Bioethical issues and contemporary applications

¶ … ethical principles apply to this case?

Autonomy: Autonomy means the ability to make autonomous or independent, rational decisions. In this scenario, the woman was able to make autonomous decisions about her health care before the incident described. She was aware of the fact that her health was failing. She signed a Durable Power of Attorney for Health Care (DOAHC) agreement, in case she was incapacitated, placing her health care in the hands of her relatives, who were aware of her wishes not to be intubated or artificially resuscitated. This agreement was meant to transfer autonomy to her relations, in the event of her incapacitation.

Beneficence: To do no harm is one of the primary concerns of all healthcare providers, as it is the first commandment of the Hippocratic Oath. This explains the paramedic's insistence that they must treat the woman, even though their actions were, according to her relations, against her clearly and coherently expressed wishes. It highlights a frequent difficulty in such cases, even after the patient's wishes are known, because healthcare providers wish to do all they can to save a life, even if prolonging it through artificial means is viewed as harmful in the eyes of a patient.

Nonmaleficence: To do no harm and not to actively hurt the patient is rendered more difficult in the above scenario for the on-call physician, as he is not merely withholding care but actively withdrawing life-preserving care because of the actions of the paramedics. Also, he is merely the on-call physician, not the woman's regular health care provider and does not know her well, or her relationship with her relatives.

Justice: Justice is served honoring the woman's wishes, but also honoring certain legal protocols to ensure that people's lives are not destroyed against their wishes and merely for their relative's comfort or convenience.

What is / are the issue(s) in the above case?

Does the DOAHC reflect the patient's wishes for her life not to be prolonged by artificial means? The DOAHC statement gives the role of "patient advocate to make care, custody and medical treatment decisions "for a patient in the event the patient becomes "unable to participate in medical treatment decisions" (DOAH, 2006). The relatives in this case state that they know the woman's wishes, and they have her regular health care provider to back their statement. Thus, it seems in the case that the on-call physician would not be in error, should he remove the support of the ventilator.

What other measures could have been placed to assure the patient's wishes were honored?

Instead of merely giving proxy to the woman's relatives, a Living Will specifying the terms that were acceptable to the woman for life support would have enabled her to put her feelings in writing when she was still functioning as an autonomous individual, and capable of making her own decisions. "Of all the various acceptable forms of evidence, a health care declaration (often called a 'Living Will') can be the best. It simply documents a person's wishes concerning treatment when those wishes can no longer be personally communicated" (Freer, 1994). In some states, like New York State, there are specific laws regarding DNR (Do Not Resuscitate Orders) that might need clarification.