Assessment 3 Instructions: Should We Withhold Life Support? The Mr. Martinez Case

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

  End-of-Life Issues

  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?

  Demonstration of Proficiency

  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.

  Preparation

  • Case Study: Mr. Martinez.

  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?

  Instructions

  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.

  Submission Requirements

  • 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.
  • Length: 2–3 typed, double-spaced pages.
  • Font and font size: Times New Roman, 12 point.
  • Resources: End-of-Life Issues
    End-of-Life IssuesThe Suicide Plan.This video explores the clandestine world of assisted suicide. Physician-assisted suicide is legal in two U.S. states—Oregon and Washington—but only for individuals facing a terminal illness. Elsewhere, individuals contemplating suicide turn to friends, family members, and activist right-to-die organizations. When people choose to kill themselves, those who help them (assisters) face a range of legal consequences, so they are advised to hide evidence and tell few people about their intentions. This documentary offers a balanced, informative viewpoint about an issue few want to contemplate.Running time: 01:25:38.Think about the following questions:
    What are your thoughts about those individuals who were arrested for helping a parent or friend die? Though they broke the law, do you believe they did anything morally wrong?Did the film change your mind, in either direction, about laws that forbid physician-assisted suicide?What do you think of Dr. Timothy Quill’s claim in the video that there is no moral difference between a doctor removing life-sustaining treatment upon a patient’s request (which is legal) and a doctor hastening the death of a terminally ill patient who asks for such help (which is illegal in most U.S. states)? Do you agree or disagree?Should those who have a treatable illness but do not choose to go through treatment and linger be permitted to receive assistance to kill themselves?Additional End-of-Life IssuesEmanuel, L. L, Barry, M. J., Stoeckle, J. D., Ettelson, L. M., & Emanuel, E. J. (1991). Advance directives for medical care: A case for greater use. The New England Journal of Medicine, 324(13), 889-895.This seminal work examines the case for expanding the use of advanced medical directives by using hypothetical scenarios.Gedge, E., Giacomini, M., & Cook, D. (2007). Withholding and withdrawing life support in critical care settings: Ethical issues concerning consent. Journal of Medical Ethics, 33(4), 215.More recent seminal work regarding the ethical guidelines and issues with regards to life support technology.Munson, R. (2014). Intervention and reflection: Basic issues in bioethics (concise ed.). Boston, MA: Wadsworth. Available in the courseroom via the VitalSource Bookshelf link.Chapter 7, “Euthanasia and Assisted Suicide,” pages 300-334.
  • Resources: Optional Enrichment
    Ethical Issues: Reproductive ControlIf you would like to learn more about ethical issues surrounding reproductive control, you may want to read Optional Enrichment: Reproductive Control [DOC] for an overview of some of the ethical considerations.
    For further enrichment, you may wish to explore the following resources:
    Munson, R. (2014). Intervention and reflection: Basic issues in bioethics (concise ed.). Boston, MA: Wadsworth. Available in the courseroom via the VitalSource Bookshelf link.Chapter 4, “Reproductive Control,” pages 189-236.Chapter 5, “Abortion,” pages 237-274.Lyerly, A. D., & Rothman, B. K. (2004). Paternalism. Retrieved from http://virtualmentor.ama-assn.org/2004/02/ccas1-04…This article presents a clinical case where a physician refuses to perform a medical procedure. (Disclaimer: The viewpoints expressed in the AMA Journal of Ethics are those of the authors and do not necessarily reflect the views and policies of the AMA.) The case study is followed by commentaries from physicians taking different positions.Ethical Issues Surrounding Genetic ControlWe are living in a time when the pace of knowledge is outstripping our ability to come to grips with the ethical challenges presented by genetic engineering. If you would like to learn more about the current and emerging ethical issues in the rapidly changing field of genetics, and the challenges and opportunities of genetic engineering, you may want to read Optional Enrichment: Genetic Control [DOC].
    For further enrichment, you may wish to explore the following resources:
    Munson, R. (2014). Intervention and reflection: Basic issues in bioethics (concise ed.). Boston, MA: Wadsworth. Available in the courseroom via the VitalSource Bookshelf link.Chapter 3, “Genetic Control,” pages 120-188.Sandel, M. J. (2004). Embryo ethics—The moral logic of stem-cell research. The New England Journal of Medicine, 351(3), 207-209.In this brief article, philosopher Michael Sandel discusses the ethical questions surrounding stem cell research. He considers several moral objections to their use, but sides with those who argue that use of embryonic stem cells is not morally wrong.A Duty Not to Reproduce? | Transcript.This video shows a discussion between a physician and expectant parents. Dr. Mendez delivers news to the expectant parents that their unborn male child has Tay-Sachs disease, a fatal and untreatable genetic disorder affecting the nervous system. Most commonly diagnosed among infants, Tay-Sachs affects the body’s inability to break down fatty substances, eventually building to toxic levels within the brain. As the disease progresses, the individual becomes blind and deaf and experiences progressive paralysis before dying around age 15.Running time: 01:44.