PHI-FPX3200-Should We Withhold Life Support? The Mr. Martinez Case
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Should We Withhold Life Support? The Mr. Martinez Case
School of Nursing and Health Sciences, Capella University
PHI-FPX3200-Ethics in Health Care
May 26, 2023
Should We Withhold Life Support? The Mr. Martinez Case
Introduction
A patient suffering from chronic obstructive pulmonary disease (COPD) named Mr. Martinez, who was 75 years old, was taken to the hospital because he had an upper respiratory tract infection. The research investigates a number of different factors, such as the patient's instructions, the quality of life, the family's expressed wishes, the ethical concerns related with restricting life support, applicable ethical principles, and crucial considerations that may emerge owing to the patient's respiratory failure.
Patient's Directives
Mr. Martinez's directives play a crucial role in guiding the decision-making process regarding his end-of-life care. He and his wife had explicitly requested that CPR not be performed in the event he required it, leading to the inclusion of a Do-Not-Resuscitate (DNR) order in his medical chart. This indicates that Mr. Martinez had made a conscious decision regarding his treatment preferences and desired to forego aggressive life-saving measures. Respecting the patient's directives is a fundamental aspect of medical ethics, rooted in the principle of autonomy. Autonomy recognizes an individual's right to make decisions about their own healthcare, including choices related to life-sustaining interventions. By adhering to Mr. Martinez's directives, healthcare professionals uphold his autonomy and honor his wishes, ensuring that his values and preferences guide the course of his medical care. The presence of a written DNR order serves as evidence of Mr. Martinez's informed decision and emphasizes the importance of honoring his autonomy, even in the absence of direct communication with Mrs. Martinez. While the inability to contact Mrs. Martinez may limit the ability to gather updated information about the family's preferences, it does not negate the significance of Mr. Martinez's own wishes as expressed in the DNR order.
Patient's Quality of Life
In the case study, when Mr. Martinez's oxygen was inadvertently turned up, he went into respiratory failure and was found in terrible distress, gasping for breath in his bed. This distressing situation indicates a significant deterioration in his quality of life at that moment. Gasping for breath and experiencing respiratory failure can be extremely distressing, causing discomfort, anxiety, and suffering. Given that Mr. Martinez is a chronic obstructive pulmonary disease (COPD) patient, it is reasonable to assume that his baseline quality of life may already be impacted by his underlying condition. COPD is a chronic and progressive respiratory disease that can severely limit lung function, leading to difficulties in breathing, reduced physical activity, and diminished overall well-being. Considering the distress and suffering Mr. Martinez experienced during respiratory failure, it becomes essential to prioritize interventions that alleviate his symptoms and improve his comfort. In this case, it may be ethically appropriate to focus on providing palliative measures to address his distress and promote a better quality of life, rather than pursuing aggressive life-saving interventions that might prolong his suffering without offering significant benefits.
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Family's Stated Preferences
In the absence of direct communication with Mrs. Martinez, it becomes challenging to obtain updated information about the family's preferences. However, it is important to recognize that the previously expressed wishes of Mr. Martinez and his wife, as reflected in the DNR order, hold significant weight in guiding the decision-making process. When family members are involved in end-of-life care decisions, it is essential to consider their perspectives and values. However, in this case, the inability to contact Mrs. Martinez necessitates a focus on honoring the patient's own directives and autonomy. The medical team must place primary importance on respecting Mr. Martinez's previously expressed wishes, as documented in the DNR order, and ensuring that his end-of-life care aligns with his values and preferences. Respecting the patient's autonomy and adhering to his previously stated directives should guide the medical team's decision-making process, while efforts to maintain open communication with the family should be made as circumstances allow (Robert et al., 2020).
Moral Issues Associated with Limiting Life Support
Limiting life support raises several moral issues, including autonomy, beneficence, non-maleficence, and justice. Autonomy emphasizes the importance of respecting patients' decisions regarding their medical care. In this case, Mr. Martinez's previously expressed directives, reflected in the DNR order, highlight the significance of respecting his autonomy. According to Curtis et al. (2020) beneficence and non-maleficence require considering what is in the patient's best interests and avoiding harm. It can be argued that honoring Mr. Martinez's wishes aligns with these principles, as aggressive interventions may not be beneficial and could potentially cause harm. Justice entails ensuring fair and equitable access to healthcare resources, considering the allocation of resources in the context of the patient's condition and prognosis.
Ethical Principles Relevant to an Ethically Sound Decision
The ethical principles most relevant to reaching an ethically sound decision in this case are autonomy, beneficence, and non-maleficence. Respecting Mr. Martinez's autonomy entails honoring his previously expressed wishes and the DNR order. Considering his best interests, it is reasonable to conclude that aggressive interventions, such as CPR, may not align with his goals for end-of-life care (Farrel et al., 2020). Upholding the principles of beneficence and non-maleficence involves preventing unnecessary suffering and ensuring his comfort and dignity.
Important Considerations and Conflicts of Interest
In the absence of direct input from Mrs. Martinez, conflicts of interest may arise within the medical team regarding the appropriateness of providing life support despite the patient's directives. However, the medical team must prioritize Mr. Martinez's previously expressed wishes and the DNR order. Palliative measures should be implemented to alleviate his distress and suffering, ensuring his comfort and dignity.
Conclusion
In the case study of Mr. Martinez, his previously expressed directives, the significant distress he experienced during respiratory failure, and the presence of a DNR order indicate the importance of respecting his autonomy and considering his best interests. Ethical principles such as autonomy, beneficence, and non-maleficence guide the decision-making process, emphasizing
References
Curtis, J. R., Kross, E. K., & Stapleton, R. D. (2020). The importance of addressing advance care planning and decisions about do-not-resuscitate orders during novel coronavirus 2019 (COVID-19). Jama, 323(18), 1771-1772. https://doi:10.1001/jama.2020.4894
Farrell, T. W., Francis, L., Brown, T., Ferrante, L. E., Widera, E., Rhodes, R., ... & Saliba, D. (2020). Rationing limited healthcare resources in the COVID‐19 era and beyond: ethical considerations regarding older adults. Journal of the American Geriatrics Society, 68(6), 1143-1149. https://doi.org/10.1111/jgs.16539
Robert, R., Kentish-Barnes, N., Boyer, A., Laurent, A., Azoulay, E., & Reignier, J. (2020). Ethical dilemmas due to the Covid-19 pandemic. Annals of intensive care, 10, 1-9.
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