RunningHead:ANALYSISOFANETHICALISSUE

AnalysisofanEthicalIssue
VanessaA.Lu
SaltLakeCommunityCollege


ANALYSISOFANETHICALISSUE

Introduction
Mr.Stoneisa53yearoldmansufferingfromheartfailure,aconditionwhichresulted
afteraseriesofcardiacissuespersistingoveracourseof10years.HesoughthiscardiologistDr.
Holmes,whorecommendedundergoingsurgeryforaleftventricularassistdevice(LVAD)until
anappropriateheartturnedup.Mr.Stonefanciedthisplanandunderwenttheprocedure.
Afterall,hewantedtodowhateverwaspossibletomakelifeeasierforhimselfandhiswife.
Alongsidethis,healsoexpressedhisdesirenottobegivenCPRwhenhisbodyrequiredit
(FamilyDoctor,2012),issuingaDNR(DoNotResuscitate)orderforhismedicalcharts(Basta
&Bramstedt,2007).
Afterthesurgery,however,Mr.Stonehadaseizureandcaughtacaseofpneumonia.The
pneumoniashowednosignsofimprovementinMr.Stone,despitebeingplacedonaventilator.
Dr.Holmesfoundthathispatientslungwaspermanentlydamaged.Withnochanceof
recoveringahealthylungagain,Mr.Stonewasnotabletoqualifyasarecipientforaheart
transplant.Dr.Holmesnotifiedhispatientabouthissituationimmediately.Mr.Stone,now
awareofhiscurrentstate,decidedthatitwasbesttodeactivatetheleftventricularassistdevice
forthesakeofhimselfandhiswife,andaskedDr.Holmesifthedevicecouldbeshutdownso
naturecouldtakeitscourse(Basta&Bramstedt,2007).
TheethicaldilemmapresentedhereiswhetherDr.Holmesshouldobeyhispatientswish
ofturningoffthedevice,orifheshouldrejectMr.Stonesrequestandfindothermethodsto
supporthispatientslife.Bothchoicesproduceadvantagesandconsequences.Theymustbe
analyzedcarefullyandtheoptionchosenshouldproducethebestoutcomeandhavemore
benefitsthandrawbacks.Doingotherwisemaynotberight.Inthemedicalfield,physicians


ANALYSISOFANETHICALISSUE

shouldbeopentotheirpatientsvalues,butatthesametime,musttakeactionsthatarenot
harmfultothepatientthemself.Dr.Holmesmustremembertobeacceptingbutcautiousallat
once,whendecidinghowtohandleMr.Stonescase.
Thesis
Dr.HolmesshouldrespectMr.Stonesrequestandturnoffthemachinetoresultinbetter
outcomes,becausethepatienthimselfwillbemoresatisfiedthandoingotherwise,andlistening
tohisdesireisonlyperformingwhatisinhisbestinterest.Mr.Stonedeclaredhimselfthatheno
longerwantedaidfromtheLVAD,andonlyhopedthatdeathwouldoccurnaturally.
Deactivatingthedevicewouldnotbeunethicalinthiscaseitisallthepatientaskedfor.Onthe
otherhand,continuingMr.Stoneslifebyforcinghimtodependonmachineryandmedications
wouldnotbemorallycorrect.Extendingthepatientsexistenceisalsopreservingthesuffering
thatitincludes.
LettingMr.Stonetocontinuelifeinhisconditionisunfair.Hewillspendtheremaining
ofitlyingonaventilator,aswellaslivingwiththehasslesofaLVAD.Nothingwilleverbethe
sameagain.Hewouldnotbeabletoresumedoingthingsthatbringhimhappinessinlife,
becausehisconditioncauseshimtobeimmobile.Ontopofthat,Mr.Stonewillloseallabilityto
work.Losingthecapabilityofworkingbringsstressformultiplereasons,cashforoneexample,
sincetheworldrevolvesaroundmoney.Plus,Mr.Stonedoesnotwanttobeartroubleuponhis
wife.
Whenmakinganimportantmedicaldecisionthatcouldimpactsomebodyslifeaswellas
thepeoplearoundthem,itisimportantthatfourmainpointsarereviewedwithinthesituation:
medicalindications,patientpreferences,qualityoflife,andcontextualfeatures.Medical


ANALYSISOFANETHICALISSUE

indicationsincludetheprinciplesofbeneficenceandnonmaleficence.Patientpreferencesconsist
oftheprinciplerespectofautonomy.Qualityoflifeincorporatesallofthesefactors.Contextual
featuresincorporatesprinciplesofjusticeandfairness.Itiseasytooverlookacircumstanceand
jumprighttoconclusions.However,theeventmustbethoroughlyexaminedaswellasthe
outcomesbeforedecidingonafinalanswer.Itisalsousefultoanalyzethebenefitsand
drawbacksofanalternatedecision.
MedicalIndications
Firstly,medicalindicationsincludetheprinciplesofbeneficenceandnonmaleficence,
whichsignifythatphysiciansonlytakeactionsthatproducefavorableoutcomeswhilstimposing
aslittlepainaspossible:Thedutyofprofessionalsshouldbetobenefitaparty,aswellasto
takepositivestepstopreventandtoremoveharmfromtheparty(Sher,2011).Itisessentialto
analyzethepatientscurrentsituation(medicalindications)beforetakingactions(principlesof
beneficenceandnonmaleficence).InMr.Stonesposition,thereseemstobenocure,exceptfor
treatmentthatmerelylengthenstheperiodofhisexistence.Itdoesnotimprovehiscondition.
Initially,theventilatorwasemployedtohelpMr.Stoneslungbecomehealthyagainsohecould
receiveaheartproperly,buttherewasnothingindicatingthathisconditionchanged.Becauseof
this,theamountofalternativetreatmentavailableislimited.ItisalsopossiblethatMr.Stone
couldbeplacedundersupervisionofacaregiver,butdoingsowouldgoagainsthisbeliefsand
wouldserveasafulfillment.Therefore,turningoffthemachineasMr.Stonewishedforwould
bethebestchoice,sincethereisnohopeforacureandthetreatmentsonlyprovetobefutile.
PatientPreferences


ANALYSISOFANETHICALISSUE

Secondly,patientpreferencesconsistoftheprincipleofrespectforautonomy,which
indicatesthatthephysicianrespectsthepatientsvaluesforhis/herownhealth,aswellas
informsthepatientthoroughlyandconfirmsthathe/sheunderstandsthecurrentsituationand
benefits/consequencesthatcomewiththechoicetheyaremaking.ItcanbesafetosaythatDr.
HolmesconsultedMr.Stoneforpermissionbeforetheseprocedures,becausehetoldMr.Stone
aboutthepurposesandeffectsMr.Stonehimselfagreedtoundergothesurgeries.Also,Mr.
StonemustbementallycompetentbecausehementionedplacingaDNRorder,whichrequires
thatapatientmustbecapableofmakingrationaldecisions.Dr.Holmesmadesurethathe
alertedMr.Stoneabouthissituationandanychangesforexample,whenMr.Stonewasfound
tobeatlossofeligibilityforahearttransplant,Dr.Holmesnotifiedhimimmediately,insteadof
hidingitfromhiminhopesofpreventingsadnessordisappointmentinhispatient.Thesefactors
helpdecidewhetherthepatientswishesaresafeenoughtoconsider,andsincetheyare,Dr.
HolmescantakeMr.Stonesideaintothought.Mr.Stoneismentallycompetentbasedonthe
evidence.HeseestheeffectsofturningofftheLVAD,andviewsmorebenefitsthandrawbacks.
Hispreferenceofterminatingtheprocedureisrationalandshouldbeimplementedwhereas
prolongingtreatmentopposeshispreferenceandbringsnosatisfactiontothepatientwhatsoever.
Hestatedthathedoesnotwanttobeaburdentohimselforhiswife.
QualityofLife
Thirdly,qualityoflifeincorporatestheprinciplesofbeneficence,nonmaleficence,and
respectforautonomy,acombinationofallthreeprecedingaspects.ForMr.Stone,treatmentwill
notallowhimtoresumeanormallife.Tobebedriddenforanunpredictableamountoftimeis
restrictingtohimandquiteundesirable,forhecannotdoevensimpletasks,suchaswalkingor


ANALYSISOFANETHICALISSUE

cleaningthedishesletaloneparticipateinactivitiesheenjoys.Healsoexpressedhisfeelings
aboutnotwantingtobeaburdenonhiswife.Withonlyonespouseworkingandcostlymedical
bills,thereisboundtobestressandcomplications.Mr.Stonefindsnointerestinrequiringcare
fromhiswife24/7hedoesnotwanttopreventherfromfulfillingherowndreams.Thereisno
happinessforMr.Stoneifheweretocontinuelivinglifecompletelydependentoftheventilator
andLVADbecauseofthesereasons.Forcinghimtocontinuereceivingtreatmenttoliveis
simplytorture.Hewillwatchtheworldchangedaybyday,knowingthatheisincapableof
doinganythingsuchasituationisdevastating.ForDr.HolmestofulfillMr.Stoneswishof
discontinuingtheprocesswouldbringMr.Stonethebestqualityoflifeandmeanofgreat
importance,sincethemosthecandonowismakedecisionsforhimself.
ContextualFeatures
Lastly,contextualfeaturesincorporatesprinciplesofjusticeandfairness,factorsthat
surroundapatientsenvironmentthatmayaffectthetypeoftreatmenthe/shegets.Noother
familymembersarementionedinMr.Stonesstoryexceptforhiswife,whichpartlyinfluences
hisdecisiontoturnofftheLVADbecausehebelievesthatlifewillbeeasierthatway.The
Stonesarelimitedintheirmoney,sotheycannotaffordtocontinuetreatmentthisisnottheonly
reasonMr.Stonemadehisdecision,however.Hecannotreturntoacomfortinglife,asthe
foregoingpassagediscussed.Afterreviewingtheseelements,itisnecessarytorememberthatall
patientsdeservetobetreatedequallywithrespectandserviceinthemedicalfield,despitesocial
status,wealth,orbackground.Inanidealworld,everyoneshouldbeentitledtohealthcare.The
humanrighttohealthmeansthateveryonehastherighttothehighestattainablestandardof
physicalandmentalhealth,whichincludesaccesstoallmedicalservices,sanitation,adequate


ANALYSISOFANETHICALISSUE

food,decenthousing,healthyworkingconditions,andacleanenvironment(NESRI,n.d.).With
thisinmind,Mr.Stonehasaccesstowholesomehealthcaredespitehiscondition.Thebestlevel
ofhealthcareforhimwouldbeforDr.Holmestosupporthiminfulfillinghisrequest,becauseit
istheoptionthatresultsinmorepositivesthannegativesforhimselfpersonally.
OpposingViewpoint
SpeakingintermsifDr.HolmesdecidednottolistentoMr.Stoneandcarryonwith
procedurestoprolonghislife,fewbenefitsarise.OnethingisthatMr.Stonewillbeabletolive
lifeentirelyuntilhisdeathcamenaturally,andhewouldhavetimetoprepareforthefutureby
planningoutwithhisspouse.Anotherreasonisthathiswifewillbeabletospendmoretime
withherbelovedhusbandandnotgrieveoverhisdeath.However,thereareflawsthat
accompanythesereasons.ShuttingoffthemachineswillallowMr.Stonetopassawaynaturally
aswell,sincetheyaremerelylifesupportdevices.Althoughhiswifemaybecaughtoffguardby
thesuddendecision,asthelovingwifesheis,shouldunderstandthatMr.Stonesdecisionwas
indeedforthebetter,andneitherofthetwoaresufferinganylongerbyextendingthisperiodof
hopelesshealing.Plus,withMr.Stonelimitedtoonlythehospitalbed,thereisnotmuchMrs.
Stonecando.
Conclusion
Inconclusion,itisbestthatDr.HolmesturnsoffthelifesupportdevicesasMr.Stone
wished.Morehappinessisgeneratedwiththischoicethancontinuingtheineffectivetreatment.
Therewouldbenochangeinthefuture,andovertime,Mr.Stonewouldgraduallyincrease
dissatisfactionwithhisstate.Fourpointsmustbeconsideredbeforetakingaction:medical
indications,patientpreferences,qualityoflife,andcontextualfeatures.Withfutureandrelated


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cases,thisthesisshowsthatpatientswhoarementallycompetentandinastatewithnocure,
shouldbeabletotakecontrolovertheirdeath.Theyshouldnotbeforcedtoendureanagonizing
lifestyle.Everyonedeservesthebesthealthcare,andsometimesthebestcareislettingnature
takeitscourse.

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