In this paper, I will be arguing a that in the Please Let Me Die case, the patient did not give informed consent to rejecting treatment due to a variety of factors. In summary, the patient was a 25-year-old male named Dax Cowart who suffered severe burns over 65% of his body after a propane gas explosion. He had several fingers amputated and his right eye removed after he was stabilized. He was discharged with minimal use of his hands, totally blind, and needed assistance with daily activities. He asked that treatment be discontinued throughout his hospital stay and rehabilitation, but his request was denied because his physicians deemed him not competent. I believe he was not competent because of his injuries; as is said about many patients …show more content…
with traumatic burns, and his inability to vividly imagine his future with his ailments. This incompetence is what denies him giving informed consent to discontinue his treatment. Vivid Imagination & Informed Consent Before I can discuss how informed consent and vivid imagination play a role in the patient’s ability to give informed consent to deny treatment, it is imperative that I provide working definitions of both to accurately explain my position. A widely-used definition is that informed consent is an autonomous authorization ; for the purpose of this paper I would like to add that informed consent cannot be given unless the patient or guardian has a substantial understanding of the situation and is deemed competent. Vivid imagination can be described as an active process that a person goes through where they imagine what the risks and rewards would be like for them in each situation . In the case of Dax, him not being able to vividly imagine his future with his ailments stems from an emotional factor that is not usually discussed. First and foremost, when patients experience severe injuries and are bedridden for an extended amount of time, they can develop situational depression. This chemical imbalance makes imaging a future with handicaps more difficult than it already is. Although he is now severely handicapped, Dax’s injuries do not sentence him to a life of misery. New skin treatments that are being developed could help rid him of his scars and state-of-the-art prosthetics could give him use of his hands again. But these are not the thoughts at the forefront of his mind in his mental state, which is where his ability to give informed consent comes in. If he cannot see past his despair to see that he has a viable future, how can he make the decision to not try to reach that future? The answer is that he can’t. Being able to rationally and accurately imagine what life will be like with new injuries is a very important part of a patient’s competency. Without it, it is hard to deem that a patient can give informed consent. Patient Competency & Informed Consent Patient competency is a widely-debated topic in the medical field.
Competency is the idea of being of sound mind, and being able to make rational decisions in a situation. In conjunction with competency is decision-making capacity. DMC is a continuum on which the patient’s ability to make a decision at a specific time is measured . A patient has DMC when they can understand all the information on their condition and the consequences of whatever choice they decide to make. In the case of those who are incompetent, physicians must use substituted judgement; treatment should be in line with what the patient would prefer if they were competent . At the time of his accident, I believe Dax was incompetent, and therefore unable to give informed consent about rejecting treatment for a plethora of reasons. The most obvious reason is that he was in immense amounts of pain. Pain has a fascinating ability to completely cloud the mind of all other rational thought. In the case of burn victims like Dax, they experience extreme amounts of pain for an extended period; as the process of recovery starts, daily bandage changes and baths aggravate the burns. Moreover, pain like that is treated with very strong medications, which have a myriad of side-effects ranging from mild sedation and confusion to hallucinations . If Dax was experiencing the pain and side-effects most burn patients do, then he was not able to think rationally, and therefore was incompetent. Because competency is a requirement for informed consent, his physicians were right to deny his request to stop
treatment. Objection & Rebuttal The view that I express in this paper is most closely related to the idea of Paternalism. Paternalism is most simply defined as a mode of decision making in the medical field in which physicians and health care workers exercise unilateral authority over patients . Opponents of paternalism feel that it diminishes the patients’ autonomy, which at its basic level is defined as self-rule that is free from interference by other people . It is very understandable why people feel this way. The world we live in allows much less autonomy than you would think. You have parents, teachers, bosses, even the government telling you what you can’t or can do. One of the few things we have control of is our bodies, so we are very protective over our autonomy to make decisions about our bodies and our health. The thing most opponents to paternalism fail to see is that allowing someone who knows more than you to help you make decisions about your body when you aren’t competent enough to do so isn’t completely giving up control. Doctors are trying to help you get back to a place where you can have control again. They acknowledge that you aren’t in control now, and their purpose is to make you better so you can have autonomy. There is also the fact that what may seem hopeless in the moment could very well be what makes you a stronger person later. A survey of patients with C4 quadriplegia who were stable and had full cognitive function showed that 90 percent were glad to be alive . If hindsight is 20/20, maybe we shouldn’t be allowed to make decisions when we have emotional blinders on. Conclusion In the Dax Cowart case, I believe the physicians were right to not abide by his requests to end life-sustaining treatments because he was in fact incompetent, and therefore not able to give informed consent. The nature of his injuries put him in a position where pain and medications rendered him unable to make rational decisions, making him incompetent. Because his injuries kept him hospitalized, immobile, and dependent on others, it is likely that he was suffering from situational depression. This made it difficult for him to accurately imagine what his life would be like with his injuries, which is a key part of competency. Although there is a lot of disagreement over whether paternalistic actions; such as those taken in Dax’s case, deny a patient control of their body and autonomy, I believe that physicians need to take such steps to help a patient return to a state where they can exercise control over themselves. It is likely that cases such as this one occur again in the future, so it is important for the conversation of paternalism vs. autonomy continue so that perhaps a consensus can be reached or, more importantly, so physicians can try to do right by their patients when faced with difficult decisions.
Autonomy is a concept found in moral, political, and bioethical reasoning. Inside these connections, it is the limit of a sound individual to make an educated, unpressured decision. Patient autonomy can conflict with clinician autonomy and, in such a clash of values, it is not obvious which should prevail. (Lantos, Matlock & Wendler, 2011). In order to gain informed consent, a patient
Emilio is terminally ill and is under the care of the Children’s Hospital in Texas. He is placed on life support by a respirator and is given pills causing the child to spend majority of his time in the pediatric intensive care unit unconscious. Showing no signs of improvement, the physician has requested the parents look for another hospital willing to continue aiding Emilio within a period of 10 days. Under the Texas “futile-care” law, the hospital’s ethics committee can, “declare the care of a terminally ill patient to be of no benefit,” allowing them to terminate care after a given time period. (Moreno, Sylvia. Case Puts Futile-Treatment Law Under a Microscope.
Any act done or decision made on behalf of an individual deemed to lack the capacity (following a capacity assessment), must be done in their best interests, this can cover financial, health and social care decisions.
Real-life heroes these days are firemen, police officers, emergency room medics. However, there are many stories of everyday people who end up hailed as heroes. In the novel A Lesson Before Dying by Ernest J. Gaines, the main characters do not follow any of the typical ‘hero’ professions. In a small American community, Jefferson, a young black man, has just been sentenced to death for a crime he never committed by an all-white jury. His former schoolteacher Grant Wiggins is forced to visit him by his aunt Tante Lou, who hopes that Grant can teach Jefferson some dignity before he faces the electric chair. Through the actions of Jefferson and Grant we can determine whether or not they are heroes to the African-American community which, after years of suppression and apartheid, is so in need of strong idols to look up to.
A divergent set of issues and opinions involving medical care for the very seriously ill patient have dogged the bioethics community for decades. While sophisticated medical technology has allowed people to live longer, it has also caused protracted death, most often to the severe detriment of individuals and their families. Ira Byock, director of palliative medicine at Dartmouth-Hitchcock Medical Center, believes too many Americans are “dying badly.” In discussing this issue, he stated, “Families cannot imagine there could be anything worse than their loved one dying, but in fact, there are things worse.” “It’s having someone you love…suffering, dying connected to machines” (CBS News, 2014). In the not distant past, the knowledge, skills, and technology were simply not available to cure, much less prolong the deaths of gravely ill people. In addition to the ethical and moral dilemmas this presents, the costs of intensive treatment often do not realize appreciable benefits. However, cost alone should not determine when care becomes “futile” as this veers medicine into an even more dangerous ethical quagmire. While preserving life with the best possible care is always good medicine, the suffering and protracted deaths caused from the continued use of futile measures benefits no one. For this reason, the determination of futility should be a joint decision between the physician, the patient, and his or her surrogate.
Patients are ultimately responsible for their own health and wellbeing and should be held responsible for the consequences of their decisions and actions. All people have the right to refuse treatment even where refusal may result in harm to themselves or in their own death and providers are legally bound to respect their decision. If patients cannot decide for themselves, but have previously decided to refuse treatment while still competent, their decision is legally binding. Where a patient's views are not known, the doctor has a responsibility to make a decision, but should consult other healthcare professionals and people close to the patient.
Though these legislative guidelines deal with the rights of a patient to refuse current medical treatment, ...
According to the NICE (2015) health and social care professionals should always seek valid consent from people with dementia. This should entail informing the person of options, and checking that he or she understands, that there is no coercion and that he or she continues to consent over time. If the person lacks the capacity to make a decision, the provisions of the Mental Capacity Act 2005 must be followed. The nurse assessed the patient capacity and ensured that the decision made was in the best interest of the patient. The doctor uses specialist knowledge and experience and clinical judgement, and the patient’s views and understanding of their condition, to identify which investigations or treatments are likely to result in overall benefit for the patient (GMC, 2008). They took into consideration how the decision made will benefit Jean. After carrying out a full assessment, it was clear that Jean lack capacity and was therefore place under the mental capacity act
The major implication of this decision is that each state decides the type of evidence required to withhold or withdraw medical treatment from an incompetent patient. The state ...
One of the many concerns is allowing incompetent individuals making this irreversible decision, which is why, “all have agreed that this end-of-life option should apply on to competent individual’s”(113). In addition, people opposed to this method argue that patients demanding this process are suffering from depression and not able to make decisions; yet, Rosenfled explains that practitioners most ensure that patients who consent to this medical intervention do it voluntarily, knowingly and
treatment should be further assessed. Due to shock and pain a patient may have a lapse in judgement as to what they truly want for care. One morally relevant detail, when it comes to Dax’s case, it was about ten months of begging to be allowed to die as he was forced to undergo excruciatingly painful and invasive procedures. During this time the doctors should have disregarded their want to be a ethically virtuous character, and instead advocated what is wanted for the patient. If the doctors would have followed deontological ethics and listened to Dax, he would not have had to live forcibly blind and disabled. This wrongdoing by the doctor’s made Dax not able to live the quality in life in which he desired. The majority of the wrongdoing that
This is a fascinating case because it presents the distinction between a patient’s right to refuse treatment and a physician’s assistance with suicide. Legally, Diane possessed the right to refuse treatment, but she would have faced a debilitating, painful death, so the issue of treatment would be a moot point. It would be moot in the sense that Diane seemed to refuse treatment because the odds were low, even if she survived she would spend significant periods of time in the hospital and in pain, and if she didn’t survive she would spend her last days in the hospital. If Diane were to merely refuse treatment and nothing else (as the law prescribes) than she would not have been able to avoid the death which she so dearly wanted to avoid.
A one hundred year old man is in a hospital suffering from excruciating pain, that is undeniable to live with. Should he have the right to attain a doctor to end his misery by just a click of a button? As a widening topic of discussion across the world, assisted suicide has been around for ages. Assisted suicide is a popular subject, that can be depicted on multiple types of television network shows. It is a controversial medical and ethical issue mainly based on the question of whether, medical practitioners should be authorized to help patients determine the time and the environment of their death. This practice is usually physician-assisted suicide. The term physician assisted suicide, describes any case,
As medical procedures and techniques have become more advanced, doctors are able to do much more to try and save a patient's life (Warriach). In some cases, however, this process is only delaying the inevitable and causing the patient even more suffering. If euthanasia were legal, patients could willingly choose to end this long process of torment, specifically in terminal cases where both would lead to the same result: death. In a hospital, a patient's life gets dragged on despite the condition by medical tools and devices such as respirators (Warriach). The only way to cease the patient’s anguish is by ending all means of life support. If euthanasia were presented as an option, it would save the patient, along with their family, from immense pain and
Autonomy (independence and the right of self-determination) is certainly valued in modern society and patients do, and should, have the right to accept or reject medical treatment. However, those who favor assisted suicide claim that autonomy extends to the right of a patient to decide when, where, how and why to die