To Make The Choice Essay, Research Paper
This paper will introduce a case study that results in an ethical dilemma. The ethical dilemma will be
clearly stated including obligations and conflicts. Using the Contemporary Utilitarianism theory I will
analyze the ethical dilemma. Finally I will analyze the same case using an Egoistic approach as an
alternative course of action.
An apparent 19 year old male is brought to the emergency room by ambulance in respiratory
failure related to end stage cystic fibrosis. The patient is accompanied by his girlfriend who states that the
patient has a do not resuscitate (DNR) order. As the emergency room physician tries to contact the patients
primary care physician he finds that the patient is under the care of a pediatrician which makes him
suspicious of the DNR request. He confronts the girlfriend about the patients age because the patient is
unable to communicate due to his respiratory condition. The girlfriend breaks down and admits that the
patient is actually 17 years old. The physician immediately intubates the patient in an effort to stabilize his
respiratory condition. The patients respiratory condition is stabilized after a short time and he is extubated.
The patient relates to his nurse that he does not want to be intubated again or placed on a respirator. The
nurse relays this information to the ph!
ysician who at this point does nothing. The patients mother arrives at the emergency department and the
physician explains the patients condition and his request for a DNR order. His mother refuses to sign a
DNR order and this information is explained to the patient by the physician with the mother present. A
discussion insues between the mother and her son and she reluctantly agrees to sign the DNR order.
The physician is informed of her decision and assists the mother in signing the appropriate paperwork. The
patient soon confronts the physician and makes him promise to stick to the DNR order no matter what his
condition, the physician agrees. Shortly after the DNR is completed and all other appropriate paperwork are
in order, the patient goes into respiratory arrest. All the parties involved in this situation are present when
the respiratory arrest occurs. The physician stands by will all intentions of honoring the DNR but within 30
seconds of the arrest, the mother orders the physician to intubate. The physician looks to the patient as he
shakes his head indicating that he does not want to be intubated, the physician also is aware that the patient
will be 18 years old in three weeks.
Initially it appears as if the dilemma revolves around what the physicians next move should be.
When actually the real dilemma is who owns the rights to make this life or death decision. It is clear what
the patient wants for his course of treatment. It is equally clear what his mother will allow his treatment to
be. Each have equally selfish reasons for wanting their decision to be upheld. The mother does not want to
lose her son and will at all costs keep him alive. She feels he is romanticizing death and has no real concept
of what dying means. Her son lived with cystic fibrosis since age four and has seen many of his friends
placed on ventilators only to later die. He does not want that quality of life in his final days. The physician
is supportive of the patients request but is placed in an awkward legal position if he abides by the patients
request. The nurse who has acted as an intermediary throughout this entire process continues to acts as a
patient advocate an ensur!
e the patients rights are observed and that his wishes are acknowledged.
Ethical Analysis of Dilemma
Contemporary Utilitarianism is divided in to four basic principles, each principle will be used to
analyze this dilemma. The first principle considers which action will provide the greatest happiness for the
greatest number. As we look at the action in this case the patient should not be allowed to discontinue
treatment because his mother and girlfriend do not wish fort him dye. This action does not provide the
greatest good and it appears that the patient looses by a vote of two to one.
The second principle is based on what the consequences of this action are, not what or how its
done but how the chosen action effects the majority. Again we find that the patients requested action of no
medical treatment and death is not the consequence that the majority wants. So the chosen action in a
bottom line analysis would not be considered good.
The third and fourth principles appear to get more egoistic in nature by definition, but remember
the basis of this theory is the greatest good for the greatest number. The final principles are centered around
human happiness and minimizing suffering. It is known that what would make our patient happy is to be
left to die with no further medical attention. The question of suffering in his mind, would be reality if he
was placed on a ventilator. This suffering would not be so much a physical pain, but a suffering of his
quality of life. To provide happiness to the majority would mean complete medical intervention. As we
attend to their happiness issue, we have also addressed and alleviated the issue of their suffering (Ufema,
1995) by prolonging the life of their loved one.
Alternative Course of Action
As an alternative to Contemporary Utilitarianism we can apply a purely Egoistic approach to the
same ethical dilemma. Egoism is very self centered and is concerned only with what benefits the
individual. This individualistic approach takes no one else?s thoughts or feelings into consideration. From
this perspective it is completely within the patients legal and moral rights (Gostin, 1993) to request that no
further medical treatment be given. The patient knows first hand that if medical treatment were to continue
that his quality of life until his death (Halliburton, Manning, and Olney, 1996) would greatly diminish.
The physician and nurse are supportive of the patients decision (Lyndaker, 1996) but have
reservations about letting someone so young die. Both the patients mother and girlfriend are against the
discontinuance of treatment. The consequences of the patients actions will result in his death a right that he
feels is his decision. His mother and girlfriend will grieve and continue to feel his decision was selfish and
As a final course of action the Egoistic approach is essentially the action that will be taken. If the
mother refuses to comply with her sons wishes it will only be three weeks until he can take control of his
own destiny. The right to refuse treatment (Halliburton et al., 1996) is a personal and individual choice of
every human being. We have the innate right to choose what care we receive or do not receive. The age of
this patient since so close to the legal age of consent is merely semantically both morally and legally. His
desires are based on his quality of life. An issue that can only be addressed on an individual basis. No one
can or has the right to determine what the best quality of life is for another. Cases of chronic terminal
illness are heart breaking for all
concerned, but until one actually lives with that illness the final outcome should be left to the afflicted
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Lydaker, C. Z. (1996). Identifying ethical values conflicts in nursing education.
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Ufema, J. (1995). Insights on death and dying. Nursing, 25 (1), 72-73