Workplace Dilemma Paper

CR, a sixty-eight year old woman, was admitted via the ED with acute respiratory failure and aspiration pneumonia. CR had amyotrophic lateral sclerosis (ALS), an incurable, progressive, neuromuscular disease. According to Lewis, Heitkemper, and Dirksen, 2000, ALS is a fatal neuromuscular disease that attacks nerve cells and pathways in the brain and around the spinal cord. All voluntary muscle actions are affected and the person eventually becomes paralyzed. The mind, however, is not affected, so the person retains cognitive function despite the total degeneration of the body. Death usually results from respiratory infection secondary to compromised respiratory function. CR had experienced severe difficulty with swallowing, difficulty with oral secretions, and respiratory distress for several days before calling emergency services. CR's primary physician had not referred her to a hospice for palliation of end-stage symptoms of ALS, nor had he offered her palliative care. CR did not want "heroic measures", but she was in such severe distress at home that she believed she had no other options. She accepted emergency intubation and ventilation in the ED because she felt she was "suffocating."

CR was admitted to our critical care unit. On the next hospital day, CR wrote a note asking about her options. She wrote, "I don't want to be on machines." The ICU staff explained all her options to her, including permanent tracheostomy, home ventilation, and the use of an enteral feeding tube to provide nutrition. CR was also told that her pulmonary function parameters were so compromised that she was unlikely to survive ventilator withdrawal for more than several minutes, if she chose ventilator withdrawal.

I was caring for CR and she wrote me to call her sister, TJ, who was her next of kin. CR's sister arrived and all treatment options were explained to her. CR had indicated her preference for ventilator withdrawal. She wrote, "I have lost nearly all ability to care for myself, I don't want to live any longer this way, especially on machines." TJ was not supportive about CR's choice.

The ethical issue in this case is whether or not the patient should make the autonomous decision to refuse a treatment or procedure that would prolong her life.

The individual should decide what quality of life is acceptable for her and therefore it is the patients right to decide about the acceptance of Treatment. CR had a fatal disease and no treatment option could stop or help her from deteriorating or dying. Death was inevitable. Would the proposed treatment options effectively palliate the patient and aid to her quality of life?

There are arguments that support the treatment options. The patient has a right to life and life should be preserved. The patient should receive the best possible care. Treatment should be applied because no treatment would result in letting the patient die, which is perceived by numerous people as mercy killing.

The patient's sister was adamant about the continuous life support. TJ felt that her sister still had a certain quality of life and that she should preserve it.

A mentally competent patient should decide what quality of life is acceptable for her. No one better than the patient knows how to determine her quality of life. It is not a choice the physician or the family members should make. The family members' view of quality of life may be very different from the patient's view. And very often relatives desire the continuing of futile treatment as a mere symbolic s display of love and concern.

Any treatment administered to CR would not cure her nor would it improve her condition. All what would have been achieved by selecting the available treatment options would have been the prolongation of the patient's survival. CR had already lost about all qualities of life which most people would consider most valuable and essential for the further being. She had voiced her decision to be artificially ventilated and fed which would have robed her of what little she had left of life.

Modern medicine has made great advances and many people believe that everything should be done to prolong life and every patient should receive the best possible care. Does this also mean everything possible to prolong