Submitted to:

Fr. Manuel Perez, SJ, MD

Submitted by:

Group 7

NMD-1A

Class number 61; JUBAHIB, Zadrach Kert P.

Class number 62; JULIANO, Aynn Jedidiah C.
Class number 63; KANAKAN, Sittie Aisah P.
Class number 64; LIBARITE, Kristin M.
Class number 65; LANDERO, Patricia Louise P.
Class number 66; LAPENA, Kimberly R.
Class number 67; LIBATIQUE, Joanna Patrica L.
Class number 68; LIM, Joseph Jr. E.
Class number 69; LLANOS, Claire C.
Class number 70; LOZADA, Noeleen Mae
 PRINCIPLES OF BENEFICIENCE AND NONMALIFICENCE

CASE #1

Joe King contracts bilateral pneumonia. He is treated with antibiotics and put on a
mechanical respirator. After a few weeks, the pneumonia improves and the physician
starts to wean Joe from the respirator. Even with a gradual approach, the weaning fails
and Joe demands to be put back on the respirator when he becomes terrified at being
short of breath. The physician feels that the ultimate chances of weaning Joe are now
no more than 20 percent. Joe, 80 years old and accustomed to being in control,
becomes discouraged and increasingly unable to bear the painful medical procedures
(constant feedings via a tube inserted into his stomach, frequent needle punctures for
arterial blood gases, suctioning, etc). After three weeks of unsuccessful attempts, he
refuses to cooperate. He asks that the respirator be disconnected. “I want to die,” he
states. Despite the pain, Joe is alert and aware and is, in the opinion of the staff, fully
competent. His wife and one son keep begging the physicians and the nurses to do
something to help Joe to recover fully. Does Joe have a right to refuse treatment on
the respirator? Do the physician and the nurses have a right or duty to help him
psychologically and pharmacologically to overcome his anxiety when taken off the
respirator? Do the wishes of the family have ethical or legal weight in such cases?
Physicians are oft ensued for keeping a person on a respirator. There is only one case
where the doctor was charged for removal from the respirator and it was thrown out
of court. Is the mere fact that the family may sue a justification for not following the
expressed wishes of a competent person?

Joe has every right to refuse treatment because after all it is his right to, and it his body. He is
mentally aware and alert of his condition and therefore, he is competent enough to make a
decision of what he think is best for him. The Physician, and the nurses do not have the right to
carry out psychological treatments that will help overcome King’s anxiety. That’s becoming too
manipulative and unethical to a point in which it now breaches the patient’s consent and his right
of refusal to continue on treatment. What the Physician, and the nurses can do is to show that
they are still there to help. It is important that they do not exhibit any form of
abandonment/negligence to the patient because that would be unethical and an improper display
of professionalism. One of the characteristics of a good physician is to care for his patients, thus
establishing trust. Once that trust is gained, you most likely have a right, to try and try to coerce
Joe to cooperate again with his medications. Talking to the patient (counseling), is also a good
way to alleviate the anxiety your patient is having. The wishes of Joes’ wife and son definitely
have legal and ethical basis given that they are the immediate family. However, since Joe is still
“competent”, the final decision of whether to continue with the treatment or not falls unto him. To
avoid lawsuit from the family in any case that the family decides to, have them (patient and
family) sign a waiver stating that, the physician, nurses and the hospital will not be held
responsible for any event that may happen to Joe upon removal of the respirator.

Feeling helpless and hopeless is a common challenge encountered by a patient facing a difficult
health condition. Patients, such as Joe King, can be overwhelmed by a variety of emotions. In
his case, it is quite clear that he has grown tired and frustrated – he feels that he has little control
over his body and health condition, and feels so uncertain over the course of his treatment that
he had decided that he wants to end his suffering by not continuing the respirator.