Mr. Lovebird, an 84-year old man suffering from Stage IV lung cancer, is in the ICU, following surgery to remove the malignant mass in his brain. Although Dr. Kutup was able to completely remove the mass, Mr. Lovebird suffered a cardiac arrest during surgery and is now unconscious and on a Ventilator. It is uncontested by the medical staff that he will remain in this condition presumably lapsing into a PVS state, if he is not in one already. Mrs. Lovebird, Mr. Lovebird's high school sweetheart and wife for 65 years, has requested a feeding tube for Mr. Lovebird and any treatments that can keep him alive. As his healthcare proxy agent, she claims that she knows his wishes, as they spoke extensively about this potential situation before the surgery. Mr. Lovebird did not leave a living will.
Dr. Kutup is upset. He believes the Vent care is futile and the feeding tube will produce more harm than good, given its propensity for infection. He is also unable to justify the poor use of the expensive resource, from a pragmatic Utility perspective. Ethically conflicted, Dr. Kutup consults with Dr. Friendly, the Lovebird's family practitioner for thirty-five years Dr. Friendly is conflicted as well. He was recently contacted by Lancelot, the Lovebird's only child, who is very upset about his father's situation. Lancelot told Dr. Friendly that Mr. Lovebird stated years ago, to Lancelot and Mrs. Lovebird, that he would never want to end his life 'existing' like Terry Schiavo. Believing Lancelot is probably right, Dr. Friendly goes to see Mrs. Lovebird who is sobbing and holding Mr. Lovebird's hand. Through tears, she tells Dr. Friendly that she cannot bear to see Mr. Lovebird like this, but he had insisted before he went into surgery that she do all she could to 'keep him going.' Dr. Friendly tells Mrs. Lovebird that from his knowledge of Mr. Lovebird, he is surprised. Mrs. Lovebird bursts into tears and confides that Mr. Lovebird made her promise that she would keep him on life support so that she could collect his social security checks as long as possible. He wanted to make sure he could continue 'looking after her.' Knowing the Lovebird's devotion to each other, and the direness of their financial situation, Dr. Friendly pats Mrs. Lovebird's hand and tells her that he will do all he can to honor Mr. Lovebird's wish. Upon hearing the outcome of the discussion from Mrs. Lovebird, Lancelot requests an Ethics Consult with the Hospital's Ethics committee.
*The case study is a fictitious composite of real-life scenarios.
Read:
•Module notes and textbook pages
•Brudney, D. (2009). Choosing for another: beyond autonomy and best interests. Hastings Center Report, 39(2), 31-37.
•Escobar-Plagman, A. (2011). Moral fatigue: Ethical reflections on the fhcda. NYSBA Elder and Special Needs Law Journal, 21(4), 11-14.
•Andreoli, E. (2012, March 06). [Web log message]. Retrieved from https://www.sterlingeducation.com/the-sterling-blog/bid/79158/Patient-s-Best-Interest-Swept-Aside-When-Attorney-General-Intervenes-in-End-of-Life-Case
•Alexia Torke et al., Substituted Judgment: The Limitations of Autonomy in Surrogate Decision Making, Vol. 23 JGIM p. 1514-1517
Read the following scenario and participate in the discussion:
You are a member of the Ethics Committee. In advance of the full committee meeting tomorrow morning, the Chair has asked you and the other members to review the case study "Lovebird's Case Study," and has assigned each member a specific aspect of the case to consider. At the full committee meeting, the Chair asks you to discuss the following:
•Presume that both Mrs. Lovebird and Lancelot are telling the truth. Should the ventilator sustaining Mr. Lovebird's life be removed, understanding the reason that Mr. Lovebird wants to remain on life support?
•In your discussion, justify your response using the four principles of bioethics and any of the moral theories we have studied that may apply.