Shania Roberts 00070648

GERONTOLOGY
ETHICOLEGAL ISSUES

Scenario: Two months ago, Mr M.T. (80 years old) and his wife were involved in a severe
auto accident. Mrs. A T died. Mr. M.T. previously told his 3 children that should he ever
become seriously injured or ill and unable to live his life as he has in the past, he doesn’t wish
to be treated with extraordinary measures to continue his life. Two of the children agreed that
their father would not want to live with the residual effects of his injuries should he recover.
The third child, emotionally distant from the father until the last 6 months, desperately desires
any relevant treatment for her father to allow his possible recovery even if it means he has
decreased quality of life.

Identifying the Issue:

The issue at hand appears to be a conflict regarding the medical treatment and care of Mr.
M.T. Mr. M.T. had previously communicated his wishes to his three children, stating that if
he ever became seriously injured or ill and unable to live his life as he has in the past, he does
not wish to be treated with extraordinary measures to prolong his life. Two of the children
agree with their father's wishes and believe that he would not want to live with the residual
effects of his injuries if he were to recover. However, the third child, who has had a distant
relationship with the father until the last 6 months, strongly desires any relevant treatment for
her father to allow his possible recovery, even if it means he would have a decreased quality
of life. This conflict raises ethical and moral questions about respecting an individual's
wishes regarding end-of-life care, autonomy, and the balance between prolonging and
maintaining quality of life.

Ethical Dilemma:
An ethical dilemma does exist in this scenario. The dilemma revolves around conflicting
values and principles, particularly autonomy, beneficence, and quality of life.

On the one hand, Mr. M.T. has expressed his wishes regarding his end-of-life care, indicating
that he does not want to be subjected to extraordinary measures to prolong his life if he were
to become seriously injured or ill and unable to live as he has in the past. This aligns with the
principle of autonomy, which emphasizes an individual's right to make decisions about their
medical care and treatment.

On the other hand, one of Mr. M.T.'s children is advocating for any relevant treatment to be
administered to her father, even if it means he may have a decreased quality of life. This may
stem from a desire to preserve life at all costs, which reflects the principle of beneficence, the
obligation to do good and promote the well-being of others.

The conflict arises from the tension between respecting Mr. M.T.'s autonomy and fulfilling
the desire to promote his well-being by pursuing potentially life-prolonging treatment, even if
it may not align with his stated wishes. This presents a complex ethical dilemma that requires
careful consideration of the competing values and interests involved.

Ethical Issues:
An ethical issue does exist in this scenario. The ethical issue centers around the question of
whether to honor Mr. M.T.'s previously expressed wishes regarding his end-of-life care or to
prioritize the desires of his third child who advocates for potentially life-prolonging treatment
despite Mr. M.T.'s stated preferences.

Respecting Mr. M.T.'s autonomy and his right to make decisions about his medical care is one
aspect of the ethical issue. His expressed wishes should be given serious consideration, as
autonomy is a fundamental principle in medical ethics. However, there is also the ethical
principle of beneficence, which emphasizes the obligation to do good and promote the
well-being of others. In this case, Mr. M.T.'s child may believe that pursuing treatment, even
against his wishes, is in his best interest and aligns with the principle of beneficence.

Balancing these competing ethical principles and considering the consequences of each
course of action presents a significant ethical challenge for the family and healthcare
providers involved. The ethical issue revolves around determining the most morally
justifiable course of action while respecting Mr. M.T.'s autonomy and promoting his
well-being.

Identifying the Ethical Principles:

In this scenario, several ethical principles are at play:
● Autonomy: Mr. M.T.'s autonomy is a central ethical principle. Autonomy refers to the
right of individuals to make their own decisions about their lives and medical care.
Mr. M.T. has expressed his wishes regarding his end-of-life care, indicating that he
does not want to be subjected to extraordinary measures if he were to become
seriously injured. Respecting his autonomy involves honoring his preferences and
decisions about his medical treatment.

● Beneficence: Beneficence is the ethical principle that emphasizes the obligation to do

good and promote the well-being of others. One of Mr. M.T.'s children advocates for
potentially life-prolonging treatment, believing that it would be in his father's best
interest, even if it means he may have a decreased quality of life. This reflects a
commitment to promoting Mr. M.T.'s well-being, even if it involves overriding his
stated wishes.

● Non-maleficence: Non-maleficence is the principle that requires healthcare providers

to avoid causing harm to patients. In this scenario, considering the potential
consequences of administering potentially life-prolonging treatment against Mr.
M.T.'s wishes is important. It raises questions about whether such treatment could
result in unnecessary suffering or harm to Mr. M.T., particularly if it goes against his
expressed preferences for end-of-life care.
 ● Justice: Justice involves fairness and equity in the distribution of resources and the
treatment of individuals. In this scenario, considerations of justice may arise in
determining how to balance the interests and perspectives of Mr. M.T.'s family
members and healthcare providers. Ensuring fairness in decision-making and
addressing potential conflicts of interest is essential to promoting justice in this
context.

These ethical principles provide a framework for analyzing the ethical dimensions of the
situation and guiding decision-making to ensure that Mr. M.T.'s autonomy is respected while
also promoting his well-being and avoiding harm.

Relating the Principles to Facts:

● Autonomy: Mr. M.T. previously communicated his wishes to his three children
regarding his end-of-life care. He specifically stated that if he ever became seriously
injured or ill and unable to live his life as he has in the past, he does not wish to be
treated with extraordinary measures to prolong his life. This demonstrates his exercise
of autonomy by expressing his preferences and decisions about his medical treatment.

● Beneficence: One of Mr. M.T.'s children, emotionally distant from him until the last 6
months, advocates for potentially life-prolonging treatment for her father, believing it
would be in his best interest, even if it means he may have a decreased quality of life.
This reflects a commitment to promoting Mr. M.T.'s well-being, as perceived by the
child, even if it involves overriding his stated wishes. This interpretation of
beneficence could be seen as conflicting with Mr. M.T.'s autonomy.

● Non-maleficence: Considerations of non-maleficence arise in evaluating the potential

consequences of administering potentially life-prolonging treatment against Mr.
M.T.'s wishes. This includes considering whether such treatment could result in
unnecessary suffering or harm to Mr. M.T., particularly if it goes against his expressed
preferences for end-of-life care. There's a need to assess whether pursuing treatment
aligns with the principle of non-maleficence and if it truly serves Mr. M.T.'s best
interests.

● Justice: Justice involves fairness and equity in decision-making. In this scenario,

justice may be considered in determining how to balance the interests and
perspectives of Mr. M.T.'s three children, each of whom holds different views on the
appropriate course of action. Ensuring fairness in decision-making and addressing
potential conflicts of interest is essential to promoting justice in this context.

By relating the ethical principles to the facts of the scenario, we can better understand the
complex ethical considerations involved and the potential implications of different courses of
action for Mr. M.T. and his family.
 Appealing to the Ethical Theory of Deontology:

In applying deontological principles to the scenario:

● Duty to respect autonomy: Deontology places a strong emphasis on respecting
individuals' autonomy and their capacity to make rational decisions about their own
lives. Mr. M.T.'s expressed wishes regarding his end-of-life care represent his
autonomy in action. From a deontological perspective, it is morally obligatory to
respect his autonomy and adhere to his stated preferences, even if it leads to outcomes
that are perceived as less desirable.

● Duty to uphold promises and commitments: Deontology also emphasizes the

importance of fulfilling promises and commitments. Mr. M.T. has communicated his
wishes regarding his medical care to his children, effectively committing how he
wants to be treated in such circumstances. From a deontological standpoint, there is a
moral obligation to honor these commitments, even if it means going against the
desires of one of his children.

● Duty to avoid treating individuals as mere means: Another key aspect of Kantian
deontology is the idea that individuals should be treated as ends in themselves and not
merely as means to an end. In the scenario, respecting Mr. M.T.'s autonomy and
honoring his wishes regarding his medical care are essential to treating him as an
autonomous agent deserving of respect and dignity. Pursuing potentially
life-prolonging treatment against his wishes could be seen as treating him as a means
to fulfill the desires of others, which would violate this principle.

By appealing to deontological principles, one can argue that respecting Mr. M.T.'s autonomy
and fulfilling commitments to him are moral duties that must be upheld, even if they conflict
with the desires of his children or the potential outcomes of his medical treatment. This
perspective prioritizes the inherent moral worth of individuals and the importance of adhering
to moral rules and duties, regardless of their consequences.

Identifying Alternatives:

In the scenario presented, several alternatives could be considered:

● Respecting Mr. M.T.'s wishes: One alternative is to honor Mr. M.T.'s previously
expressed wishes regarding his end-of-life care. This would involve refraining from
administering potentially life-prolonging treatment and instead focusing on providing
palliative care to ensure his comfort and dignity in his final days.

● Pursuing potentially life-prolonging treatment: Another alternative is to provide the

potentially life-prolonging treatment that one of Mr. M.T.'s children advocates for,
despite his stated wishes. This would involve administering medical interventions
 aimed at extending his life, even if it means he may have a decreased quality of life or
may not fully recover from his injuries.

● Mediation and family discussion: A third alternative is to engage in mediation and

open discussion within the family to explore the underlying concerns and interests of
each family member. This could involve facilitating dialogue to better understand Mr.
M.T.'s wishes, addressing any misunderstandings or conflicts, and working towards a
consensus or compromise that respects his autonomy while also considering the
perspectives and concerns of all involved.

● Seeking guidance from a medical ethics committee: If the family is unable to resolve
this internally, they could consider seeking guidance from a medical ethics committee
or consulting with healthcare professionals trained in medical ethics. These experts
can provide insight into the ethical considerations involved and help facilitate a
decision-making process that is consistent with ethical principles and respects Mr.
M.T.'s autonomy.

● Legal consultation: In some cases, seeking legal consultation may be necessary to

clarify the legal implications of different courses of action, particularly if there are
disagreements within the family or concerns about the legality of honoring Mr. M.T.'s
wishes. Legal experts can guide relevant laws and regulations governing medical
decision-making and end-of-life care.
These alternatives represent different approaches to resolving the ethical dilemma presented
in the scenario and highlight the importance of considering the interests, values, and
preferences of all involved parties while upholding ethical principles and legal
considerations.

Ranking Ethical Principles of the Case:

● Autonomy: Mr. M.T.'s autonomy takes precedence in this case. His expressed wishes
regarding his end-of-life care should be respected as a fundamental aspect of his
rights as an autonomous individual.

● Non-maleficence: The principle of non-maleficence is closely tied to autonomy in this

case. It emphasizes the importance of avoiding harm to the patient. Respecting Mr.
M.T.'s autonomy and honoring his wishes helps to prevent potential harm that may
result from administering treatment against his will.

● Beneficence: While beneficence is an important ethical principle, it takes a secondary

role in this scenario compared to autonomy and non-maleficence. Advocating for
potentially life-prolonging treatment, even if motivated by a desire to promote Mr.
M.T.'s well-being, must be balanced against the potential harm of overriding his
autonomy and causing undue suffering.
 ● Justice: Justice is also significant but may have less immediate relevance in this
specific case compared to the principles of autonomy, non-maleficence, and
beneficence. However, considerations of fairness and equity should still inform
decision-making processes, particularly in addressing potential conflicts of interest
among family members and ensuring that decisions are made impartially and
ethically.

The Resolution:

The resolution of the ethical dilemma presented in the scenario would depend on the decision
reached by the family and healthcare providers involved, guided by ethical principles, legal
considerations, and the specific circumstances of Mr. M.T.'s situation. Here are some
potential resolutions:
● Respecting Mr. M.T.'s wishes: The family and healthcare providers may ultimately
decide to honor Mr. M.T.'s previously expressed wishes regarding his end-of-life care.
This would involve refraining from administering potentially life-prolonging
treatment and instead focusing on providing palliative care to ensure his comfort and
dignity in his final days.

● Facilitating family discussion and consensus: The family may engage in open
dialogue and mediation to explore the underlying concerns and interests of each
family member. Through facilitated discussion, they may work towards a consensus
or compromise that respects Mr. M.T.'s autonomy while also considering the
perspectives and concerns of all involved.

● Seeking guidance from medical ethics experts: If the family is unable to resolve
internally, they may seek guidance from a medical ethics committee or consult with
healthcare professionals trained in medical ethics. These experts can provide insight
into the ethical considerations involved and help facilitate a decision-making process
that is consistent with ethical principles and respects Mr. M.T.'s autonomy.

● Legal consultation: The family may seek legal consultation to clarify the legal
implications of different courses of action and ensure compliance with relevant laws
and regulations governing medical decision-making and end-of-life care. Legal
experts can guide how to proceed following Mr. M.T.'s wishes and legal requirements.

Ultimately, the resolution of the ethical dilemma will involve careful consideration of the
interests, values, and preferences of all involved parties, while upholding ethical principles
and legal considerations. The specific resolution may vary depending on the unique
circumstances of the case and the preferences of Mr. M.T. and his family.