We didn't sufficiently discuss this question, p. 716
"When a patient who is in a great deal of pain, weak, and close to death makes a request that seems at odds with a decision he made when he may have been more fully autonomous, which request should guide those caring for him?"
I would say that the doctors should go with the patients most recent request. For one, the request they made earlier could have nothing to do with their most recent request, like in this case with the internal bleeding. Another reason to go with the patients most recent request, could be that if the patients family members (if they have any) found out that the doctor didn't obey the patients wishes, couldn't there be an issue of suing the doctor (i'm not entirely sure on this one but figured i should mention it anyway)? Not to mention if the request helps ease their pain and make the life they have left better, why wouldn't a caring doctor even question whether or not they should full fill that request? It would be heartless to not give them some medication that could make their pain dull or go away. Now if the request was something like euthanasia, now that is a touchy subject in and of itself. That would probably be the only situation where I would even say that they ( as in the doctor) would be able to ignore or not go through with the request. After all, this is just my opinion on the matter.
ReplyDeleteFrom what I remember in class, this case involved the patient stating that they wanted the doctors to let them die if the situation became more severe, but when it did get life threatening, the patient changed their mind and wanted to live. In this case I would definitely play it safe and go with the patients final request for several reasons. First reason being, in the right state of mind or not, the patient should be kept alive upon any request when related to life or death. Even if the patient regrets later (if he returns to complete consciousness) for being kept alive, it is still always best to play it safe in case he truly still did want to live on. Finally, the doctor should never question a patients request upon life or death when it comes to the patient asking to be kept alive. This is where it could become very messy due to legal measures and morale ethics both coming into play.
ReplyDeleteHowever if the entire situation was reversed and patient requested life and then in their final moments of immense pain (but still a chance to be kept alive) decides to die, becomes a much more interesting situation. If it was me I would not be able to just let the patient pass if there was the slightest possibility that I could keep them alive. I would need the patient to be completely conscious, an understanding family, and to fully understand that the patient's life time was failing before even considering letting the patient pass. As stated in class it is a doctor's oath to do whatever possible to keep people alive. It would not just counter the doctors oath by allowing a patient to die, but also in some cases may be considered assisted suicide. Like I said the situation would be very sticky, and even if the patient asked to die, I would greatly question and analyze the matter before executing any type of final decision.
Autonomy is defined as a person's right to self-determination. That being said,it is critical that the doctor abide by the patient's wishes. In this particular situation, the patient may not be in the right state of mind to make a life or death decision for himself, however, it appears the doctors do not have time to entirely confirm this. Thus, they must assume he has had a recent change of heart and wants to be saved from death. Much better that the doctors be wrong and save a person's life than to allow someone to die who was asking to be saved. This could be emotionally and legally detrimental to the doctors if they were to allow the patient to die as previously stated. In the event that a decision must be made immediately, it is best that physicians respect patient autonomy in the form of the most recent demand.
ReplyDeleteI agree with Kyle. I think it would be much more safe to go with the request to be kept alive especially if it is the most recent request. In any life and death situation for a doctor I think that if there is any confusion on the matter they should go with the life side to be safe.
ReplyDeleteI think that the doctor should go with the request that the patient made when he was coherent and attentive. When the patient is in pain and suffering he or she might be speaking out of confusion, like Adam said, and therefore incompetent in making a serious request that could ultimately judge whether he lives or dies.
ReplyDeleteI believe that you must also protect the healthcare providers. The doctor has to live with the decision to let a patient die when he or she was begging for life. I believe that you save the patient to protect the professionals
ReplyDeleteI agree with most people that you should go with the patients most recent request. If I was in the physician's place, I know that I could not allow someone to die if they were begging me to save them. I would be completely devastated and messed up if that situation occurred. I think it is morally acceptable to go with the saving of a person's life.
ReplyDeleteFrom a legal standpoint, you cannot sing away your rights. You have a right to LIFE, liberty and pursuit of that one thing. You can deny yourself these things all day long, but they cannot be denied to you, should you so choose. Mr H's request "To do something" would take precedence over anything he signed and sealed. Oral contracts have weight, as well as written. The safe bet for the doctor would be to save him. Refusing treatment to a patient begging for it would have his license revoked in no time.
ReplyDeleteThe doctor needs to abide by the most recent request. As Brad has stated from a legal standpoint the doctor has to resuscitate John if he is asking. Some people are saying that you need to abide by the request that he has made earlier but refusing to be resuscitated, but I am not willing to take the chance and risk a person life if he is asking to be saved.
ReplyDeleteI agree with what almost everyone stated previously. When the body is placed under a great deal of duress/pain it would not be very surprising to see a patient change their minds. Until we are in a certain situation, we cannot know truly what we would do. The patient has the right to change his/her mind at any point. It would be a scary world if everything we said at one point in our lives was legally binding. As long as the patient has the ability to state their wishes and is in a semi-lucid state, the doctor should conform to the patient's wants.
ReplyDeleteI agree with Michael that decisions can change drastically by the situation. Even if the new request directly conflicts with a previous request it needs to be taken into consideration. The new situation of extreme pain cannot be prepared for by the patient and so a patient cannot truly know what they would want to happen in that situation. The best thing a physician can do is respect the new decision. An exception is when a patient makes a request in a delirious state, because this state impairs the patients ability to think autonomously.
DeleteThe doctor should listen to this request ask questions and get other doctors opinions on if the patient is fully autonomous at the time of the new request. The doctors should also consult the family if there is any. With all that said I think the doctor should go with the patient's first request because the doctor knows for certain that the patient was fully autonomous at the time of the first decision.
ReplyDeleteI agree that the doctor should let follow through with the patients most recent decision. Only if he is in the right state of mind and can make the choice autonomously. I agree with most who say that he should consult the family and other physicians to become better informed about what the proper course of action should be. To not to fulfill this odd request of the patient would not be right in the sense i agree with Michael when he says that the patient has the right to change his mind at anytime during the course of his treatment. the patients words do take an enormous precedence over whatever paper work he legally signed. If i were in the doctors place i know i could not go against the request he had just made despite the fact of what he actions he may have had during an earlier time.
ReplyDeleteI think that the doctor should abide by the patients most recent request, like most of you have been saying. The patient has a right to their own autonomy. The only situation in which this could become iffy, is if the patients mental health may be comprised for one reason or another, that is causing them to differ from their previous requests. In that case the doctors choice would not be as clear cut and would require some further considerations.
ReplyDeleteThis is exactly what I also think. I feel like the professional duty of a physician is to abide by the requests of the patient at that moment in time unless the patient in a state of mental distress or too young or too old to make clear decisions (form of mental distress). The physician should follow the requests. This is no different than stating that physicians should do certain procedures, regardless of the meaning behind why a patient wants what they want, the doctor should just listen and act, unless they disagree morally, then another doctor should step into the picture.
DeleteI also completely agree with this. It is always better for the physician to play it safe and follow the most recent request of the patient than to just let the patient die. If the patient is a state mind that is clearly unsound or distressed,then a family member or someone who can speak on behalf of the patient should be brought in to make the final decision.
DeletePatient autonomy is a huge part of biomedical ethics, especially when dealing with end-of-life care. I believe the doctor should listen to the patient's most recent request, to a certain extent. If the patient happens to be in a great deal of pain, he or she still may be able to think clearly enough to make rational decisions. If it gets to the point where the patient can no longer make rational decisions, that is where I would draw the line and have to bring in family / a surrogate to discuss the situation.
ReplyDeleteI feel as though if a patient is in a great deal of pain and under great stress than their judgment may be clouded and they may not be thinking with full rationale. If the decision that is made at the current time that conflicts with the previous decision, the old decision should be honored because that was the decision that was made when the individual was fully autonomous. I agree with what Lucas said because autonomy is a crucial element in today’s healthcare world and anytime a patient’s autonomy is at risk some provisions should be implemented. When you violate someone’s autonomy it isn't only immoral but you also take away their value of basic human rights to life; so to restate what I said earlier, in instances such as these, the previous statement that was requested while the patient was fully autonomous should be the one honored.
ReplyDeleteI think first you need to determine if the patient is alert and oriented. With his pancreatic cancer in its final stage, he could have a change of mental status. Family and or power of attorney need to be included in the decision making process. Another issue that needs to be addressed is comfort care. Even though he has decided to have a "do not resuscitate" order initially, internal bleeding can be painful and the procedure may delay death, but may subside pain. Once mental status has been determined and proven to be cognitive, I believe the the "do not resuscitate" order must be revoked. Just because they are stopping the internal bleeding, does not change his diagnosis of pancreatic cancer that he will not survive. This may be an issue of comfort for the patient and the physician needs to respect the patients wishes.
ReplyDeleteThis seems to be a tricky question to answer. First things first if the patient had stated what he wanted treatment wise earlier while in the right state of mind why wasnt put down on paper. Secondly if the pt. states again a change in his care contradictory to his previous wishes one must ask if he is alert and oriented. Another good question is how old the the pt. is... this could be the answer to well maybe he is showng signs of dementia or maybe he has an infection of some sort. The DNR is a tricky topic he knows he has pancreatic cancer but whether or not is should stay in place or be revoked is unclear in my opinion
ReplyDeleteAccording to the utilitarianism point of view Dr. W should act quickly to stop the internal bleeding. If he did not then he would not be maximizing the greater good for the greater number, because even though he intended on sticking with John H's DNR the consequence would be that even after John changed his mind he did not follow his orders. Also, the Dr. should listen to the last request that the patient wants and even though it may be at odds from what John said earlier he would be maximizing the greater good for John because that is what John wanted.
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