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The patient presented in this case is suffering from a medical condition that makes her entirely dependent on ventilator support, hemodialysis, and total parenteral nutrition. When these medical interventions are removed, the likelihood of the patients survival outside the hospital setup is very slim. This patients condition is indeed incurable and this makes her fall in the category of those who should be subjected to end-of-life care. Any kind of medical intervention cannot remedy her condition. Her daughter is therefore at fault for trying to push for her continued treatment aggressively. The daughter should instead focus on availing the patients care to her mum to make her even more comfortable. She is supposed to be given treatments that focus on controlling pain and other symptoms. The patient should be helped to embrace the next phase of life even if that means death. If push comes to shove, this womans body should be left to undergo natural breakdown.
The fact that a doctor must uphold the autonomy of the patients is not in dispute. However, the inability of the patient to communicate complicates is the whole issue. In this case, a proxy has to be relied on who may be presenting a diverging position. Respect for the autonomy of patients goes beyond their explicit desires to even cover the physicians role of relieving pain and suffering which is a core requirement in care. Against this backdrop, life-sustaining treatments can be withdrawn in the best interest of the patient. It would be foolhardy to close our eyes to the fact that it is too expensive to put a patient under life-supporting machines for four months especially if chances of them recovering from their illnesses are very remote.
This patients interests and values are not known. The physician must therefore intervene to provide medical care in the best interest of the patient. The daughter is not aware of the fact that her advocacy for extensive medical treatment is not preserving her mothers life but just prolonging her death. In fact, as a result of staying longer in hospital, she has developed a peptic ulcer which is only worsening.
The patients daughter has insisted on medical intervention even if it doesnt improve her mothers quality of life. Despite having been subjected to parenteral nutrition, hemodialysis, and ventilator support for 4-months, the patient seems not to improve. She cannot survive on her own without these interventions. This underscores physiological futility.
Were it that the patient was in a position to make sound decisions, her transition to palliative care could not have drawn debates. Her daughters assertion that her mother should be subjected to aggressive treatment even when it is apparent that this would not remedy her situation interferes with the patients subjection to end-of-life care. In practice, the daughters decision should be taken as a rule but the patients best interest should be upheld especially when the patient was not clear enough in issues about end-of-life care. The doctor should be allowed to discontinue the treatment because other than being physiologically futile, the patients autonomy and quality of life should be upheld. Based on these, the daughter is not acting on her mothers own interest.
On the backdrop of justice and allocation of resources, it is unfair to keep somebody who should be under palliative care in an ICU for 4 months while many others whose lives could have been restored by admission into the ICU die due to congestion of the ICU1.
Bibliography
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Curtis JR, Vincent JL. Ethics and end-of-life care for adults in the intensive care unit. Lancet. 2010.
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RCSI. Ethics Challenge. Royal College of Surgeons in Ireland Students Medical Journal. 2010; 3(1): 5.
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Ellershaw J, Chris Ward C. Care of the dying patient: the last hours or days of life. British Medical Journal, 2003; 326: 30-34
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