The ethical issue is derived from whether doctors should have hard paternalism over patient autonomy when a decision could negatively affect the patient’s health goals. Some of the pertinent ethical facts in the case of whether Mrs. B may be taken off of life support is as followed:
Does Mrs.B have a living will and has her daughter inquired for it? If Mrs. B has a living will, some state’s jurisdiction will insist that any directions in it must not be compromised by her daughter's decisions.
Does Mrs. B's condition render the requirements necessary to prompt the provisions of the health care power of attorney edict? Often times, the certification must consist of an opinion regarding the cause and nature of the patient’s inability to consent.
The concept of hard paternalism is interfering with a competent person’s liberty for that person’s own good. Furthermore, strong paternalism is defined as interfering with a competent person’s liberty for that person’s own good, due to the judgment that the person’s goals are mistaken. These paternalisms are harder to justify ethically than weak paternalism, especially in hospitals. The issue with doctor paternalism has become an ethical battle in which physicians are monopolizing the patient-physician relationship. Meanwhile, patients and their families have resorted to fight in court, in order to claim their right to patient autonomy. I believe that the decision is much more complicated than whether the patient or their family have an autonomous right. There is no disagreement in honoring the will of the patient, or an appointed family when the patient no longer has the capacity to make medical decisions. However in the case of Mrs. B and her daughter, there are two points, which have led me to contend that doctors should not allow the discontinuation of oxygen via facemask.
Firstly, while Mrs. B did authorize her daughter to make medical decisions for her, the daughter should then be treated as though she were the patient. Therefore, Mrs. B’s daughter must have full competency of the patient’s current state and the prolonged results of her options. What is troubling about the particular case of Mrs. B is not whether they have the right to refuse life-support. She does. Instead, it is more so the question of whether the Mrs. B or her daughter has been fully informed to competently consent the goals of the patient’s care. Mrs. B’s daughter seems to lack direction and wavers in her decisions. Despite consenting to a DNR order, her daughter still assents to intubations, which may have made the quality of Mrs. B’s remaining life. Often times, for the family, this is both a case of misinformation and a psychological battle. The physicians would simply ask if the family is consenting to the DNR order, without fully explaining the patient’s up to date situation. The family would then feel the need to, “do everything and save them,” (Saunders, 2003) as the option to simply let their family die would weigh heavy on their psyche. Often times the family member would feel comforted by the fact that something is done, even when it is a futile effort, rather than allowing their loved ones to die.
Secondly, the patient still retains a minimal amount of consciousness throughout the process of extracting antibiotic and food. The only remaining “treatment” (Saunders, 2003) that remains is oxygen through facemask. If the patient was no longer conscious, the removal of the facemask might not have crossed the ethical boundaries. However, if the facemask were to be removed, Mrs. B may still be able to suffer intensely from the inability to breathe. To expect her physicians to stand by and allow Mrs. B to die in an excruciatingly painful manner would be unreasonable. I believe that taking away the food and antibiotic was also ethically impermissible, as it would cause a magnitude of suffering for the patient who cannot die comfortably. Some of the applicable ethical and religious directives are 23-37, 57, 58, 61, and 62 (Catholic Church, 2009, p.20-32).
Reference
Catholic Church. (2009). Ethical and religious directives for Catholic health care services. Washington, D.C: United States Conference of Catholic Bishops. 18-37.
Saunders, D. E. (2003, March 1). Removing the mask. (case study). Retrieved September 3, 2016, from http://www.thefreelibrary.com/Removing the mask. (case study).-a0101259979
