This paper examines the biomedical ethics surrounding the case of Dr. Nancy Morrison and her patient Mr. Mills, who underwent ten surgeries for esophageal cancer before being removed from life support in extreme distress. The paper outlines the medical facts of the case, evaluates the legal and ethical arguments both for and against Dr. Morrison's decision to administer potassium chloride to hasten her patient's death, and considers the broader debate over physician-assisted dying versus palliative care. It concludes by recommending that ICUs incorporate structured palliative care procedures to prevent similarly agonizing end-of-life situations in the future.
The case of Dr. Nancy Morrison and Mr. Mills is an important one, as it forces the legal system to confront the question of euthanasia and end-of-life care. The important questions raised by this case include: What is the extent of a doctor's responsibilities toward a patient who is in pain and dying? Can a doctor make a judgment call and end a patient's life prematurely? Can a patient make that decision on their own? Is it ethical to let a patient die in agonizing pain for hours? And is it ethical for a healthcare provider to make that decision themselves? This paper examines the specifics of the case, the extent of the suffering Mr. Mills underwent, and the ethical and moral issues associated with Dr. Morrison's actions.
Mr. Mills was admitted to the Moncton General Hospital in April 1996 for cancer of the esophagus (Sneiderman & Deutscher, p. 3). The cancer was removed via surgery, but due to necrosis there was leakage of gastrointestinal fluid, which infected other tissues. Mr. Mills underwent three further surgeries in Moncton before he was transferred to the QEII in Halifax, where he underwent another six surgeries, for a total of ten. Mr. Mills lost 42 pounds between October 15 and November 6, and his infections were so severe that healing from his surgeries became unattainable. He was described as "heavily sedated, on narcotics, on antibiotics, multiple IVs running. Probably in the realm of 10 tubes in him, fully catheter arterial line, central lines for administration of antibiotics, and tubes in his stomach and tubes in his chest" (Sneiderman & Deutscher, p. 3).
His condition continued to deteriorate rapidly. On October 15 he was admitted to the ICU and placed on a ventilator. On the 17th, his doctors and family signed a DNR order. When it was time to take Mr. Mills off life support, it was believed that he would pass away quickly, thereby shortening his anguish. However, Mr. Mills experienced an extreme shortness of breath for hours. He was administered morphine, Dilaudid, and Versed, yet his distress continued (Sneiderman & Deutscher, p. 4). The nurse in charge of Mr. Mills conveyed his distress and her concerns to Dr. Morrison. Dr. Morrison administered nitroglycerin to decrease his blood pressure, and when his blood pressure increased after an initial drop, she administered potassium chloride. Dr. Morrison was subsequently suspended by the hospital, and police later pressed murder charges against her.
There are several legal and ethical objections that can be raised against Dr. Morrison's actions. First, while the patient had previously expressed a wish to die approximately a month before his death, he was not conscious and therefore unable to make an informed decision concerning his healthcare at the critical moment. Second, there is the question of whether Dr. Morrison willfully committed murder, and whether a hospital or any healthcare setting should employ providers willing to resort to ending a patient's life, even under extreme circumstances.
It is a doctor's or nurse's responsibility to look after the welfare of their patients; however, the limits of that authority must be defined. Should a doctor determine whether a patient should live or die? (Collier & Haliburton, p. 20). To opponents of Dr. Morrison, the answer is an emphatic no. A physician may remove a patient from life support, but the intention behind that action is not to kill the patient — it is to acknowledge the limits of modern medicine (Reynolds, Cooper, & McKneally, p. 474). When no alternative exists, that option may be exercised. However, it is not the physician's role to expedite a patient's death, only to lessen their suffering. To those opposed to euthanasia, any action beyond allowing nature to take its course constitutes murder. The intention behind euthanasia may be benevolent, but the end result is still considered a crime. Furthermore, in the case of Dr. Morrison and Mr. Mills, there is the additional question of whether Dr. Morrison should have consulted other physicians before making such a consequential decision as administering potassium chloride.
"Moral imperative to relieve extreme patient suffering"
"Policy proposals to prevent future end-of-life crises"
"Sources cited throughout the paper"
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