The Will to do What is Right

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 patient” sage 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 patient”s 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 physician who at this point does nothing. The patient”smother arrives at the emergency department and the physician explains the patient”s 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 ensued 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 is 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 physician”s 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 has 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 patient”s request but is placed in an awkward legal position if he abides by the patient’s request. The nurse who has acted as an intermediary throughout this entire process continues to acts as a patient advocate and ensure the patient’s rights are observed and that his wishes are acknowledged.

Contemporary Utilitarianism is divided into 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 for him to die. This action does not provide the greatest good and it appears that the patient loses by a vote of two to one.

The second principle is based on what the consequences of this action are, not what or how it”s done but how the chosen action affects the majority. Again we find that the patients requested action of no medical treatment and death is not the consequence that the majority wants.