PRESERVATION OF LIFE WITH LIMITS. PDF

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PRESERVATION OF LIFE WITH LIMITS.EUTHANASIA.ADVANCE DIRECTIVES.FUTILITY OF TREATMENT.WITHHOLDING AND WITHDRAWAL OF TREATMENT.DO-NOT RESUSCITATE ORDERS....

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PRESERVATION OF LIFE WITH LIMITS. Preservation of life with limits refers to the professional and ethical responsibility placed on health care providers to do everything in their power to preserve a patient’s life. This involves employing all available technology, medicine, and expertise to help preserve lives as long as doing so does not interfere with the patient’s right to refuse some treatments. Health care providers are needed to uphold the patient’s needs as far as the patient wants help. Patients have a right to accept or refuse treatment (Luce & Alpers, 2009). The health care provider can only preserve the patient’s life to the extent that has been consented to by the patient. Health care providers have a duty to inform patients about their State of health and enough details to make an informed decision about the type of procedure offered to them (PSDA). A health care provider is only expected to preserve the patient's life to the extent that the patient has consented. In Canterbury v. Spence, the Court of Appeal held that physicians have to offer patients sufficient information to provide informed consent to the medical procedures and treatment being offered to them. Although the Court ruled against Canterbury, the decision on informed consent and the patient's right to refuse treatment is the cornerstone for the consent of preservation of life with limits. Federal and State legislations have been crucial in ensuring that the health care providers respect a patient’s right to self-determination. 42 CFR S 482.13 provides that patients and their agents have a right to make informed decisions regarding the best care for the patient. A patient has a right to be informed of the nature of the procedure being offered to them, the possible risks and benefits of the treatment, any other alternative treatment available, the risks or benefits of the alternative treatment, and full assessment results of the patient's case (Luce & Alpers, 2009).

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The patient's right to refuse or limit medical procedures is protected under 42 CFR S 482.13. Physicians in line of duty to preserve the patient's life must respect the patient's rights to refuse the treatment procedures they offer. In Cruzan v Harmon, the Supreme Court held that a patient has a right to refuse any intrusion with their body. The physician cannot force the patient to accept treatment even if such refusal reduces the patient's chance of survival. Similarly, the New Jersey Supreme court allowed the parents of a woman in comatose an order allowing them to get the patient of the artificial ventilation (In re Quinlan, 1976). In this case, while out partying, a young lady drank alcohol and tranquilizers, which led to her passing out. She was rushed to the hospital and was declared to be in a vegetative state, and needed the help of an artificial ventilation machine. The parents wanted the use of that machine halted, but the hospital refused. The Supreme Court decided that the parents acting as the patient's representative had a right to refuse to keep the patient on artificial ventilation. The Court issued an order directing the cessation of ventilation for the patient. Subsequently, the patient died from pneumonia. Another Court also mirrored this decision in Re Conroy, where a patient who, being incompetent, had been incapacitated requested through her representative that the life support machine be withdrawn, and she would be left to die. The issue presented was whether a hospital should withdraw life support treatment when it is was clear that the patient would have objected to the treatment, the fatal repercussion notwithstanding. The Court held for the plaintiff granting an order to have the life support treatment withdrawn. The Court argued that, if presented with the same circumstances, the hospital should withdraw the life support treatment if it is clear that the patient objects to the treatment.

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Although the patient and their representative have a right to refuse treatment, the State plays a crucial role in ensuring that it preserves the patient's life even when it may contradict the patient’s advance directive. The Supreme Court emphasized that the State has an undeniable interest in a patient’s life and its preservation which supersedes the patient’s desires and wishes (John F. Kennedy Memorial Hospital v. Heston, 1971). In this case, the mother and legal guardian of the patient refused to give consent for a blood transfusion based on their religious beliefs as Jehovah’s Witness. The Court ruled that the State was interested in preserving life contrary to the mother's refusal to the medical procedure offered. The Court further argued that the State's interest in preserving life in such a circumstance increased as the patient's representative's interest in self-determination decreased. Based on this argument, the Court affirmed the need for a blood transfusion to preserve the patient's life. EUTHANASIA. Euthanasia, also referred to as mercy killing or assisted suicide, refers to the practice of deliberately or intentionally terminating a patient’s life. A patient, in this case, should be suffering from an incurable or terminal disease. Unending debates surround the concept of euthanasia, with some arguing that allowing patients to have access to voluntary active euthanasia respects a patient's right to self-determination and the patient's autonomy (Dugdale et al., 2019). The patient's right to self-determination and access to euthanasia provides the patient an informed choice to end their suffering. Arguments against euthanasia include the possibility of suicide by the patient (Dugdale…et al, 2017). The argument is that allowing patients to give up hope in living and choosing to die is aiding suicide. The difference between euthanasia and assisted suicide is that in the latter concept, the patient wants to die and seeks a doctor's

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assistance in committing suicide. There are different classifications of euthanasia, and definitions include; i.

Voluntary active euthanasia.-The health care provider directly administers a lethal amount of medicine to a consenting terminally ill patient who wants or wishes to die (Brazier, 2018). Under this classification, the patient must be terminally ill and voluntarily consent to have a dose of lethal medication administered directly to them to help them die.

ii.

Non-voluntary euthanasia.-A physician may act on their discretion and without the patient's consent to terminate the patient’s life by either giving a dose of lethal medication or withholding life-sustaining treatment. In this case, the patient is often incapacitated, comatose, or having a terminal illness. Non-voluntary euthanasia is illegal and not practiced ( ibid). A patient’s relative or representative may ask the medical provider to end the patient’s life through non-voluntary euthanasia.

iii.

Voluntary passive euthanasia.-Although not commonly used, voluntary passive euthanasia involves a medical provider refusing, withdrawing, or withholding a patient’s life-sustaining procedures. This allows the patient to die.

iv.

Involuntary euthanasia.-This is performed on a patient who can make an informed decision but is not informed of the decision to the euthanasia nor their consent sort. In this case, the patient is neither asked if they want to end their life. Euthanasia under this circumstance is considered murder.

v.

Physician-assisted dying or assisted-euthanasia.-A medical provider informs the patient of the available methods and means of committing suicide. These methods could include a lethal drug that the patient may be able to access without a

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prescription. This information assists the patient in making an informed decision to end their life. Although most jurisdictions have not legalized non-voluntary euthanasia, some jurisdictions have laws and regulations that allow the practice of euthanasia to some extent. Over the years, the State of California has had a leaning opinion towards making it easy for patients and their representatives to choose the administration of euthanasia to end the patient’s pain. In the landmark decision in Barber v. Superior Court, two clinicians were charged with murder after they withdrew life-sustaining treatment of a comatose patient. The clinicians had taken action to remove the patient's life-sustaining treatment at the request of the patient’s family. It was evident that the patient's State was not improving, and the family wished to end the patient's situation. The issue was whether a physician should continue treating a comatose patient even when it was evident the patient had no chance of recovery. The Court held that the clinicians had no obligation to continue the treatment of the patient. They had not committed any murder by taking action as requested by the patient’s family. The California End of Life Option Act was enacted in 2016 and gave provisions for assisted euthanasia. The Act gives terminally ill adults the option of requesting their physician a drug that will aid them to end their life. The person must be a resident of California, above the age of eighteen years, has been informed by two or physicians that their medical State is dire, and has less than six months to live. They are competent to make medical decisions to be eligible under the Act. The patient must prove that they are requesting assisted euthanasia voluntarily and not out of pressure by family members (UCLA Health, 2021). Although there have been good reports about the Act and its importance towards assisting terminally ill patients in choosing to end their lives, the main setback presented by the Act is the requirement that willing patients must

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complete 13 step process (Callinan, 2020). Many eligible patients are finding it hard to meet the lengthy process, and some opt to await death as they would otherwise do without the benefits accorded to them by the Act. The State of Texas signed into law the Texas Advance Directive Act in 1999 that gives directives on the special care service providers should provide to terminally ill patients. Section 166 of the Act provides that health care providers have a legal right to discontinue or withhold lifesustaining procedures. The physicians must give a written notice stating that the continuation of the life-sustaining procedure is considered futile care. Some have criticized the Act arguing that it violates the patient's right to self-determination. In the case involving the infant Emilio Lee Gonzales, the Children’s Hospital of Austin issued the family a 10-day notice stating that the hospital would discontinue mechanical respirator services (Townsend, 2007). The infant had been born with a fatal case of Leigh’s disease and had been on life-sustaining treatment for over five months. The family objected to the hospital's decision, and the Court issued a temporary order barring the hospital from terminating the life-sustaining treatment. The infant, however, died shortly after from the same condition. The State of New Jersey has equally had an open perspective towards euthanasia. In the landmark decision in In Re Quinlan, the Supreme Court affirmed that it was ethically acceptable to withdraw life-sustaining treatment where a patient had been in a comatose state for an extended period (Luce & Alpers, 2009). In 2019, The Aid in Dying Bill was signed into law, and its main objective is to allow eligible patients to apply for an order for euthanasia to end their pain. The concept of euthanasia raises the ethical and professional issue about whether a physician violates the Hippocratic Oath when administering lethal medication to help end a patient's life

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(Legg, 2018). Originally the Hippocratic Oath stated, “I will neither give a deadly drug to anybody who asked for it nor will I make a suggestion to this effect.” Though there have been many modifications to the original wording, the Hippocratic Oath still requires physicians to save lives. On this basis, many have argued that physicians commit murders when they administer lethal drugs to help end a patient’s life. In Roe v Wade the Supreme Court argued that the Hippocratic Oath does not represent a collective medical opinion of all physicians. Hence, the rigidity presented by the Oath should not bind physicians. This judicial opinion indicates that the Hippocratic Oath, although based on the principles of preserving life, should not be interpreted rigidly to the extent of barring physicians from helping terminally ill patients to end their suffering through euthanasia. ADVANCE DIRECTIVES. Advance directives refer to legal documents that provide precise instructions on the type of treatment or procedure to accord a patient if the patients cannot make the decision themselves due to an illness. The patient has a right to give a written or oral order that guides his health care provider and loved ones what type of care they would want or how to represent him should the illness progress to the extent that they are incapable of making decisions for himself. The advance directive may give direction on the type of medical team the patient prefers, the type of treatment procedures, emergency care procedures, and whether or not the patient would want euthanasia administered on them should they be in a comatose state for a lengthy period. The Patient Self Determination Act was enacted to support a patient's right to make informed decisions regarding his health. The Act directs that health care providers have an obligation to inform the patient of the actual state of their health, the treatment options available to them, alternative treatment options, and the risks involved with each procedure. Additionally, during

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the patient's first admission, health care providers and hospitals are obligated to inform the patient of his legal rights and the institutional policies on advance directives (Tippet & Sugarman, 2009). Section 1866(f)(2) of the Act requires that health care providers ask the patient if they have an advance directive and record the patient’s medical information in the advance directive in accordance with State and Federal laws. Section 1866(f) (1)(C) makes it illegal and unethical for health care providers to discriminate against patients who do or do not have advance directives. The Act also requires that health care providers conduct community-based education to teach about advance directives (Omnibus, Reconciliation Act, 1990). A patient has a right to sign a durable power of attorney for health care form in which he names a third party that will make medical decisions for them during the patient is incompetent to make such decisions (NIA, 2018). The third party often referred to as the patient’s representative or agent, must know the patient's life values and wishes and make medical decisions for the patient similar to how the patient would have decided for themselves. The State of New York under the New York Codes, Rules and Regulations provides an elaborate definition of advance directives. Section 400.21 defines advance directives as any written or oral directions about a patient's wishes for the type of health care procedures they wish to receive. The patient makes these directions before they are terminally ill. Medical facilities are required to comply with State and Federal regulations relating to a patient's advance directive. All medical facilities in the State are required to develop, implement and maintain written policies and procedures regarding advance directives.

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In a situation where patients are housed in a nursing home, the nursing home staff shall be obligated to educate the adult residents on their rights to have an advance directive and appoint a health care proxy. The staff must inform the residents on how the proxy works and on how they can choose to revoke or change a proxy. The staff must ensure that the residents have the choice to appoint a proxy and that they do so voluntarily (NY Code, Vol C). At the patient's request, the staff may assist the patient in filling the NYS Advance Directive Form: Health Care Proxy. Where a case is presented of a patient who does not have an advance directive, the Supreme Court ruled that in such a situation, the decision to withdraw or withhold life-sustaining treatment is made by the patient's family and not the Court (In Re Quilan, 1976). The Court further argued that where a patient without an advance directive is mentally incompetent to make decisions for themselves, family members or a representative is obligated to make such decisions for them. Re Quilan presented an ethical dilemma regarding whether advance directives provide a solid ground for the suspension of life-sustaining treatment. The argument behind this ethical dilemma is that advance directives limit the procedures that physicians should use in the event that the patient is unable to make decisions for themselves. In Re Martin, the Court noted that it is legally and philosophically challenging to answer the ethical dilemma presented by advance directives. A physician's obligation to adhere to such orders disregards the possible best treatment for the patient. The judiciary’s position in deciding matters related to advance directives are best elaborated in Cruzan. The Court stated that the judiciary is obliged to protect the desires of third parties, including the patient's family/agent, to protect the State's interests, including preserving life, preventing suicide, and promoting medical ethical integrity. The judiciary must find a balance in

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this obligation to ensure that life is preserved and that the cost is appreciable to the patient and the family. FUTILITY OF TREATMENT. This refers to the medical practice of continuing a patient's treatment procedure even when there is a slight possibility or proof that the process will improve the patient's health state or quality of life (Robinson, 2010). For a medical treatment procedure to be considered futile, the procedure should be one that a medical team or the patient's family believes is non-beneficial. Still, they should consider it as an intervention to keep the patient alive (Barnhart, 2014). The concept of medical futility treatment is complex due to the limited availability of medical resources and treatments in intensive care units and nursing homes. The ethical issue raised by this concept is whether a physician’s obligation to the patient is to save the patient’s life despite the uncertainty of the treatment procedure they propose or let the patient die for the fear that the procedure might not work (Robinson, 2010). The legal and ethical issues presented by the concept of the futility of treatment have been presented to the courts for a determination whether it is of any benefit to the patients to allow medical teams to provide medical procedures that have little or no benefit to the patient (Luce & Alpers, 2009). This issue was presented in the case of Helga Wanglie, an elderly woman who had taken ill, and there were no clear or specified medical procedures that would improve her health state (In Re Helga Wanglie, 1991). Mrs. Wanglie survived a bad fall and developed lung issues and pneumonia attacks. She was dependent on a medical ventilator, and her medical bills amounted to close to one million dollars, which raised concern for Medicare and the hospital. The hospital advised the family that it would be of no use to keep the patient on the life support treatment as her health state would not improve. The family sued to keep the patient on the

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ventilator, stating that although the patient's physical state was deteriorating, the ventilator could improve her life. The Court decided in favor of the patient's family, reasoning that the ventilator had a chance, although futile, to improve the patient's health state. Physicians arg...