Life Support vs. Dignity

A decision is complicated not just by the people affected by it, but also by the people making the decision. For health care professionals, decision making is usually complex because of their role in providing care to patients and their families. One of the most difficult decisions for these professionals is scenarios involving life support or death. In these situations, health care providers work with the patient and his/her family to decide whether to sustain a patient’s life or ending it. When facing such decisions, the providers should identify risks, evaluate risks, assess interventions, and determine suitable measures to mitigate risks. Some of the important aspects to consider during this process include informed consent, vicarious liability, strict liability, and res ipsa loquitur.

Case Scenario

A family is notified by the physician that their grandfather has respiratory failure, hepatic failure, cardiac failure, and has no blood pressure. The physician has also notified the family that the grandfather is septic and that his current condition has been like this for a week and appears to be worsening. He has no likelihood of survival. The doctor requests that the family make a decision about sustaining the grandfather’s life or ending it.

Analysis of the Scenario

Life support is a mechanism that is used to sustain a patient’s life after the failure of at least one vital organ or system. On the contrary, physicians are sometimes faced with a duty to hasten a patient’s death, especially when the patient has no chance of survival following the failure of at least one organ. However, doctors need to ensure that a patient dies with dignity when it’s the most appropriate decision for the patient’s condition. The decision on whether to subject a patient to life support or death is usually complex for doctors and the patient’s family members because of its impact on their lives.

The above scenario is an example of an incident in the medical community whether physicians and a patient’s family need to decide whether to place the patient on life support or hasten his death. According to Miller (2011), the medical community must handle the process and event of life support or death carefully because it’s the single most important experience in a person’s life (p.81). When making the decision on whether to sustain or end the grandfather’s life, the physician and family members need to consider all risks, evaluate them, and determine suitable measures to mitigate the risks.

Risks in the Scenario

The patient in this scenario has been diagnosed with four major conditions i.e. heart failure, cardiac failure, respiratory failure, and no blood pressure. Given these conditions, the physician has determined that the patient has no likelihood of survival. Consequently, there are two probable decisions that the physician and the patient’s family can make i.e. sustaining the patient’s life through life support or ending it in a dignified manner. However, there are several risks involved in each of these decisions because of complexities associated with the processes.

In relation to life support, some of the major risks involved in this scenario include the likelihood of further medical complications. Secondly, life support may generate risks of slow and frustrating recovery because it’s a difficult and emotionally draining experience. The other risks associated with such a decision include huge financial costs of the techniques, emotional consequences and suffering, physical dangers, and societal discord.

On the contrary, the decision to end the patient’s life is also accompanied by several risks, which heightens the complexity of the scenario. One of the potential risks in this scenario is the probable disagreement by some family members. Secondly, when making such a decision, physicians face the risk of carrying out the process in an inhumane way or without dignity. Third, ending the patient’s life may result in lawsuits, especially if some family members disagree with the physician or if the process is not carried out with dignity. The other risk is that the decision to end a patient’s life may not reflect his/her wishes regardless of whether the patient’s family agrees with it.

Analysis of the Risks

Risks associated with the decision on life support emerge from the fact that the process is very painful, expensive, and an emotionally draining experience. In cases where it’s successful, life support can lead to slow and frustrating recovery because it exposes the patient to significant medical complications that worsen his/her underlying condition. Physical dangers emerge from hazards of life support techniques on the patient’s underlying condition and treatment while emotional risks affect the patient, his/her family, and care providers. The financial burdens of life support are brought by the expensiveness of the techniques utilized to sustain a patient’s life.

Ending a patient’s life or death with dignity has experienced several concerns and risks in the recent past because of modern advances in life-sustaining technology. The process itself threatens the autonomy and dignity of the patient. In addition, surrogates’ understanding of the patient’s desires may not reflect the patient’s wishes, which generates more risks and concerns (Song, Ward & Lin, 2012, p.412).

Probable Interventions

As probably mentioned, the two probable interventions in this scenario are life support or death with dignity. While the physician has stated that the patient has no likelihood of survival, life support would still be an ideal intervention to address the patient’s condition. The implementation of this intervention would require adequate preparation through proper evaluation of the patient and utilizing proper equipments and techniques. This would also involve placing the patient in intensive care unit through which every effort is undertaken to sustain life without consideration of death (Vitals, 2013). It’s important for the physician to ensure res ipsa loquitur so that they are not liable for any medical complications that could arise from the use of this process. This can be ensured by informing the family of potential complications associated with life support prior to the commencement of the process. Nonetheless, the physician will be held liable for damages or losses caused by his/her actions or omissions based on vicarious liability and strict liability. To ensure this doesn’t conflict res ipsa loquitur, the specific duties of the physician and their potential impacts will be discussed with the family before the intervention is adopted.

The other probable intervention is ending the life of the patient based on the physician’s assessment of his illness or condition. This would seemingly be the most suitable decision or intervention because the patient has no chance of survival because of hepatic failure, respiratory failure, cardiac failure, and no blood pressure. However, the implementation of this intervention would require identifying ways to mitigate the risks. The first measure is to adopt the decision based on the physician’s autonomy in end-of-life scenarios in ICUs. Secondly, the physician should discuss with the family extensively regarding every issue relating to this decision. Third, the physician should seek for informed consent before adopting this intervention.

In conclusion, physicians face difficulties when making decisions regarding patient care, especially life support or death decisions. The scenario in this analysis is an example of a life support or death situation in which the physician is consulting the family on the best possible measure. When making this decision, the physician and family should not only consider risks in every intervention but also examine legal and ethical ramifications of the decisions.

References

Miller, P.J. (2011). Death with Dignity and the Right to Die: Sometimes Doctors Have a Duty to Hasten Death. Journal of Medical Ethics, 13, 81-85.

Song, M., Ward, S.E. & Lin, F. (2012). End-of-Life Decision-Making Confidence in Surrogates of African-American Dialysis Patients Is Overly Optimistic. Journal of Palliative Medicine, 15(4), 412-417.

Vitals. (2013, May 21). Pulling the Plug: ICU ‘Culture’ Key to Life or Death Decision. NBC News. Retrieved May 31, 2016, from http://vitals.nbcnews.com/_news/2013/05/21/18382297-pulling-the-plug-icu-culture-key-to-life-or-death-decision-lite

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