A.

The case involves a young, ventilator-dependent quadriplegic patient who after being
shunted about to various facilities, sought to have his ventilator unhooked. The court
recognized him as a competent adult and allowed the withdrawal of his life support.
In this case, neither the court, the health care providers, the right-to-life
movement, nor the churches came forward to argue that the ventilator should be
continued. After he had gained permission to withdraw from life support, the patient
decided against the action and remained on the ventilator.
The question that this case brings forward is whether the young man’s demand
to have the “right to die” was real or just another way of saying, “Do you care about
me?” A secondary question that is equally problematic is whether the acceptance of
his request was based on a respect for his personal autonomy, or was it just an
answer to the, “Do you care about me?” question with a “No!”
Respond to the idea that our current acceptance of “a right to die,” especially for
those who are unconscious and need a proxy decision maker, is a rather slippery
slope that may in the future be used not to protect individual autonomy or privacy but
rather as a façade to rid us of individuals whose lives we do not value.

As individuals, we all have a sense of who we are. In the course of our lives, each of us
has discovered things we value and believe in. We are shaped by our families, our past
experiences, our society and our culture. The choices we make and the way we live our
lives are a reflection of who we are, our values and beliefs. We bring our sense of self to
all of our life experiences including that of illness and, in turn, our sense of self is
influenced by our state of health. Physicians have a duty to truthfully inform patients of
the expected course of illness, without conveying false hope, and to help patients
decide which of the available treatment options are best for them. In these ways,
physicians show respect for the dignity of the person and moreover, show that they see
and care about the patient not solely as a patient but, more importantly, as a unique
person. A patient's death brings him or her the end of pain and suffering. Patients have
an opportunity to die with dignity, without fear that they will lose their physical or mental
capacities. The overall healthcare financial burden on the family is reduced. Patients
can arrange for final goodbyes with loved ones. While suffering, indignity, and loss of
independence are undesirable, only the person enduring them should decide whether
they are unbearable. If a patient is competent to decide, nobody other than that patient
should have the authority to decide whether life is worth continuing. Although some
people might decide that the suffering and indignity that characterize their lives are not
sufficiently bad to make life not worth continuing, other people in the same situation will
deem their condition unbearable. Just as it would be wrong to force people to die, so is
it wrong to force people to endure conditions that they find to be unbearable. If
individuals cannot express their own wishes and cannot give informed consent, the
authority to make such decisions passes to a surrogate decision maker, such as a legal
guardian, spouse, or parent, who signs it in the presence of witnesses and the doctor.

B. Differentiate between the various lines of reasoning and arguments needed to decide
the following types of cases in regard to withdrawing or withholding care:
1. Persistent vegetative state cases
2. Profoundly retarded patient cases
3. Baby Doe cases
4. Informed nonconsent cases

Which of these case types is best served by proxy judgements, and if so, what
form: best interest or substituted judgement?

Informed nonconsent cases is the best served proxy judgements and it falls into the
best interest form.  Although the doctrine of informed consent resolves many of the
ethical problems in treating the competent adult, difficult ethical problems arise when
life-saving strategies are required for the survival of legal incompetent individuals who
are unable to make therapeutic decisions for themselves: infants and young children,
the mentally retarded, the deranged, the senile, the comatose. Where legal
incompetents are the subjects, crucial decisions on which life or death may depend
must be made by others acting as their surrogates or proxies. As for my opinion, the
health care team is there for you to be better, if you’re in the verge of dying, you may
have lost your faith about living, but what if after they gave you another chance to live
and it is the best life you had? I mean, if you are in that point of your life wherein you
thought everything might fall apart, you cannot think properly that you tend to decide on
something that can cause you harm or even death, and that’s where the proxy comes in
and makes decision for your betterment.

C. The philosopher Joseph Fletcher issued a paper listing the characteristics of a

person. The following are taken from his positive criteria:
1. Minimal IQ: Mere biological life, before minimal intelligence is achieved or after it
is irreversibly lost, is without person status.
2. Self-awareness: The development of self-awareness in babies is what we
watched and take such joy in. In psychotheraphy, the lack of self-awareness
would be present grave pathology.
3. Self-control: An individual not only not controllable by others (without restraint),
but also not in his own control.
4. A sense of time: Memories, a feeling of now, and expectations for the future.
5. The capability to relate to others: Interpersonal relationship seem essential to
being a person in any meaningful sense.
 6. Concern for others: Extra-ego orientation is a vital characteristic of a “real
person.”
7. Curiosity: A person is a learner; total indifference is inhuman.
8. Communication: Utter alienation or disconnection from others is not a
characteristic of humanity.
9. Neocortical function: Personal reality is dependent upon cerebral function; it
forms the basis between life in a biographical and biological sense.
10. Idiosyncrasy: Humans are distinct; to be a person is to have identity, to be
recognizable or callable by name.

Rank-order the list from most important to least important in your view of what
makes up a person. Check those that you would consider to be essential in regard to
personhood. If you feel that a particular characteristic is essential, you must be
willing to deny those who do not possess it the rights and privileges of person status.

In regard to the personhood criteria that you have selected, state how this would
affect you decisions in the following cases.

Nancy Cruzan
Elizabeth Bouvia
Baby Doe
Baby K
In regard to KoKo the Gorilla, who uses sign language to communicate with
humans and appears to have a kitten that she cares about and misses when it is gone,
what is her level of personhood?

If an angel or alien appeared out of the sky and had all the elements that you
sais were essential to being a person, would the alien have all the rights and privileges
of a person?

10) Curiosity: a person is a learner: total indifference is inhuman.

3) Communication: utter alienation or disconnection from others is not a

characteristic of humanity.

1) Self-awareness: the development of self-awareness in babies is what we

watch and take such joy in. on psychotherapy, the lack of self-awareness would
represent grave pathology.

2) Self-control: an individual not only not controllable by others (without restraint),

but also not in his own control. 6) A sense of time: memories, a feeling of now,
and expectations for the future.
 4) Concern for other: extra-ego orientation is a vital characteristic of a “real
person”

5) The capability to release others: interpersonal relationship seems essential to

bring a person in any meaningful sense.

7) Minimal IQ: mere biological life, before minimal intelligence is achieved or after
it is irreversibly lost, is without person status.

8) Neocortical function: personal reality is dependent upon cerebral function: it

forms the basis between life in a biographical and biological sense.

9) Idiosyncrasy: humans are distinct: to be a person is to have identity, to be

recognizable or callable by name.

 Nancy Cruzan
In for this case, the capability to relate to others would totally be fit this
situation. You should learn how to understand and be at the situation of
others before making a decision on judging them.
 Elizabeth Bouvia
Elizabeth’s case was an informed nonconsent case wherein the
healthcare team showed how they are concerned for her. They’ve given
everything just to make her live even without her consent.
 Baby Doe
In this case, concern for others also controlled the whole situation wherein
the whole situation was then brought out to the topic because the parents
refused to have the baby live, and the other party opposed when the baby
died.
 Baby K
In baby K’s case, the capability to relate to others is also the criteria that
comes into my mind in assessing the situation.

In the case of Koko the gorilla, I believe that animals have emotions, thoughts
and inner lives could still draw a bright line between them and us thanks to
language. It took a great, complex, even blessed mind to encode actions and
objects into sounds and words that were then turned into a working language.
Based on what I have read if a creature has vocal cords, a palate, a tongue and
lips that could produce such an infinitely varied array of sounds. If animals had
something like that, they could express themselves, too.

In the case of the alien, yes, he would have the rights since he knows how to mingle,
communicate, and understand the feelings and beliefs of people.
D. Assuming that Baby Doe would have grown up to know himself, know those around
him, walk, talk and play, and perhaps even go to school, was the decision not to
provide the surgery ethical? Regardless of how you answer, justify your decision
using ethical criteria. Also note that legal decisions are ethics neutral, and vice versa:
Something truly can be legally correct, medically correct, socially correct, and morally
reprehensible. Ask Dr. Mengele (Nazi war criminal who performed ghoulish
experiments in the death camps), for he surely felt that relative to his society, what he
was doing was socially, medically, and legally correct.

I think the decision not to perform surgery is ethical since the Doctor knows how the
baby will live his life when he grew up just like what happened in the situation above. If
parents refuse to perform the procedure then doctors do not have legal right to perform
the procedure. It is ethical since he knows what he did and it is medically correct since it
his own perspective as a doctor and it is legally too.

E. Mr. Martinez was a 75-year-old chronic obstructive pulmonary disease patient. He

was in the hospital because of an upper respiratory tract infection. He and his wife
had requested that CPR not be performed should he require it. A DNR order was
written in the charts. In his room on the third floor, he was being maintained with
antibiotics, fluids, and oxygen and seemed to be doing better. However, Mr
Martinez’s oxygen was inadvertently turned up, and this caused him to go into
respiratory failure. When found by the therapist, he was in terrible distress and lay
gasping in his bed. Should Mr. Martinez be transferred to intensive care, where his
respiratory failure can be treated by a ventilator and his oxygen level can be
monitored? Whatever your answer, provide an ethical rationale.

A DNR order does not mean that no medical assistance will be given. Health
care providers may continue to administer oxygen therapy, control bleeding, position
for comfort, and provide pain medication and emotional support. However, they will
not initiate cardiac monitoring or administer chest compressions, artificial
respiration, defibrillation, or cardioversion though some hospitals also allow chest
compressions even the patient has DNR order, it really depends on the execution of
the hospital.