The need to balance between withholding and withdrawing life-sustaining treatment has become a controversial issue in the health environment. When making decisions on life-sustaining treatment, it is important to analyze the ethical, medical and legal issues. In this case, the patients have suffered serious brain damage and do not meet the criteria of being classified as brain dead. The family members are divided on whether to take the patient out of life support while other want to keep him on life supports. The fact that the family members’ arguments are disrupting the nursing and medical staff it is important to take action.
What are the ethical issues?
The ethical issues to address in this homework case are whether the patient has the right to decide on the issue and whether the family members have the rights to make the decisions for him. It is critical to analyze the ethical perspective of this case before making any decisions. The ethical decision as identified by Ackermann (2000) should only be based on the merits of the case and not on the availability of the machines to serve the patients. The patients, in this case, has the right to life and decision on whether they should live.
If the patient has a written living will then the ethical decisions here would be to respect his wishes. Another ethical issue to address is the extent the family has in the decision-making process. The family members, in this case, are divided on the issue and therefore when decisions on the final decision to make the direct family members such as the wife and children get a greater say. Keeping patients on life supports when the brain is not function is unethical and causes increased suffering to those who are left. However, in this case, the particular patient still has brain activity and therefore cannot be termed
What are the legal issues?
The legal issues to address in this case is whether the patient has a living will and the state law on brain dead patients. The living will as defined by Ahronheim et al. (2005) is the set of instructions that an individual notes down on the issue of life-sustaining methods. The living will if available would set the legal precedent in this case as the living will is a legal document that must be respected. The role of the physician, in this case, is to identify if a living will exist and what the wishes of the patients were in such a situations. The living will, therefore, takes precedence over the decisions of the family members. The living will is enforceable in all situations unless in the situation where the patient would have been pregnant as the Texas law identifies that a patient who is pregnant cannot have a living will under the jurisdiction of the state.
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According to the Texas law, an individual is termed as dead if there is an irreversible cessation of spontaneous respiratory or circulatory functions. Brain death is the irreversible cessation of the brain and loss of brain functions which identifies that there is no brain antiquity or reaction to stimuli such as pain. Brain death is termed as complete death even when the heart is pumping as the brain cannot recover from this effect. If the patient was brain dead, then the law allows for the physician to take off the life support machines after consulting the family and giving them enough time to come to terms with their loss. The patient, in this case, is technically alive as they have brain damage and not brain dead. Even if the patient is reactive, then there is a need to continue with the provision of life-sustaining health services in this case. The patient is not legally or medically dead in this case. The law identifies the criteria for death as the irreversible functioning of the brain or other vital organs and therefore in this case the law identifies that the individuals is not dead and cannot be taken out of life support under state law.
What are the medical care issues?
From a medical perspective, the patient is alive due to some factors. The first is that the patient has severe brain damage and does not meet the criteria for being labeled as brain dead and this may be due to neurological activities in the brain. In this case, the patient may be termed as in a state of the persistent vegetative state and which means that the patient exhibits symptoms of reactivity and which is not a coma which is characterized by a chronic unconsciousness which persists for more than a week.
The medical distinction between persistent vegetative state and brain death is that in the persistence vegetative state the patient may recover although the chances are minimal. Brain death is irreversible, and this means that the individual is a corpse and cannot revert to its original state. Brain death is the only reason for a family to ask for the removal of life supporting machines and this is not the case here. Although the brain damage is extensive, the patients are still alive as they present brain reactivity which responds to stimuli, which sets it apart from brain death.
What actions would you take? Why? How?
The first action to take is to analyze the mental capacity of the patient. The elements of assessing mental capacity are the ability to communicate a choice, ability to understand the relevant information, ability to appreciate the situation as well as its consequences and the reasons behind the treatment options. This can only be done if the patient is conscious enough. In this case, the patient may only nod and not be able to speak. If the mental capacity of the patient cannot be assessed the next step is the assessment of brain activity again to ascertain that the patient is not brain dead. Getting the living will would also help to make an informed decision on what to do next.
If the patient is unconscious and mental competency cannot be ascertained, and his decisions in his living will is to be removed from the medical support, the next step will be implemented. This step involves giving the patients another month of treatment to determine if there are any improvements or the brain has deteriorated. If the health of the brain improves during this time, the patient will not be taken off life support. If the patient health deteriorates into brain death, then the physicians should communicate the fact that brain death is irreversible and is in all actuality death before taking the patient off life support. Conducting this steps in the right order is important to address the ethical issues and the legal issues involved in this case.
What resources would you tap?
The reasons as a physician I would tap to include research conducted by peer-reviewed articles, for example, those developed by the New England Journal that identifies how brain death is categorized and actions to take when dealing with the withholding or withdrawing life support. Other reasons include peer-reviewed articles from other researchers that identify the ethical, legal or medical perceptive on addressing brain dead patients and the decisions of whether to maintain or remove them from life support. Legal texts such as laws of the state on what death means and the role of the physicians on the issue. Expert advice from more experienced health professionals would also be an important resource that can help to effectively address this medical issue.
This case identifies the dilemma health professionals’ face when deciding whether to withhold or withdraw life-supporting treatment. The health professional must analyze the ethical implications of the case as well as the medical issues and the legal issues. The legal issues play a critical role in helping to addresses such dilemmas as they define when a patient is termed as dead and the actions of the physicians. More research is needed as well as universally accepted rules on addressing life supporting treatment in different situations.