Ethics: principles, applications, and contemporary issues

Ethics

The case touches on Alzheimer-type degeneration. Alice mother, Martha, suffers from this clinical condition. She is not capable of taking care of her self and relies on her daughter for virtually everything. Her daughter takes her to a special unit where Alzheimer patients are taken care of because the facility can provide long-term care for Martha. Before Martha is taken to this facility, Alice realizes that Martha is in a frail state.

Upon admission at the facility, Alice fails to complete doing the paperwork because of weariness. Unfortunately, only a few forms are in the process signed. She gave her mother's directive that if her heart stopped beating she never be subjected to Cardiopulmonary Resuscitation (CPR). It is however not clear whether the physician cosigned DNR order. After Alice had left the facility, her mother suffered a cardiac episode and was taken to an intensive care unit where she was put on a heart monitor, ventilator, and an intravenous line, something that really infuriated Alice.

This case highlights some important professional obligation of healthcare professional with regards to terminally ill patients or patients under long-term medical care. The case highlights issues pertaining to when CPR can or cannot be withheld. Conventionally and depending on the policies of a particular hospital, CPR is withheld when it is deemed to be of no medical benefit to a patient or when persons designated to make decisions for them indicate that they do not want CPR, should the need arise.

Martha's clinical condition cannot be remedied because there are no medical interventions to it. It is therefore futile administering CPR because it is of no clinical benefit. The caregivers were therefore ethically wrong in administering CPR after she had suffered a cardiac episode because this would not have saved her from her impending death. Martha must have been unconscious after she suffered the cardiac episode. She therefore had no intact decision making capacity. However, she had made it clear to her daughter Alice that she never wanted CPR, something that Alice intimated to the hospital authorities before she left. This ought to have been respected. Martha's condition could not be cured.

Even if CPR was administered, the quality of her life was so poor that meaningful survival was not expected. Respect for autonomy requires that the patient and/or their family members be allowed to play a role with regards to Do-Not-Resuscitate Order. Written DNR Orders must be cosigned by the attending physician (University of Washington School of Medicine, 2008). Alice actually singed the color-coded DNR order.