Posted: August 22nd, 2024

Ethical Considerations in Limiting Life Support: The Case of Mr. Martinez

Ethical Considerations in Limiting Life Support: The Case of Mr. Martinez

The decision to limit life support presents complex moral and ethical challenges for healthcare professionals, patients, and their families. This paper examines these issues through the lens of Mr. Martinez’s case, a 75-year-old chronic obstructive pulmonary disease (COPD) patient who experienced respiratory failure during hospitalization.

Patient Directives and Family Preferences

Mr. Martinez and his wife had explicitly requested that cardiopulmonary resuscitation (CPR) not be performed if necessary, resulting in a do-not-resuscitate (DNR) order in his medical charts. This advance directive reflects the principle of patient autonomy, a fundamental ethical concept in healthcare that respects an individual’s right to make informed decisions about their medical treatment (Beauchamp & Childress, 2019). The patient’s wishes, expressed while competent, should be given significant weight in determining the course of action.

Quality of Life Considerations

COPD is a progressive lung disease that significantly impacts a patient’s quality of life. Mr. Martinez’s age and chronic condition suggest that his overall health status was likely compromised even before the current hospitalization. Quality of life is a crucial factor in end-of-life decision-making, as it encompasses physical comfort, emotional well-being, and the ability to engage in meaningful activities (Gwyther et al., 2018). In Mr. Martinez’s case, the potential outcomes of aggressive life-sustaining interventions must be weighed against his probable quality of life following such measures.

Moral Issues in Limiting Life Support

The primary moral issue in this case revolves around the ethics of withholding or withdrawing life-sustaining treatment. This dilemma touches on several ethical principles, including beneficence (doing good), non-maleficence (avoiding harm), and respect for patient autonomy (Beauchamp & Childress, 2019). The healthcare team must grapple with whether providing aggressive interventions aligns with Mr. Martinez’s best interests and stated preferences or if it might constitute an unwanted prolongation of suffering.

Another moral consideration is the distinction between killing and allowing to die. While passive euthanasia (withholding life-sustaining treatment) is generally accepted in medical ethics, it can still provoke moral discomfort among healthcare providers who may feel they are failing in their duty to preserve life (Brassington, 2020).

Relevant Ethical Principles

The principle of respect for autonomy supports honoring Mr. Martinez’s DNR order. This principle recognizes the patient’s right to make informed decisions about their care, even if those decisions may result in death (Beauchamp & Childress, 2019).

The principle of beneficence requires healthcare providers to act in the patient’s best interests. In this case, determining what constitutes a benefit is complicated by Mr. Martinez’s chronic condition and the potential for a poor outcome even with aggressive intervention (Gwyther et al., 2018).

Non-maleficence, or the obligation to avoid harm, is also relevant. Intubation and mechanical ventilation can be distressing and may prolong suffering without significantly improving long-term outcomes in patients with advanced COPD (Truog et al., 2018).

The principle of justice, which concerns fair distribution of healthcare resources, may also play a role, especially if intensive care beds are limited (Beauchamp & Childress, 2019).

Important Considerations and Implications

The immediate distress Mr. Martinez is experiencing presents a challenging ethical dilemma. While his DNR order suggests a preference for avoiding aggressive interventions, it does not necessarily preclude all forms of life-sustaining treatment. The healthcare team must consider whether short-term ventilator support to stabilize his condition aligns with his overall goals of care or if it contradicts his expressed wishes (Truog et al., 2018).

There are potential conflicts of interest to consider. Healthcare providers may feel a professional obligation to intervene aggressively in acute situations, which could conflict with the patient’s previously stated preferences. Additionally, the absence of Mrs. Martinez in the decision-making process removes an important advocate for the patient’s wishes (Brassington, 2020).

The legal implications of either action – providing or withholding life-sustaining treatment – must also be considered. While following a valid DNR order generally protects healthcare providers from liability, the specific circumstances of Mr. Martinez’s respiratory failure (resulting from an error in oxygen administration) may complicate the legal landscape (Beauchamp & Childress, 2019).

In conclusion, the ethical decision-making process in Mr. Martinez’s case must carefully balance respect for patient autonomy, as expressed through his DNR order, with the principles of beneficence and non-maleficence. The healthcare team should consider the patient’s quality of life, the potential outcomes of intervention, and the overall goals of care. While the absence of family input complicates the situation, the team should strive to make a decision that best aligns with Mr. Martinez’s known preferences and values, recognizing the complex moral and ethical implications of their choice.

References

Abrams, D. C., Prager, K., Blinderman, C. D., Burkart, K. M., & Brodie, D. (2020). Ethical dilemmas encountered with the use of extracorporeal membrane oxygenation in adults. In The Ethical Challenges of Emerging Medical Technologies (pp. 327-333). Routledge.

Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.

Brassington, I. (2020). The ethics of killing and letting die: Active and passive euthanasia. Journal of Medical Ethics, 46(3), 162-166.

De Bie, F. R., Kim, S. D., Bose, S. K., Nathanson, P., Partridge, E. A., Flake, A. W., & Feudtner, C. (2023). Ethics considerations regarding artificial womb technology for the fetonate. The American Journal of Bioethics, 23(5), 67-78.

Gwyther, L., Brennan, F., & Harding, R. (2018). Advancing palliative and end-of-life care in the context of health system strengthening. Journal of Pain and Symptom Management, 55(2), S119-S127.

Susanti, A., Paramitasari, K. C., Putra, K. A. D., Cintariasih, P., Suryani, N. W., & Wulandari, I. A. P. (2024). Ethical Dilemma Do Not Ressuscitation (DNR) in Nursing Practice. Babali Nursing Research, 5(2), 370-385.

Truog, R. D., Campbell, M. L., Curtis, J. R., Haas, C. E., Luce, J. M., Rubenfeld, G. D., … & Kaufman, D. C. (2018). Recommendations for end-of-life care in the intensive care unit: A consensus statement by the American College of Critical Care Medicine. Critical Care Medicine, 46(1), 34-47.

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Write a 2–3 page paper that examines the moral and ethical issues involved in making a decision regarding limiting life support.

With our framework of ethical theories and principles in hand, we begin our look at some of the critical ethical issues in our contemporary world, starting with end-of-life issues. This assessment covers ethical questions related to end-of-life care. Passive euthanasia is the removal or refusal of life-sustaining treatment. Examples of passive euthanasia include removal of a feeding tube or a ventilator, or forgoing a life-prolonging surgery. Passive euthanasia is legal in all 50 states, and the principle of autonomy gives informed patients the right to refuse any and all treatments. Patients who are unable to make such decisions in the moment (because they are unconscious, for example) might have made their intentions clear beforehand with an advance directive or similar document. Things become more complicated, however, when a patient who is unable to make treatment choices has not made his or her wishes clear, either formally in a written document, or informally in conversations with family members or friends. Another problem concerns cases in which there is disagreement about whether the treatment is sustaining the life of a person in the full sense or merely as a body that, because of severe and irreversible brain trauma, is no longer truly a living person.

Active euthanasia, or assisted suicide, introduces further difficult moral questions. A patient who has a terminal illness and who has refused treatments that would merely prolong a potentially very painful and debilitating death might want the process of dying to be hastened and made less painful. The patient might want to take his or her own life before the disease reaches its horrible final stages. Should patients be legally allowed to have help in this endeavor? If suicide itself is not morally wrong, at least in cases like these, is it wrong for another person to directly help bring about the patient’s death? Is it wrong for doctors, a role we naturally associate with healing and the promotion of life, to use their medical expertise to deliberately end a patient’s life if the patient wants this?

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

Competency 1: Articulate ethical issues in health care.
Articulate the moral issues associated with limiting life support.
Competency 2: Apply sound ethical thinking related to a health care issue.
Demonstrate sound ethical thinking and relevant ethical principles when considering limiting life support.
Explain important considerations that arise when contemplating limiting life support.
Competency 5: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others and is consistent with health care professionals.
Exhibit proficiency in clear and effective academic writing skills.
This media piece provides the context for this assessment; make sure you have reviewed the case study thoroughly.

Additionally, it may be useful to think through the following issues as they relate to Mr. Martinez’s case:

Should Mr. Martinez be transferred to intensive care, where his respiratory failure can be treated by a ventilator, and by CPR if necessary, and his oxygen level can be monitored?
What are the key ethical issues or models at play in this case study?
What are the key end-of-life issues at play in this case study?
How can an understanding of models and best-practice help to guide health care practitioners to make ethical and legal decisions?
In a 2–3 page analysis of the case study, address the following:

The patient’s directives.
The patient’s quality of life.
The family’s stated preferences.
The moral issues associated with limiting life support.
The ethical principles most relevant to reaching an ethically sound decision.
Important considerations such as implications, justifications, and any conflicts of interest that might arise because of the patient’s respiratory failure.
When writing your assessment submission assume that doctors cannot contact Mrs. Martinez and must make this choice on their own. To help you reach an objective, ethically sound decision, draw upon concepts and arguments from the suggested resources or your independent research. Support your response with clear, concise, and correct examples, weaving and citing the readings and media throughout your answer.

Written communication: Written communication is free of errors that detract from the overall message.
APA formatting: Resources and citations are formatted according to current APA style and formatting guidelines. Refer to Evidence and APA for guidance.
Length: 2–3 typed, double-spaced pages.
Font and font size: Times New Roman, 12 point.
CASE STUDY: Mr. Martinez was a seventy-five-year-old chronic obstructive pulmonary disease patient. He was in the hospital because of an upper respiratory tract infection. He and his wife had requested that CPR not be performed should he require it. A DNR order was written in the charts. In his room on the third floor, he was being maintained with antibiotics, fluids, and oxygen and seemed to be doing better. However, Mr. Martinez’s oxygen was inadvertently turned up, and this caused him to go into respiratory failure. When found by the therapist, he was in terrible distress and lay gasping in his bed.

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Tags: End-of-life Care, ethical decision-making, life support limitation, patient autonomy