Ethical and Moral Considerations in Limiting Life Support

The Patient’s Directives

In the case of Mr. Martinez, the central ethical concern is respecting his autonomy, which is expressed through a Do Not Resuscitate (DNR) order. Another principle in bioethics is autonomy; a patient has the right to make decisions pertaining to their medical care. In the instant case, Mr. Martinez and his wife had explicitly requested that no CPR be performed, and this request was legally noted by means of the DNR order. This order must be followed, as it mirrors his informed decision to forgo life-sustaining interventions in the case of respiratory or cardiac arrest. However, the DNR does not comment on whether the patient would want other potentially life-prolonging treatment, such as being connected to a ventilator. It thereby leaves much uncertainty for the medical team and creates an ethical grey area regarding how far the DNR extends to other treatments.

The Patient’s Quality of Life

Mr. Martinez’s quality of life is another critical factor in evaluating whether to limit life support. Being 75 years old, the patient already had compromised health due to COPD and respiratory infections. He had been improving with treatment but had an error in judgment when the weaning of oxygen was accidentally increased, worsening his condition and leading to respiratory failure. The ethical principle of beneficence is defined as healthcare providers doing what is in the patient’s best interest (Varkey, 2021). In this case, it may be that the ventilator would sustain Mr. Martinez’s life and continue his biological functioning, but at the risk of prolonging his suffering. This creates a conflict with the principle of non-maleficence, which emphasizes “do no harm.” Ventilator support, in this case, may prolong his life temporarily but at the cost of decreasing his quality of life to possibly further suffering and an extended dying process.

The Family’s Stated Preferences

Although it is impossible for Mrs. Martinez to provide input at this critical juncture, family wishes generally carry significant weight in decisions about life support. Of course, when there is no clear idea of what the patient wants or when it is in dispute, relatives may argue for or against the continuation of life-sustaining treatment. In this case, however, the prior directive from Mr. Martinez should be the DNR. Justice requires that providers balance the expressed wishes of the patient against the preferences of family members. Had Mrs. Martinez expressed wishes inconsistent with the directive by her husband, a difficult moral dilemma could have arisen. Since the DNR is in place, it should guide decision-making in the absence of new information from the family.

The Moral Issues Associated with Limiting Life Support

In the case of Mr. Martinez, the moral considerations concerning term limits of life support are as follows: passive euthanasia and the ethical dilemma of medical treatment. The type of euthanasia that is legally allowed in all states is called passive euthanasia, where the patient’s life-sustaining treatment, such as the removal of the ventilator or avoidance of further invasive treatment, is withdrawn (Akdeniz et al., 2021). Hence, by putting the patient on a ventilator, the healthcare team is in a position to understand whether the current move infringes on the spirit of the DNR order and the patient’s decision to avoid extraordinary attempts to keep him alive. The doctrine of the principle of autonomy implies that his prior expressed wishes should be honored and that they should be implemented even if the patient has developed acute respiratory failure.

Ethical Principles in Decision-Making

In deciding how to proceed, the healthcare team must balance the ethical principles of autonomy, beneficence, non-maleficence, and justice. For autonomy, there is a need to ensure that Mr. Martinez’s desire is considered, as well as his needs for beneficence and non-maleficence, which call for a determination of whether it is beneficial to continue treating the client (Cheraghi et al., 2023). Justice requires that the patient’s and the family’s opinions be given equal weightage as much as the patient’s advance directives will be given precedence.

Important Considerations and Conflicts of Interest

A critical consideration in this case is whether initiating life support, despite the DNR, would violate Mr. Martinez’s autonomy. The healthcare team also must avoid conflicts of interest, such as institutional pressures to prolong life for legal or financial reasons. The team puts both legal and ethical sanctions at risk in disregarding Mr. Martinez’s DNR. Ignoring this directive may also set a precedent that undermines patient autonomy and erodes trust in the healthcare system.

Conclusion

Considering the DNR of Mr. Martinez, his old age, poor quality of life, and the fact that he refuses any transfer to intensive care or aggressive use of the ventilation, the ethical decision should be left to his discretion and not take him to intensive care. On this line of action, his expressed wishes, principles of beneficence, and non-maleficence are given cardinal consideration, and conflict of interest is avoided. In this case, the ethical obligation is clear: withholding or withdrawing life-sustaining treatments is the most ethical and reasonable approach to be taken.

References

Akdeniz, M., Yardımcı, B., & Kavukcu, E. (2021). Ethical considerations in end-of-life care. SAGE Open Medicine, 9(9). https://doi.org/10.1177/20503121211000918

Cheraghi, R., Valizadeh, L., Zamanzadeh, V., Hassankhani, H., & Jafarzadeh, A. (2023). Clarification of ethical principle of the beneficence in nursing care: An integrative review. BMC Nursing, 22(89). https://doi.org/10.1186/s12912-023-01246-4

Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119

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Assessment 3 Instructions: Life Support