Medical Bioethics
When dealing with critically ill patients who require special care and end-of-life matters, there are many factors that should be considered. Therefore, bioethics plays a great role in determining a patient’s fate. Professionals have to consider what is advocated for constitutionally and what the patient and its family wishes. This paper aims at discussing five cases that are closely related to end-of-life issues.
Section 1
Universally practice of medicine ethically and lawfully respects life and aims at promoting it. Hippocrates oath sworn by all medical practitioners requires that life is respected as well as patient confidentiality and decisions (McHugh, 1996). General American bioethics requires respect for persons, beneficence, and justice are practiced by physicians.
Respect for persons requires that medical practitioners respect decisions of autonomous persons and protect people that lack capacity in decision making and are therefore considered non-autonomous. Under this situation, Mrs. B is risking the life of her unborn child to contracting the HIV virus. The child has a right to life, protected from any kind of potential harm and be allowed to live a health life (McHugh, 1996). It is the moral and ethical duty of physicians to ensure safety of non-autonomous patients like the unborn child from harmful decisions made by Mrs. B. Clearly, the unborn child is a third party caught between the beliefs and denial of the mother and it requires physicians with medical knowledge to protect it from any kind of harm.
Principle of beneficence requires that any kind of medical treatment or recommendation be for the benefit of the patient and any third party involved (Furrow, 2001). Taking antiviral drugs benefits both Mrs. B and the unborn child. It improves life of the child by ensuring it is born HIV free and prolongs the life of the mother. This is beneficial not just health-wise but also increases the life span that Mrs. B can spend with her child once it is born.
Mrs. B is confused and revelation of her HIV status affects her critical thinking therefore the hospital in this case has a right to do what is best for her and the unborn baby. The state of her sound mind should be questioned since she depicts behavior of a person in denial. Clearly this discovery affected her mentally and psychologically and this requires court to grant the hospital and physicians the power to do what is best for her and the baby.
However, Mrs. B’s decision of not wanting to take any antiviral cocktails should be respected at all cost. Seeking to have the court intervene in the matter goes against this moral ethic and questions practice of medical practitioners. There is a right to decision making and when this right is broken it questions the level of democracy in the field of medicine (Furrow, 2001). It also jeopardizes patient confidentiality sworn by physicians. Having the court intervene exposes this vital information to masses of people which increases chances of stigmatization and abandonment by society. This in the end is harmful for the baby and persuasion should be the only method that medics use in convincing Mrs. B to take the antiviral cocktail.
Despite all this principles, the sanctity of life is the major driving force in practice of medicine. Saving and improving life is what medics are meant for and if taking antiviral cocktail is best for the mother and unborn child then it should be implemented. There is no justification in jeopardizing the health and life of people who are incapable of fighting for themselves over life principles like respect. There are no life principles if there is no life (McHugh, 1996).
Mrs. B should prevail in this case. Normally, law grants pregnant women the discretion and freedom to do what they see fit for the unborn baby. That is why abortion has been legalized and the question of good or bad parenthood is mostly applied in already born children. Mrs. B may have broken the enacted statute but charging her is more harmful to the baby and will definitely impact on the matter of parenthood and custody of the baby. Charging Mrs. B will mean that the baby will be given up to foster care and will have no opportunity of being brought up by her biological mother. Basing on facts and existing research this will affect the child psychologically in future.
Discovery of contraction of HIV virus affected Mrs. B’s rational and critical thinking therefore the state prosecutor is not justified in prosecuting her. It caused increased level of stress that impaired her judgment and sanity. Considering that she was not in her right senses, she should not be charged (McHugh, 1996). It is a killer virus and the state should not take more from such a person. To the best interest of the child, the state prosecutor should ensure guidance and counseling for Mrs. B to relieve her stress. If anything, charging her means more stress for her which could negatively affect her parenting skills.
Section 2
Law and medical ethics require that any measure be applied to enhance the life of a patient despite the circumstances and depending on his or her consent (McHugh, 1996). Claims by Mrs. C have no proof and, therefore, the state and hospital should do what if beneficial to the patient. Absence of a written statement authorizing physicians not to connect him to life supporting machines require that medics carry out their first most important moral and ethical duty which is to improve life in any way possible.
Mr. C has a right to have his life fought for despite his non-autonomous state. According to ethics, respect for persons in this case requires respecting Mrs. C’s decision as the next of kin and protecting Mr. C who is incapable of making decisions. Respect actually requires respecting Mr. C’s decision on the matter which is not provided by any prior statement therefore state and hospital should do what is perceives beneficial to the patient (McHugh, 1996).
Self-induced suicide or murder is a crime against criminal law. It is against medical practice to help patients commit suicide or murder whether they request it or not. Mrs. C violates the law and requires to be charged for that. She has no power in deciding the death of her husband whether it was his wish or not. Death is a natural cause and should remain that way under all circumstances. It is against humanity to advocate the death of a patient in the life supporting machines unless one can physically prove it (Furrow, 2001).
However, Mrs. C sees the pain that her husband if going through and disconnecting the machines is the only way of relieving him of the pain. Medical practice aims at relieving pain from patients but the longer he stays on the machine the more he suffers which is against this code. She also wants to fulfill her husband’s wish which was never be sustained by machines in the event of a brain malfunction. She as the next of kin has a right to make this decision and she understands what her husband expects of her. Therefore, it is her duty to decide what is best for him. McHugh (1996) argues that the life supporting machines are prolonging his pain since he contracts pneumonia and is prone to contracting other diseases. Therefore, Mrs. C has the legal right to decide what is best for her husband and at the same time relieve him of his pain.
In spite of this, medical practitioners are sworn to saving lives, improving lives, respect, and confidentiality. If they advocate that Mr. C be kept alive then it is necessary to do so since Mrs. C crosses the line when she goes as far as asking a physician to murder her husband. Her intentions maybe pure but her approach is completely wrong. The life of Mr. C should be safeguarded for his benefit.
Section 3
Absence of Mr. K’s consent in the matter counters this request. Mr. K left no prior written statement allowing harvesting of his sperms for his wife’s use upon his death. A written statement advocating that would justify Mrs. K request but its absence therefore shows that it was not his wish. Legally and ethically, donation of any body organs requires prior consent of the donor through a written statement authorizing this request (McHugh, 1996). If Mr. K had wanted to have a child with wife his under all circumstances then he would have allowed it through written documents. This shows that even if he wanted to be a father he had his limit as to when that would end and that is his death. It proves that he only wanted to be a biological father if he was alive, breathing, and had the opportunity to directly raise his children. Therefore, court has no right going against his wishes to satisfy the emotional demands of his wife in wanting to feel connected to him.
According to laws regarding assisted reproduction, physicians have no obligation in assisting couples or individuals who are incapable of having children naturally. Issues like in-vitro fertilization, cloning, post-hummus reproduction, sperm and egg donation, and surrogacy go against the natural law of sex as a means of reproduction and are an intrusion of in the sacred covenant between a couple. Ethical right that children should be able to know their roots is violated since the death of Mr. K means that he will not participate in raising the child (McHugh, 1996). If Mr. and Mrs. K planned on having children later in the marriage then timing does not all harvesting of his sperms. If anything, the couple talked about bringing up the children together therefore indicating that his wish was to be present and actively participant in this process. Therefore, court should deny the request to allow harvesting of his sperms.
Section 4- The press release
Many states practice organ donation after circulatory determination of death. These programs increase organ pools and patients have a chance to donate organs if they are not brain dead. The state Senator proposed that the ‘dead donor rule’ should be changed to a circulatory standard. In DCD (Donation after Circulatory Death), procuring crucial organs immediately in seventy five seconds following circulatory arrest is not a violation of DDR (Dead Donor Rule) since circulation cessation has become permanent (McHugh, 1996). It is worth pointing out that losing the circulatory function permanently is dissimilar to irreversible conventional meaning; circulation can never be reversed that has been the ancient requirement for death declaration. In addition, this weak assertion of permanence as far as DCD protocols are concerned might be permitting organ procurement sometimes when consciousness and brain function are not irreversibly lost.
Basically, DCD involves donation following uncontrolled (Spain, France, and United States) and controlled (United Kingdom, Canada, United States, and Netherlands) circulatory death. In DCD, there is permanent cessation where people may be declared dead when their vital functions can be reversed. Electrical cardiac activity on its own is irrelevant in determining death. Only spontaneous blood circulation in the body is considered to be meaningful resuscitation (Furrow, 2001).
Physicians need to apply death’s circulatory criterion similarly regardless of whether organs are to be donated or not (McHugh, 1996). If a patient with a DNR (Do Not Resuscitate) order is dying and not an organ donor, usually death is declared at the asystole moment, during when the patient can be resuscitated if CPR (cardiopulmonary resuscitation) is attempted. Therefore, physicians only need permanent circulation cessation so as to be able to declare death.
However, irrespective of the state Senators assertions, the standard organ replacement’s moral framework emphasizes that the DDR (Dead Donor Rule) should be respected. It is worth pointing out that there are persistent controversies concerning the crucial status of individuals that undergo DCD (Donation after Circulatory Death) and brain-dead donors (Furrow, 2001). DDR is associated with increased organ supply while maintaining transplantation systems’ trust. In this regard, the society is reassured that donors will undergo no hard as organs are being procured. Although there is credibility in the assumption that no harm can be exposed to people after they are dead as far as brain-dead protocols are concerned, it is worth emphasizing that DDR is an inappropriate strategy for protecting donors from harm during DCD protocols. Organ procurement practices are justifiable if the donors are adequately protected from harm, respected accordingly through informed consent, and making sure that the society is fully aware of the intrinsically debatable nature of the criteria for death declaration (McHugh, 1996).
Considering that Mrs. M had secured an advance directive that she could be an organ donor and the hospital has a non-heart beating donor practice, she applies under the ‘dead donor rule.’ Although Mrs. M has issued an advance directive that life support should not be used to sustain her is such a case arose, she is on a ventilator since this is more beneficial to her health. There is no consensus regarding the period that circulation should cease for an individual to be declared dead. Regardless of all this, DDR is still considered the standard and moral organ replacement framework.
Section 5
This provision is not constitutional. In 1990, the US Supreme Court legally rules out that artificial hydration and nutrition are similar to other life-sustaining treatments. Life-sustaining treatments ought to offer medical benefits to patients and respect their preferences, as communicated by legally recognized surrogates or patients (McHugh, 1996). Treatments including hydration, artificial nutrition, and mechanical ventilation can only be provided if authorized by a court, surrogate, or patient. After they have been started, life sustaining treatments can be withdrawn ethically is the court, patient, or surrogate authorizes. Patients possess a right of participating in decisions regarding their medical care. This is a fundamental medical ethics principle that applies for all forms of medical treatments. On the same note, patients can deny treatments even if the consequence of this is death (Furrow, 2001).
It is illegal for physicians to administer medications that are likely to cause patient death. According to McHugh (1996), the Court never identifies a right to permit physicians to assist in dying. In this case, the state laws’ merits that hinder physician- assisted suicide can only be decided by states. On the same note, the Americans are forbidden from ending or refusing life-sustaining treatments including feeding tubes and ventilators. According to the Court, there is an outright difference between helping and letting someone die. Refusing treatment is giving the disease a chance to take its natural course. This is different from having a person who is helping in suicide (Furrow, 2001).
The Court also stresses on the significance of pain control in patients. Patients are entitled a right to symptom and pain management. In the United States, it is illegal for physicians to give lethal injections, prescribe pills deliberately, or be present when a patient is committing suicide. The US Supreme Court handled two cases that were related to physician-assisted suicide in 1997; Gregoire v. Glucksberg and Vacco v. Quill (McHugh, 1996). According to the court, there is no Constitutional permission towards physician-assisted suicide be it founded on personal liberty or equal protection. During its decisions, the Court was aware of the numerous unwanted and unintended impacts that could result if assisted suicide was acknowledged constitutionally. In these cases, the Court allowed states to decide the legitimacy of physician-assisted suicide.
For instance, in Oregon State, physicians are permitted to prescribe overdoses to certain patients as no legal actions may follow (Furrow, 2001). In these cases, it is the patients who take the drugs on themselves and, therefore, the physicians are not administering lethal drugs directly. All United States jurisdictions forbid physicians from administering lethal drugs intentionally (McHugh, 1996).
The manner in which physicians view pain management in terminally ill patients is based on individual autonomy’s value, the significance of treating symptoms, and fear of narcotics’ addiction. Narcotics may be accompanied by side effects such as respiratory depression, constipation, inability to focus, and drowsiness. Physicians are usually in fear of criminal and legal scrutiny as well as punishment for excessive prescription of narcotics or giving them to wrong people.
In the light of this discussion, physicians should avoid prescribing medications that cause death. In addition, pain management medications should be beneficial to the patients. Patients have a right towards making decisions about their health as long as they are mentally sound. Although the law generally forbids physician-assisted suicide, end-of-life issues are upon the decisions of different states. Finally, life-supporting treatments should not be terminated unless indicated so.
References
Furrow, B. R. (2001). Bioethics: Health Care Law and Ethics. New York: West Publishing Company, College & School Division.
McHugh, P. R. (1996). Hippocrates a’la Mode. Natures Medicine, 2: 507-509.
