In this case, there are serious ethical issues pertaining to the withdrawal of life support. The first ethical issue pertaining to this case is based on the fact that medical practitioners have a calling to sustain the health and life of patients, but this case calls for a decision that goes against these duties. The second ethical issue is that the decision to refuse medical intervention (in this case life support) and effectively end an individual’s life should rest with the individual and not anybody else. In this case, the patient has delegated the right to make this decision to his representatives who differ on opinion.
Statutory and case laws on the limitations of life-sustaining hospital equipment vary depending on the state. For example, the first case that the U.S. Supreme Court addressed in this regard is the 1990 Cruzan v Director, Missouri Department of Health case in which parents requested the court to make doctors remove the feeding tube from their daughter who was in a vegetative state. The court required parents to provide clear and convincing evidence reflecting the patient’s wishes, thereby limiting the power of surrogates (Luce & Alpers, 2000). Historically, most courts have chosen to order continued life support in cases where family members or the patient’s executors have differed. The law states that physicians must always document how they arrive at decisions to withdraw life support (Luce & Alpers, 2000).
The ethics committee faces the task of arriving at a decision by having the two healthcare surrogates arrive at a compromise to put an end to the disagreement. The healthcare surrogates should indicate in writing any decision made in agreement towards the resolution of the stalemate. The decisions taken should be based on objective manifestations of the patient’s distress levels whenever possible. Also, the decision should be based on the patient’s perceived individual values and treatment choices as well as their cultural, religious, and philosophical beliefs. Dialogue is the best path towards resolving stalemates regarding patients. According to White (2015), conflict usually arises as a result of some of the surrogates or family members not understanding the patient’s prognosis, treatment preferences, as well as their values, religious, cultural, and philosophical outlooks. Clinicians should always be in constant communication with all the patient’s surrogates to ensure that they are up to date with the patient’s condition (White, 2015). Surrogates also suffer from lack of adequate emotional support. They suffer the negative emotional burden, stress, guilt, and doubt regarding the decisions to be made. White (2015 indicates that surrogates can reach consensus on serious issues like ventilator support through open communication channels and honest negotiations. They can also involve a palliative care consultant or ethics consultant. Studies have shown that there are shorter ICU stay lengths in cases where surrogates and relatives of vegetative patients involve palliative care consultants than in cases where these professionals are not involved. Ideally, clinicians should have a discussion with their patients regarding their preferences for ventilator support.
If a conclusive decision is not reached, the ethics committee has the legal right to review the circumstances of the ethical dilemma. After reviewing the circumstances, the ethics committee should take the decision that best reflects what the patient would have done if he/she were in the position to make an informed and rational decision on removal of life support equipment. The committee should also listen to the reasoning of the surrogates before arriving at their decision to ensure that they make the best decision.
References
Luce, J. & Alpers, A. (2000). Legal Aspects of Withholding and Withdrawing Life Support from Critically Ill Patients in the United States and Providing Palliative Care to Them. Am J Respir Crit Care Med, 162(6), 2029-2032. http://dx.doi.org/10.1164/ajrccm.162.6.1-00
White, D. (2015). Withholding and withdrawing ventilatory support in adults in the intensive care unit. Wolters Kluwer, 2(3), 1-10.
