Case 27 re: artificial nutrition
The
theories: Kant, Utilitarianism, Virtue Ethics, Casuistry, Ethics of
Care, Ross' Principles, Principles of Bioethics, Coherence theory.
Then critique each other. Each person pick another post and analyze the response. Be charitable.
KANT'S PERSPECTIVE:
ReplyDelete1.) Is it morally legitimate to withhold nutrition in this case?
No the patient has the right to live even if it is under bad conditions. Kant says that no suicide is right and that you should never kill yourself. I believe that I would also want to die just like Mildred. There is no point in living like that if you don't have too. I don't believe that is really living at all.
2.) Does the family have the right to make such a decision for the patient?
According to Kant they do not have the right to make the decision that will eventually end their mothers life. He emphasizes that killing is wrong and that it is not morally ethical to do so. However, I believe the family should have that right to put their mother out of misery, I know I would want my children to do the same for me is I was living like Mildred. Her children should be able to make that choice.
3.) Should the refusal of resuscitation be considered an indicator that the patient would also refuse nutrition.
Kant's perspective on this is that it is suicide once again. The patients and their family is willingly letting them die when the only thing keeping Mildred alive is the feeding tube. This is morally unethical according to Kant because he believes that all like is worth living. A DNR and the refusal of Nutrition I believe are two completely different things, with a DNR you are already dead and with refusing nutrition you are just slowly killing yourself. Kant would see that the DNR is okay because the person has already died and that the refusal of nutrition is not ethical. I personally believe that the person has the right to do whatever they want with their lives and make choices to either carry out their life as they want or end their life if they want.
Jayson, I agree that at the end of life most of us will want respect of our own dignity. Being kept alive by an NG tube is not how we picture ourselves in the end. But if Kant believes that we should avoid pain shouldn't this apply to the end of life?
DeleteKant's Perspective:
ReplyDelete1) Is it morally legitimate to withhold nutrition in this case?
Kant would say no because he believes all life is valuable. Since receiving nutrition through the NG tube is the only thing keeping Mildred alive, withholding this would kill her and Kant doesn't believe there is any good in helping to end someone's life. Removing the tube would be treating her as a means to an end because she would be dying to increase the utility of those around her. I personally don't agree with this because Mildred has lost all quality of life and I think it would be right to take away the nutrition and let her die.
2) Does the family have the right to make such a decision for the patient?
Kant believed that it was wrong to be disrespectful of other people and their goals and plans. I believe then that Kant would think it was okay for the family to make the decision for the patient only if they followed Mildred's wishes (treat humanity as ends, never as a means only). However in this case, they don't know Mildred's wishes so Kant would say the family didn't have the right to make the decision. Still, he would be against the removal of the feeding tube because that would cause Mildred to die. This would be killing her and is morally wrong.
3) Should the refusal of resuscitation be considered an indicator that the patient would also refuse nutrition?
I believe Kant would also say no to this. Mildred indicated that she would not want to be resuscitated, but that does not mean she would also refuse nutrition. She would already be dead when they would try to resuscitate her. She is still alive and functioning with the feeding tube therefore removing it would kill her. Kant would see this as morally wrong. Although she expressed her want to not be resuscitated, this does not mean she wouldn't want treatment while still alive.
I agree with this stance because killing the person is being used as a means to an end. The idea of not giving someone the proper nutrition to stay alive is wrong, even if a patient asks for it. There is another way I feel that situation could be handled to bring agreement towards each side.
DeleteKant says a persons good will is the only thing which is unconditionally good and that actions are right if they are done for the right reasons and from good will, not for the fact that they make us feel good or if they bring about good consequences. Is removing a feeding tube the same as killing a person? Removing the tube isn't necessarily doing it for the sake of others since the person has the inability to survive without it. Even with the feeding tube the person will just slowly wither away until their organs shut down. Back in Kant's time there was none of today's technology that was able to live for a person. So even with preserving human life to what extent would Kant think its a matter of preserving life or simply prolonging death? I think Kant would want to preserve life up to the extent that the person will no longer be able to acquire nutrients on their own, to the point that they are too weak to even perform the basic acts of survival. Especially if it goes against the patients wishes to die a peaceful or natural death.
DeleteUTILITARIAN VIEW
ReplyDelete1) Is it morally legitimate to withhold nutrition in this case?
Yes. Although the woman would suffer from the withdrawal of the food tubes and starvation, her death would be expedited. That means that those resources would be available for others. Also, her family would be less burdened financially in comparison to if she were to stay on feeding tubes and fade out slowly over a long period of time which would be expensive.
2) Does the family have the right to make such a decision for the patient?
Yes. Minimizing pain and maximizing pleasure for the greatest good: having her hooked up to machines for a long period of time would get really expensive really fast and would drain a lot of resources that could be reallocated to someone who might need it more.
Also, her brain was already proven to be destroyed significantly by the stroke so they would have power of attorney anyways.
3) Should the refusal of resuscitation be considered an indicator that the patient would also refuse nutrition?
Yes. Especially considering her advanced age and state. I personally like to think of an earlier time jn history when we didn't have machines. I think that the women would prefer to let die instead of keeping her alive by extraordinary means in order to just prolong her inevitable death.
Katrina, I agree with all three of your answers! The Principle of Utility defines right action as that which maximizes pleasure or minimizes pain for the greatest number. Withholding nutrition from Mildred would result in her death, but this maximizes "pleasure" for the greatest number. The nutrition would go to others who need it and the family wouldn't have to suffer from the burden of the medical bills any further as you mentioned. The family would also have the right to make such a decision for her because what they want would maximize pleasure/ minimize pain for the greatest number. You would also be following the Principle of Utility for the last question because its best for the greatest number of people for the same reasons as the previous questions.
DeleteI would agree with these answers in most cases the patient doesn't really even feel pain from the starvation but usually from whatever is causing it whether it be old age or cancer. It doesn't make any sense to resuscitate someone when they will likely die from starvation in a matter of days in fact that would probably be the less painful route to go because in that situation there is almost never a recovery from it.
DeletePrinciple of Bioethics
ReplyDelete1. Is it morally legitimate to withhold nutrition in this case?
No because the doctor is acting for the patient's autonomy. Even though she indicated this to her family, there is no legally proof for the doctor to stop treatment. The doctor is also trying to be non-maleficent and do no harm, such as letting a patient die.
2. 2) Does the family have the right to make such a decision for the patient?
If the doctor was trying to show justice and be fair, then yes, but the doctor also has to be non-maleficent and do no harm. The doctor also has to take patient autonomy into consideration and respect her even though she cannot make a decision about what she wants.
3. Should the refusal of resuscitation be considered an indicator that the patient would also refuse nutrition?
No, because there is a difference between resuscitation and refusing nutrition. The doctor is obligates to be non maleficent and do no harm and be beneficent and do good, such as keeping the patient alive.
Is it really considered doing harm if the woman is already going to die and there's no chance of recovery due to the amount of damage from the stroke?
DeleteIs the doctor really acting for the patients autonomy in this situation? The doctor knows she does not want to be resuscitated, so how do you know she would want her dying process to be prolonged when feeding her through a tube is not improving her condition at all?
DeletePrinciples of Bioethics:
ReplyDelete1. Is it morally legitimate to withhold nutrition in this case? Before Mildred had a stroke she was conscious and aware of what was happening around her. She had previously indicated to her family that if she was ever in this type of situation she would not want to be resuscitated. The only thing keeping her alive at this point is the NG tube. The doctor is only doing his duty and using the principle of nonmaleficence to not harm the patient. But Mildred also has patient autonomy and the right to maintain her values and goals at the end of life. These two principles contradict each other but in the end it is morally wrong to withhold the nutrition.
2. Does the family have the right to make such a decision for the patient? The family has the right to decide for the patient if they are Mildred's durable power of attorney. They are to respect what she wants in the end (autonomy).
3. Should the refusal of resuscitation be considered an indicator that the patient would also refuse nutrition? The refusal of resuscitation does not imply that that the patient would want to refuse nutrition. The goal for the doctor is to keep the patient alive and to promote good (beneficence).
Why doesn't the refusal of resuscitation indicate that the patient would refuse nutrition? Aren't both of those minimizing pain for Mildred? Also, why is the patient's duty to keep the patient alive if she is suffering as well? Are you siding with beneficence over non-maleficence in this case?
DeleteI agree that both the principle of autonomy and the principle of non-maleficence are in conflict in this case, but I think that autonomy wins here. She has expressed a desire for a DNR because she realized that she did not want to live in a situation such as this. To me, since it would also be following the family's wishes, it would be morally legitimate to withhold nutrition. Another piece of information to consider is that she is semicomatose. If she became conscious enough, then the doctor could ask her what she wanted and follow her direct wishes about the nutrition.
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ReplyDeleteRoss' Principles
ReplyDelete1. Is it morally legitimate to withhold nutrition in this case? This case exemplifies a classical Ross case of conflict of duties. In this sense it is hard to interpret which of Ross' duties should take precedence but it seems a few can be interpreted to lead to the same conclusion. In the case of Mildred the first duty, that of fidelity, comes to mind in that her children should keep their promises to her. The case states that in previous conversations Mildred stated she would not want to exist in the current condition she is in. Therefore in this way it is morally right to remove her feeding tube. Also, the duty of beneficence and non-maleficence comes to mind in this case in that there is clear evidence Mildred's health cannot be made better so it is more of an obligation to make her comfortable in her dying? Non-Maleficence can be viewed in two ways in this case. First, it can be said keeping her on the feeding tube is keeping her alive and Ross does not believe in killing. But, by keeping her on the feeding tube are we causing her suffering which we could possibly stop by taking her off of the feeding tube. In all of these duties it is Ross' belief that the people involved need to make a decision on which takes the most precedence.
2.Does the family have the right to make such a decision for the patient? In this situation Ross would say yes because through the duty of fidelity they are keeping their promise to her by not letting her continue in this state. Also, they must make a decision based on the duties of beneficence and non-maleficence to Mildred.
3. Should the refusal of resuscitation be considered an indicator that the patient would also refuse nutrition? In this situation Ross would likely say no because in a sense the nutrition is helping Mildred and not harming her so the duties of beneficence and non-maleficence take precedent. This is different than resuscitation because this can possibly do more harm than good to a woman of Mildred's age.
I agree that according to Ross the decision needs to be made based on what takes precedence. I think Ross' Principles of Bioethics would say that ensuring fidelity would definitely come in the form of leaving the decision up to the family. Mildred's age does become a factor in this case and it was imperative that you brought that up. Precedence is key and it is a tricky situation.
DeleteUtilitarian Perspective
ReplyDelete1.Is it morally right to withhold nutrition in this case?
From this perspective I think it would be acceptable to keep the patient from being treated because overall the pain will be minimized. If he continues to be treated it does not guarantee that the pain will stop or help, it is just said to soothe the patient. The more permanent pain would end if the patient died naturally which I feel does not qualify as suicide.
2.Does the family have the right to make such a decision for the patient? I do not believe the family has the right because they are not the ones being harmed. Emotionally they may be harmed but the patient dealing with the pain should be in charge. They have to make the right decision that they feel minimizes the most pain. The family has the potential to be selfish and keep them alive for their personal benefit.
3. Should refusal of resuscitation be considered an indicator that the patient would also refuse nutrition? Yes because of how technically they will serve the same function. The idea of medicine being turned down would almost guarantee no other help is needed. The pain has already been minimized by refusal. If they try to add any more it will lower the pleasure from the patient in serving their request.
I agree that the withholding of nutrition would be minimizing the harm presented to the patient and her family. As a utilitarianism perspective, I disagree with Josh that the family has no right to decide. The decision is also affecting the family and therefore causing harm to them. If they decide to follow her wished, they are minimizing the harm done to her physically and the financial harm being put on them. She has requested to her family that she doesn't want to be in this state and therefore she has given them consent. They are not personally benefiting from keeping her alive. Her being alive is causing the family financial and emotional harm because they have to keep paying for her to be alive, when she said she did not want to be in that state, and emotionally because they have to see her in a state that she said she did not want to be in. I agree that refusal of resuscitation can be the same as refusal of nutrition because it the long term, it can cause more harm than good in this case.
DeleteUtilitarianism Perspective
ReplyDelete1. I feel that someone with a utilitarianism perspective would say that it is morally legitimate to withhold nutrition, as long as it is minimizing pain for the greatest number. Since it is minimizing pain for the greatest number, it is ethical. In this case, it would be morally legitimate to withhold nutrition, since Mildred is in so much pain with nutrition. Allowing her to die peacefully would be minimizing the most pain. As her pain is minimized, the pain of her family would be minimized too.
2. I think someone with a utilitarianism perspective would say that the family does have the right to make such a decision for the patient, as long as they are maximizing pleasure or minimizing pain for the greatest number. And, if the patient can’t make the decision. In this case, the family wants to remove nutrition and let Mildred die peacefully, so that her pain is minimized. By minimizing her pain, the family’s pain is also minimized. Mildred has also indicated that she would not want to be kept alive on a feeding tube.
3. I would say that the refusal of resuscitation would be an indicator that the patient would also refuse nutrition, because nutrition is keeping the patient alive. In other words, nutrition can be a factor in resuscitation. In Mildred’s case, she has indicated that she would not want to be resuscitated. By leaving the feeding tube in, she remains alive and in a vegetative state. If the doctor removes the feeding tube, Mildred will slowly die.
Casusitry
ReplyDelete1. Since casusitry is based off of a case by case basis, it states that you should withhold nutrition from Mildred. Since she has indicated that she does not want to be resuscitated, I hardly think that she would want to suffer through weeks or months of pain than starve to death. The kids also want to do this for her. I believe that in this circumstance it should be up to the family and if that is what they want, then the physician should abide by this.
2. The family does have a right to make this decision. This is because she has trusted some of what she wants in these kind of cases already. If she has trusted them with this information, then I believe that they understand what she wants well enough to make a decision.
3. Yes I believe that both refusal of resuscitation and refusal of a feeding tube would indicate that the patient would not want to be put through pain. This indicated, the physician should take this and the family's thoughts in to consideration and make a choice based on the woman and what she would want.
Virtue Ethics:
ReplyDelete1. Is it morally right to withhold nutrition in this case?
According to virtue ethics the action is not the focus. I nutrition is withheld then virtue ethics begins to analyze the reasons the nutrition was withheld. If it was done out of kindness and mercy then it was morally right to stop giving nutrition to the patient. If the person withholding the nutrition did it out of spite for the patient then it is absolutely immoral.
2. Does the family have the right to make such a decision for the patient?
Virtue ethics says that anyone has the right to take action in this situation as long as they are acting within the means of virtue. So yes, the family has the right to pull the plug.
3. Should refusal of resuscitation be considered an indicator that the patient would also refuse nutrition?
A virtuous person would ask his or herself whether or not the person ever has a chance to recover with a normal life. If the patient has a chance to lead a life of quality then a virtuous person would apply nutrition and resuscitation. But I do not think that refusal of resuscitation is an indication to refuse nutrition as a person of virtue.
You do not really answer the first question. Are you saying that it should not be given to the patient so that she does not suffer? Is that beneficence or a good for her to die from no nutrition when she could survive with it?
DeleteEthics of Care:
ReplyDelete1. From the perspective of the ethics of care, it would be morally right to withhold nutrition in the case. The patient cannot feel it in this instance, and and it would eventually allow the family closure upon the death of the patient.
2. From an ethics of care perspective, the family does have the right to make the decision, mostly because it is honoring the patients previous indication, and also because it is the empathetic response to their pain over their relatives's situation.
3. No, it shouldn't if only because nutrition in this instance would never actually result in resuscitation.
From the Virtue Ethics Position:
ReplyDelete1. I believe that ignoring the act of withholding nutrition and just looking at the intentions of the doctors which would be to respect the patient's wishes to not be resuscitated and to show the patient mercy by not reviving her and giving her a poor quality of life. However if the intentions are to withhold nutrition because keeping the patient alive would be a waste of time or some other unvirtuous reason, then this would not be morally right. An unvirtuous doctor may also keep the patient alive to make more money so that should be considered.
2. I think the family could make the decision if they have the patient's best interest in mind and are acting out of virtue (mercy, respect, duty...)
3. Looking at the reason for refusing resuscitation which would be the belief that a life after resuscitation would not be worth living, a virtue ethicist would have to consider what quality of life the patient would have and then base the decision off of that.
From the Ross's principles viewpoint:
ReplyDelete1. I believe that it is moral to hold nutrition due to the duty of fidelity, which is keeping the promises of the patient. Also with the duty of nonmaleficence by withholding the nutrition it is taking the patient out of harms ways but stretching out the dying process.
2. I think the family could make the decision of the patients as long as they carry out her wishes. This would go along with the duty of fidelity.
3. I think you can conclude that the refusal of resuscitation can be considered an indicator that the patient would refuse nutrition. By continuing feeding her through a tube even though she is dying and is semicomatose and paralyzed. With the duty of nonmaleficence by feeding her she is being put more in harms way because it is just stringing out the inevitable, just like if she was resuscitated.
Principle of Biomedical Ethics
ReplyDelete1. The principles of nonmaleficence and autonomy are in conflict here. The principle of autonomy indicates that she would not want the feeding tube due to her DNR. Nonmaleficence tells the doctor to give her nutrition so that he does not starve her to death. Beneficence can come into play if she values no life more than her current state. In this case, I think it is strongly indicated that she would not want to be kept alive on any sort of support, meaning it would do good to her if she was taken off. In the end, I think it is morally legitimate to withhold the treatment.
2. I do believe that the family has the right to make the decision in this case. From what is known, it seems as if she had thought about this situation before and the family's wishes align with the wishes of the patient.
3. I do think that the refusal of resuscitation is an indicator to refuse nutrition. It appears that the patient does not want to drag out her death to be slower and more painful.