The case illuminates one of the most complex and intricate issues of withholding life support under the patient and his family members’ directives. It is evident that Mr. Martinez clearly stated that he should not be brought back to life, where he said that do-not-resuscitate order or DNR needs to be put in place. However, there are unavoidable ethical concerns regarding such actions, where withdrawal of life support and withholding lifesaving methods might possess a varying degree of morality.
It is stated that patient directives might not always be reliable, and thus, in certain situations, such as ICUs, healthcare professionals have more autonomy (Emmerich & Gordijn, 2019). Patient directives play a critical role in determining whether or not the withholding needs to be conducted. In the case of Mr. Martinez, the DNR order is passive inaction, which was given by both him and his wife without any rushed decision-making disruptions, such as ICU. Therefore, the patient’s directive needs to be respected, and it is ethically right to withhold cardiopulmonary resuscitation (CPR).
It is also important to analyze the quality of life of the patient in the case of withholding life support or providing it nonetheless. The given metric for Mr. Martinez is highly ambiguous because he can only be alive through maintenance with oxygen, fluids, and antibiotics. It would not be ethically wrong to withhold the CPR because his quality of life would not improve, and he would still remain under the strictest maintenance. In addition, there are clear family stated preferences, where his wife also requested DNR order alongside the patient, and they are adults. The case would have been highly complicated if there had been a disagreement between the patient and his family.
One should be highly aware that there are moral issues associated with limiting life support. It is stated: “they would reveal very little about the ethics of withdrawing and withholding life-saving medical treatment more generally. Blanket statements about the moral equivalence of withdrawing and withholding are of little use.” (Emmerich & Gordijn, 2019, p., 38). In other words, the moral aspect of the case can be discussed without arriving at a proper conclusion because they are evident underlying complexities.
However, this particular case presents mostly easy and simplistic elements, where an adult with another adult family member gives a clear order of DNR without any pressure from the environment or situation. It is important to note that the moral issue of withholding life support or withdrawing from a living patient can be tied to the active aspect of the action. Withholding life support is passive inaction, which is most likely the most morally unambiguous option. Withdrawing life support from a living patient can be considered an active intervention of euthanasia, and thus, it is morally ambiguous and even immoral without proper justification.
Ethical principles for making a sound decision should not be tied to morals only, as it was described above. It is ethical to be patient-centered by respecting his or her choices in regards to the treatment. It is also ethically sound to take the family members’ claims into consideration. Therefore, the most critical ethical principle at play is the autonomy of the patient, which needs to be respected and adhered to under most circumstances, even if there are surrogates.
Mr. Martinez and his wife exercised their autonomy to request the DNR order, and the inadvertent oxygen turn up should not be the factor, which alters the decision. Both Mr. Martinez and his wife were well-aware of their decision, and there were a clear motivation and goal behind it. Using CPR despite DNR order because of the oxygen failure would be considered as undermining the autonomy of the patient.
There are clear implications of not following the DNR order, which can result in major ramifications. Although it is unethical to ignore patients’ DNR orders, it is ultimately a medical expert’s decision to proceed or not to do so. However, the case shows that a DNR order was requested prior to the incident, and it is most likely to be signed by a physician, which makes it clear that CPR must not be provided. The provision of such life support measures will undermine the authority of a physician as well as immorally disrespect Mr. Martinez’s decision. Therefore, the case lacks any conflict of interest, which makes the adherence to the DNR order as the most ethical and correct option.
Mr. Martinez should be transferred to ICU, where his respiratory failure can be treated by a ventilator, but the order needs to be still followed, where CPR is not used. Although such an approach sounds highly technical and precise, it is important to utilize the specificities of the order. One might argue that the DNR request was asked with an implication of not being alive, which means that ventilators also should not be used. However, this form of thinking creates room for interpretation and can allow medical specialists to make additional decisions for the patient. Therefore, the precise request of the DNR order needs to be adhered to, which does not prohibit ventilators.
Mr. Martinez needs to be transferred to an intensive care unit, where ventilators can be used to aid him. The key ethical issues revolve around the autonomy of a patient over his fate. The most critical end-of-life issues are centered on withholding medical therapies and resuscitation status. Understanding models and best-practice can greatly help to guide health care practitioners to make ethical and legal decisions by providing a precise perspective on these matters.
Reference
Emmerich, N., & Gordijn, B. (2019). Beyond the equivalence thesis: How to think about the ethics of withdrawing and withholding life-saving medical treatment. Theoretical Medicine and Bioethics, 40, 21-41. Web.