Christian Medical Ethics Decision-Making - Coursework Example

? Ethical Case Study Analysis   Word Count 581 Health care decisions have the potential to dramatically alter the lives of patients and their families in many ways. Because of this, it is critical that health care practitioners make ethical decisions which take all the relevant factors into consideration. For many people, Christian values and tradition play a strong role in the process of ethical decision making, and can play a significant part in the decisions that are made for any given patient. This essay will examine the process of ethical decision making within the case of Mrs. M and the application of Christian ethics on the case. In this case study, Mrs. M was 54 years old and had suffered a heart attack as well as having multiple secondary diagnoses. Mrs. M had experienced a history of depression and anxiety, which had resulted in an attempt at suicide ten years prior. She had also discussed end-of-life situations with her husband, and did not wish to remain alive if her quality of life was below a certain point. Her treatment options led to her requesting to be withdrawn from ventilator support, a decision that had full support of her daughter and husband. Despite this, four days after she had entered the hospital, the doctor began to question her decision-making ability and/or competence. Mrs. M’s case is complicated by the fact that there are multiple secondary diagnoses in addition to her primary diagnosis. This makes the prediction of outcomes difficult. Acute pancreatitis is an inflammatory process that occurs in the kidneys, which is able to be reversed. The survival chance for this diagnosis is high (Carroll et al. 1513), and Mrs. M has previously recovered from this problem. In the case, Mrs. M was suffering from severe pain as a result of the inflammation. Diagnosis involves the use of a range of clinical markers, which are increased when acute pancreatitis is occurring. Acute pancreatitis can vary significantly in severity, which affects amount of time in hospital, morbidity and mortality (Carroll et al. 1514). In this case, a significant proportion of Mrs. M’s pain was attributed to the acute pancreatitis, resulting in the recommendation of pancreatic surgery. The treatments that are used for acute pancreatitis vary, and are not limited to surgical approaches. Other treatments that can be used include nutritional management, aggressive volume repletion and the use of antibiotics (Carroll et al. 1516). This suggests that the recommendations for treatment for Mrs. M were not necessarily extensive, and there may have been alternative options that could have increased Mrs. M’s quality of life. Another issue is that although the treatment options given to Mrs. M do not appear to be complete, no second opinion was sought or given. The provision of a second opinion is important because research has indicated that medical decision making is influenced by a range of factors that are outside of the medical field. This includes aspects such as the personality of the physician, the organizational setting and the age of either the physician or the patient (Feldman et al. 343). This means that a patient such as Mrs. M might not be given all of the treatment options or alternative diagnoses available. This is a particularly important part of the case, because Mrs. M and her family are making decisions that will influence her future, and it is critical that they have all the information possible when they are doing this. At the time of the case study, Mrs. M was in a position where her quality of life was considerably compromised and did not want to spend the rest of her life in this state. However, there are several factors that suggest that her condition may improve over time, and lead to an increase in quality of life. The first of these indications is physician’s perception that Mrs. M had the ability to rally medically, which indicates that over time her quality of life would improve. The second aspect is that the pancreatic surgery, if successful, would relieve the pain that Mrs. M would experience. The recovery from this surgery would require extensive care, but the recommendation suggests that this would be an issue only while Mrs. M was recovering from the surgery, rather than for the rest of her life. In Mrs. M’s case, the removal of the ventilator would mean the removal of life-sustaining treatment, which is effectively physician-assisted suicide or euthanasia. Euthanasia is an issue that is under considerable debate, both from the ethical and the Christian viewpoint. The term has come to be understood as a form of mercy killing, where an individual would be in considerable pain to continue to live (Holt 257-59) . Depression and alterations in the patient’s decision have also been shown to occur. This problem has been addressed in Oregon, where patients are required to verbally request euthanasia twice, with the requests being 15 days or more apart (Lindsay 19-27). This is an important consideration in the case of Mrs. M, because she has a history of depression and has attempted suicide in the past. As such, it is reasonable to argue that her desire to have the ventilator removed may change at a later stage. Her request to have the ventilator removed came after she had been at the hospital for only three days, so it is probable that she had not had enough time to weigh up the consequences of her decision or all the options that were before her. Although Mrs. M had talked to her husband previously about end-of-life situations and decisions, she did not have all of the facts before her at that time. Because of this, her pervious desire not to suffer a low quality of life cannot be taken as evidence that being removed from the ventilator is a non-emotionally influenced desire. From the Christian perspective, allowing a patient to die when the ability exists to save them presents a religious and moral dilemma. Euthanasia is sometimes considered murder from an ethical standpoint, as it is the actions of the physician that actually kill the patient, despite the fact that the patient desired the action. In this case, the bible clearly states “You shall not murder” (NIV, Exodus 20.13). However, this is only one interpretation of euthanasia. Other perspectives argue that it differs from murder, because the patient desires it to occur. This argument has some merit because specific types of killing are excluded from murder, such as capital punishment and murder, although these are both discussed within the bible itself, while euthanasia is not Euthanasia and suicide are perspectives that are not directly covered in the bible. Instead, they must be understood by inference based on the passages in the bible. The most prominent theme in the bible that is relevant to the discussion of euthanasia is that God is sovereign and that man is only a steward of his own life. As such, it can be argued that only God has the right to determine the timing and the nature of a person’s death. This perspective can be seen in many versus. For example, Genesis talks about the dignity of human life and how people are created in the image of God (NIV, Genesis 1.26-27, 9.6). This suggests a strong responsibility to maintain human life. One of the confounding factors about euthanasia is the aspect of patient choice. The medical profession follows for primarily moral principles, autonomy, beneficence, nonmalefience and justice (Beauchamp and Childress 1). Historically a stronger focus has been placed on the issues of doing no harm (nonmalefience) and helping patients (beneficence) than on the patient’s right to autonomy. While euthanasia clearly violates the principles of beneficence and nonmalefience (Beauchamp and Childress 149), if the patient wishes this to occur, then not following their wishes would potentially be a violation of patient autonomy. In this case, Mrs. M’s husband and daughter have been involved in the decision making process, and agree with the decision that Mrs. M has made. Despite her depression and being in and out of consciousness, Mrs. M’s decision is consistent with previous perceptions on end-of-life. However, there has been no written statement about her decision or wishes, and there is no evidence of a living will. The law clearly states that a person has the right to accept or deny any medical treatment, even treatment that would prolong life. There is no indication that Mrs. M is unable to make medical decisions for herself, even with the presence of depression. If it was believed that Mrs. M was unable to make her own health care decisions, then her husband would be able to do that in this case. The case study of Mrs. M comes down to two main, contradictory, aspects. The first of these is her right to decide on her own treatment, and she has requested to be removed from ventilation. The second aspect is the fact that removing her would probably result in her death, meaning that this would be euthanasia. Furthermore, there is a significant chance that she would improve medically over time. On analysis of this case it is evident that both perspectives need to be taken into account. One recommendation would be that the situation is discussed with Mrs. M and her family and that she remains on ventilator for a set period of days where she can make the decision again. This would make her decision clearer, and allow both family and medical staff to work on finding an alternative solution during this time. Works Cited Beauchamp, T.L., and J.F. Childress. Principles of Biomedical Ethics. 6th ed. New York, NY: Oxford University Press, 2009. Print. Carroll, J.K., et al. "Acute Pancreatitis: Diagnosis, Prognosis and Treatment." American Family Physician 75.10 (2007): 1513-20. Print. Feldman, H.A., et al. "Nonmedical Influences on Medical Decision Making: An Experimental Technique Using Videotapes, Factorial Design, and Survey Sampling." Health Services Research 32.3 (1997): 343-66. Print. Holt, J. "Nurses' Attitudes to Euthanasia: The Influence of Emperical Studies and Methodological Concerns on Nursing Practice." Nursing Philosophy 9 (2008): 257-72. Print. Lindsay, R.A. "Oregon's Experience: Evaluating the Record." The American Journal of Bioethics 9 (2009): 19-27. Print. “New International Version”. Grand Rapids: Zondervan, 1986. Print. Read More