Should We Withhold Life Support? - Special Academic Support

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It goes without saying that the expediency of life-sustaining treatment for terminally ill patients currently raises multiple ethical questions. According to recent studies, the majority of Western clinicians regard the withholding of life support as acceptable under specific conditions (Phua, et al., 2015). However, regardless of the influential development of patient autonomy and the right to self-determination, the requested termination of treatment substantially affects health care providers as the moral conflict between the sanctity of life and its quality exists (Kassim & Alias, 2016, p. 119). At the same time, they should follow comprehensive ethical codes and legal standards to make correct decisions as well.

In general, the main goals of cardiopulmonary resuscitation (CPR) are to restore health, preserve life, limit disabilities, and relieve suffering with respect to individuals rights, decisions, and privacy. However, as CPR efforts should be initiated immediately, a clinician may be unaware concerning the patients attitude to health care and the existence of an advance directive (Mancini, et al., 2015). As a result, CPR may be opposite to the individuals interests and desires. According to the 2015 American Heart Association (AHA) Guidelines Update for CPR and Emergency Cardiovascular Care, there are specific rules for health care providers who face a considerably difficult decision to withdraw or provide emergency life support.

According to the fundamental health care ethical principles, emergency treatment should be provided for patients to save their lives. However, there are the following significant exceptions that make the withholding of CPR generally appropriate:

Situations when a clinician would be placed at considerable risk of serious illness, injury, and mortal peril (For instance. if he or she will be exposed to infectious disease.) (Mancini, et al., 2015);
Patients show obvious clinical signs of irreversible death, such as transection, decapitation, rigor mortis, decomposition, or dependent lividity (Mancini, et al., 2015, p. 384);
The existence of a legal advance directive that indicates the reluctance of a patient to have resuscitation. It may be either a Physician Orders for Life-Sustaining Treatment (POLST) form or a Do Not Attempt Resuscitation (DNAR) order (Mancini, et al., 2015).

Respect for autonomy may be regarded as a highly significant social value of medical ethics. Its principle is based on the significance of a competent individuals ability to make decisions about his or her own health care (Mancini, et al., 2015, p. 383). Adults have a right to make decisions concerning the withholding of life support unless they are declared incompetent by law. In order to guarantee the deliberateness of the patients decision, health care provided should provide accurate information concerning his or her health condition, risks and benefits prognosis, proposed interventions, and alternatives (Mancini, et al., 2015). In addition, a clinician should be certain that a patient understood all information, asked all necessary questions, and considered all alternatives before a final decision. Moreover, when the patients capacity of decision-making is temporarily limited due to disease recurrence, necessary emergency treatment should be applied to restore the patients capacity. In this case, CPR is ethically appropriate as the persons preferences may be uncertain or unknown.

Concerning the case of Mr. Martinez, from a personal perspective, he should be transferred to intensive care after his respiratory failure. On the one hand, a DNR order was prepared upon his request. However, his respiratory failure was connected not with the natural deterioration in his health condition but with medical error as oxygen was inadvertently turned up. As Mr. Martinez did not show obvious signs of death when he was discovered, the withholding of CPR would imply the violation of the ethical principles of benevolence and maleficence.

References

Kassim, P. N. J., & Alias, F. (2016). Religious, ethical and legal considerations in end-of-life issues: Fundamental requisites for medical decision making. Journal of Religion and Health, 55, 119-134.

Mancini, M. E., Diekema, D. S., Hoadley, T. A., Kadlec, K. D., Leveille, M. H., McGowan, J. E., Munkwitz, M. M., Panchal, A. R., Sayre, M. R., & Sinz, E. H. (2015). Part 3: Ethical issues. Circulation, 132(18), 383-396.

Phua, J., Joynt, G. M., Nishimura, M., Deng, Y., Myatra, S. N., Chan, Y. H., Binh, N. G., Tan, C. C., Faruq, M. O., Arabi, Y. M., Wahjuprajitno, B., Liu, S., Hashemian, S. M. R., Kashif, W., Staworn, D., Palo, J. E., & Koh, Y. (2015). Withholding and withdrawal of life-sustaining treatments in intensive care units in Asia. JAMA Internal Medicine, 175(3), 363-371.

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