Morality of Suicide and Active Euthanasia

Medical Ethics

Assisted Suicide & Euthanasia

The dilemma in the case of John H. is the disagreement between the two specialists handling his case. Because of John's immediate condition (internal bleeding), the doctors disagree as to whether they should obey John's wishes from earlier or whether they should follow his immediate request for assistance. Perhaps the real dilemma is John's lack of specificity regarding his wishes. In the case that his condition continue to deteriorate at the present rate, he wants the do not resuscitate. Yet in the case of a spontaneous and unforeseen complication, he wants the former order suspended for immediate care. Whether or not the doctors decide to take immediate action on John H., it is still quite likely he will die from pancreatic cancer. Whether or not John is fully coherent at the time he makes his request for immediate emergency care is somewhat irrelevant because if the doctors cease the bleeding, his condition will not improve to the point of survival. If the doctors make the attempt and fail, then they made their best efforts to treat John as well as adhere to his wishes, but in his state, his death is probable.

I think the most appropriate response in John's case is for both doctors first to confer and hopefully reach the same conclusion: whether or not they try to stop John's internal bleeding, he is likely to die. Since John did make a last minute request for assistance, there seems no more unreasonable harm that usual to follow his wishes and try to provide immediate assistance. The most appropriate response would be to inform John as well, if he is still conscious of the decision the doctors make. If he is still conscious, the doctors should tell him what they plan to do and what the chances of success are; if he is still conscious, he still has the power to accept or reject care. When the patient is unconscious and alone like John H., the choices they face seem tougher with regard to medical ethics.

When a patient is close to death and makes a request what seems at odds with a decision he made when he may have been more fully autonomous, it may be difficult to know which wishes to follow. If patients have their wishes in writing, they should be followed. Some patients may have wills or other kinds of legally recognized documentation with explicit instruction of their wishes in specific situations. It is a tough call that probably must be decided on a case by case basis.