Introduction
The discussions in this biomedical ethics case study involving the death of a patient named Mr. Paul Mills during his stay at one of the hospitals in Halifax, Nova Scotia will focus on whether Dr. Nancy Morrison’s decision to help end the patent’s suffering by injecting nitroglycerin into the IV line in an unsuccessful attempt to decrease blood pressure and thereby end the patient’s suffering and on a separate instance, injecting potassium chloride a few minutes prior to the patient’s point of expiration. It is important to note that this paper will not focus on the medical but on the moral ethics side of the case. In order to come up with a valid assessment of the case, one has to be able to establish the key facts first. Some of the morally-relevant facts include Mr. Paul Mills’ already bad condition prior to Dr. Nancy Morrison’s allegedly unethical intervention; the fact that “A DNR (Do Not Resuscitate) order was put in place, and on 9 November, when it became clear that there was no hope of recovery, the family agreed to withdraw active life support in favor of palliative care”.
Additionally, physician-assisted suicide or euthanasia is already legal in the entire country of Canada and so what is needed to be focused more on would be how Dr. Morrison implemented the term physician-assisted in Paul Mills’ case. The attending nurse may also be at fault here because Dr. Morrison appears to have acted in accordance with attending nurse Bland MacInnes’ request to relieve the patient (i.e. Paul Mills) of his apparent agony. This request from the attending nurse was based on her highly negative perception and description of the patient’s experience. It is worth noting that other members of the medical team (e.g. ICU resident Dr. Cohen) described the patient’s experience as the only signs of distress and discomfort. The main moral questions here, however, are whether there was a violation of biomedical ethics in Paul Mills’ case.
In this paper, the author argues that what happened or specifically what Dr. Morrison committed was not in line with the agreement that was made between the hospital and the patient’s family, hence there was a clear violation of biomedical ethics committed by Dr. Morrison and the attending nurse Bland MacInnes.
Arguments for Side 1
The first side of the argument suggests that Dr. Morrison and Bland MacInnes’ committed a violation of established biomedical ethics norms and the law on physician assisted death in Canada. This argument is supported by the fact that they acted based on their own perception and not on the agreement that was made between the patient, his family, and the hospital. The agreement was that the medical staff would not resuscitate the patient if it is already appearing that he is dying because both the side of the family and the attending medical team have agreed that continuing the provision of life support was futile and would not really lead to any significant health and other outcome improvement for the patient; if anything, it would only prolong his agony and that of his family as well as they continue to witness his body deteriorate (e.g. pus oozing out of his body every time he moves violently, numerous tubes, machines, and equipment being connected to his body just to keep him alive). The directive was for the medical team to focus on palliative care.
In order to determine whether there was indeed a violation of the agreements (which would constitute as a violation of biomedical ethics as well), a clear definition of palliative care must be provided. Palliative care, within the context of treatment of terminal illnesses like cancer, is “care given to improve the quality of life of patients who have a serious or life-threatening disease”. The main objective is to treat not the disease itself, but only its secondary complications such as pain and discomfort. It is important to note, however, that its goal is not to force the patient’s expiration—but rather to improve his condition so that he could pass away with ease and as much comfort as possible.
Applying this to the current case, the logical question to ask would be whether the appropriate palliative care was provided. Some indications that suggest that it was indeed appropriately provided would include the administration of the pain medications to make the patient’s condition less miserable. However, the turning point was when Dr. Morris, who was technically under the directive of the nurse Bland MacInnes appeared to have initiated the death of the patient. Their actions can technically be considered as against the definition of palliative care—i.e. It was not palliative care that they initiated, but from a legal standpoint, first degree murder. They were supposed to provide comfort to the patient and not to end his life.
Focusing entirely on Dr. Morrison’s situation, the weakness of this argument would be the fact that her involvement in the technically premature death of the patient was in good faith. This was, in fact, something that the court considered when Nova Scotia’s College of Physicians and Surgeons chose to issue a formal reprimand instead of a higher degree of corrective action.
Arguments for Side 2
The second side of the argument suggests that Dr. Nancy Morrison and nurse Bland MacInnes did not commit a violation of biomedical ethics despite the actions that they committed. In order to prove this, one has to be able to prove that there was no violation of the agreement between the hospital, Paul Mills, and his family. This argument’s strongest point would be the fact that Bland MacInnes described Paul Mills’ experience as the worst death, she has ever experienced as it was violent, horrible, and hideous. The main weakness and the most reliable evidence that can then be used to determine the validity of this second argument, on the other hand, would be the results of the investigation of the Nova Scotia College of Physicians and Surgeons. The said organization ruled that the use of the drugs (i.e. nitroglycerin and potassium chloride) was outside the scope of Mr. Mill’s medical management under the supposedly palliative care-centered directive.
Recommendations and Conclusions
Based on the data from the case and other credible sources that were presented, it would be safe to conclude that there was indeed a biomedical ethics violation committed by both Dr. Nancy Morrison and attending nurse Elizabeth Bland MacInnes. This is based on the notion that they decided to intervene (or in the case of Bland MacInnes, influence another person to intervene) and breach an already-made agreement between the patient, his family members, and the hospital management. The directive was to focus on palliative care and treatment and to not resuscitate the patient (i.e. withdrawal of life support systems). According to the information presented and as supported by the main outcome of the case determined by the Nova Scotia College of Physicians and Surgeons, Dr. Morrison and nurse Bland MacInnes violated this specific part of the agreement. This therefore constitutes a biomedical ethics violation. This also directly confirms the validity of this case study’s thesis statement. The recommendation therefore would be for healthcare professionals to simply follow the agreements made between the different parties involved in any case, and to set their emotions and own opinions aside once such agreements have already been made.
Bibliography
Canadian Virtual Hospice. (2016). What is Palliative Care. http://www.virtualhospice.ca/en_US/Main+Site+Navigation/Home/Topics/Topics/What+Is+Palliative+Care_/What+Is+Palliative+Care_.aspx.
Fisher, J. (2013). Biomedical Ethics - A Canadian Focus. Oxford University Press Canada, 262.
NIH National Cancer Institute. (2016). Palliative Care in Cancer. NIH, http://www.cancer.gov/about-cancer/advanced-cancer/care-choices/palliative-care-fact-sheet#q1.
Palmer, R. (2016). Canada's High Court Gives Green Light to Assisted Suicide. Reuters, http://www.reuters.com/article/us-canada-euthanasia-idUSKCN0UT2FJ.
