment; one includes Melindas’ wide understanding of legal and ethical implications regarding end-of-life issues. Signing her advance directive two years prior to her present illness, helped exercise Melinda’s greater self-determination that supports that if a person is no longer competent, the rights still exist. Furthermore Melinda’s family who are emphatic to honoring her wishes as recorded on her advance directive is significant to social factors that can support this position. Legal factors include informed consent; a doctrine which provides that a physician has a legal, ethical, and moral duty to respect patients autonomy and to provide only such medical care as authorized by the patient. Melinda and Dr. Ryan discussed the possibilities of a recurrent episode of myasthenia gravis and the implications for her and the fetus, at which point Melinda reminded Dr. Ryan of her advance directive and stated that her wishes concerning continuing treatment remain the same with the impending birth of their first child directing “keep me alive.”
Weaknesses that can be found within the argument- Brandi Hurd
Not to withdrawal treatment:
Others from the opposing side could argue that Melinda’s health is deuterating, and Matt is under a great deal of stress taking care of his son as well as deciding what to do about Melinda’s situation. Melinda’s quality of life is no longer sustainable at the time. The intervention is no longer working in Melinda’s favor and is longer achieving her goals for care; it is ethically appropriate to withdraw care. “The patient’s surrogate clearly violates the patient’s previously expressed values, goals for care, or treatment preferences or is not in the patient’s best medical interest” (AMA n.d.). The goal of physicians is to relieve pain and suffering and sustain life. Life sustain treatment is any treatment that serves to prolong life without reversing the medical condition.
References
AMA.n.dWithholding or Withdrawing Life-Sustaining Treatment. Retrieved from www.ama-assn.org
Bioethics Forum 13 (2), Summer 1997
Mary E. Schloendorff v. The Society of the New York Hospital,, No. 211 N.Y. 125 (Apr. 14, 1914).
Morrison, E. E., & Furlong, B. (2019).Health Care Ethics (Fourth ed., pp. 41-42, 44-45). Burl, MA: Jones and Bartlett Learning.
Morrison, E. E., & Furlong, B. (2019).Health Care Ethics (Fourth ed., pp. 41-42, 44-45). Burl, MA: Jones and Bartlett Learning.
Talebreza, S., & Widera, E. (2015, April 1). Advance Directives: Navigating Conflicts Between Expressed Wishes and Best Interests. Curbside Consultation, 91(7), 480-484. Retrieved from https://www.aafp.org/afp/2015/0401/p480.html
Pozgar, G. D. (2018). Legal aspects of healthcare administration (13th ed.). Jones and Bartlett.