Decisions On Behalf Of The Patient example essay topic

The fear not merely of death but of vegetating encrust- ed with tubes, respirator, and pacemaker drugged into stupor or mindlessness and nevertheless alive, some- times agonizingly so - in short, the fear of ending in a 'living death' - has made many converts to the cause of euthanasia. Their position can be summed up in a single cry: Death with dignity. (Kluge, 42) In December of 1979, on a lonely two-lane road, Gary Fickler, a 23-year-old Kewaskum, Wisconsin man, lost control of his vehicle after hitting a patch of ice. The car flipped over trapping Gary inside. When medical help arrived approximately 10 to 15 minutes later, Gary was pulled from his car and his breathing was restored with the help of a respirator; his brain had been without oxygen during this time. Gary was admitted to the hospital listed as brain dead, meaning there was a cessation of activity of the brain.

Gary never thought about something like this happening to him. He never planned ahead for his death. He never thought about power of attorney or a living will. After the doctors confirmed to Mr. & Mrs. Fickler that Gary would not survive without life-support machinery, the Fickler discussed the removing of all tubes that would prolong their son's life. They wanted their son to be able to die with dignity. Soon after Gary was disconnected from his life support he died.

This story is from a personal interview with Stephan Bradford, Gary' brother-in-law, is not an uncommon story. Incompetent patients such as Gary, with no hope of recovery, cannot relay their desire to end their own lives; to make certain these wishes will be carried out family members need to be given the right to act on behalf of the incompetent patient. Patients also need to be informed of their rights and options for future medical care. In an article in Modern Healthcare by Lynn Wagner, nation- wide estimates show that between ten and fifteen thousand patients are existing in a "vegetation state". The approximate cost to keep these patients alive is $1.3 billion dollars annually. Rough estimates show that this could break down to almost $1,000 per day for a room and artificial feeding with additional costs of $24 per hour ventilator usage (36).

Patients kept alive with the help of machinery and tubes might consider death a relief. Some believe that death is a stepping stone to another life. According to Jonathon Bradford, head administrator at Freedom Square Nursing Center in Seminole, Florida, a competent person who did not want to live, could starve themselves to death. The question is who can make that decision for the incompetent? Thus the subject of euthanasia arises. The debate over euthanasia has been ongoing since the time of Socrates, Plato, and the Stoics.

Euthanasia is derived from the Greek words, "eu-" meaning good and "thanatos" meaning death. Euthanasia has also been known as mercy killing or a gentle or quiet death as opposed to a violent and tortured death (Ladd, 3). Activists for the euthanasia movement believe that they are alleviating suffering by allowing people the right to end their own lives (Jennish, 28). Problems arise over determining what death is and when it occurs.

Death is described, in Section 1 of the Model State Law for Determination of Death, as. ".. cessation of circulatory and respiratory function or irreversible cessation of all functions of the brain" (Barnard, 139). The brain is the organ that determines the capability and quality of one's life. If the brain stops functioning the other organs of the body need not function. When the brain dies the other systems stop their duties and die, but this is only after the brain is dead.

Death replaces life and in a drawn out illness dying precedes death. In Gary's case his brain was dead but his body was functioning because of machines that made them function. Once removed from machinery his body functions shut down since his brain was already dead. Patients that are brain dead are considered to be only a shell or a "biological organism" and not a person anymore. Allowing patients to die without treating them is an issue hard for the medical professions to address. Doctors take the Hippocratic Oath which states that they will treat and try to cure patients but will not administer any lethal drug to a patient or even talk to that effect as an end to a patients' life.

There is one problem that has arisen over a part of the oath that states that a doctor is to treat patients using his own "ability and judgment" (Kluge, 108). What one doctor's ability and judgment is, may not be another's. Thus the question as to what treatment is right or wrong cannot be truly answered. Each patient is to be treated according to his or her needs and wishes. For the terminally ill and comatose patients, what judgment should the doctors use? Some doctors feel they are needlessly prolonging life when their medical training and medical facilities could be used to help other patients.

Keeping these patients alive using "extraordinary means" can be painful, costly, difficult and very dangerous (Kluge, 66). Other considerations also need to be given to the family of these patients, such as, keeping these patients alive brings joy or anguish to the patient and those around them. Dr. Tw crones, in his speech at the 1979 Anglo Conference on Care of the Dying, states: In terminal illness, the primary aim is no longer to preserve life, but to make the life that remains as comfortable and as meaningful as possible. Thus what may be appropriate treatment in an acutely ill patient may be inappropriate in the dying. Cardiac resuscitation, artificial respiration, intra- venous infusions, nasogastic tubes, antibiotics - all intrusions to assist a patient through the initial period toward recovery of health. To use such measures in the terminally ill, with no expectancy of a return to health, is inappropriate and is -therefore- bad medicine by definition.

(Barnard, 22) In Canada, doctors can remove life-support of a patient near death without the consent of the patient or family. These doctors are given the right to decide whether or not there are other patients with a greater need of equipment and medical help. While they may be omitting treatment to those patients, they are not acting to end a life, as in injecting drugs to kill the patient. They are allowing the incurable patient's life (Jennish, 24). In 40 states in the U.S. and in the District of Columbia doctors can legally withhold life-sustaining treatment if re- quested by the patient.

Putting these requests in writing helps protect the hospital and doctors from negligence and malpractice suits stemming from the withdrawal of life-support (Lawton, 38). Dunlop Eck en, administrator at a 871-bed Washington D.C. Hospital center, said he would prefer to leave the patient care decisions to the discretion of the physicians and families (Wagner, 39). This is fine for competent patients or patients who left previous medical requests. With the increase of knowledge in the medical field and more sophisticated life-support machinery patients in a comatose stage could be kept alive indefinitely.

There must come a point at which keeping these patients alive by artificial means need to stop. Patients have a right to have treatment stopped and to be allowed to pass away in peace. If the patient is comatose, who can make these decisions? The comatose patient is unable to express views on death and dying.

Without receiving prior written request, doctors only can assume that their patients want to be kept alive. For the families of comatose patients, seeing these loved ones in a "vegetative" state seems cruel and senseless. The comatose patient has lost the ability to decide his or her medical treatment, but this right still exists. In these cases where consent cannot be given the law needs to decide who will make decisions on behalf of the patient. The ideal of self-determination is gone with the incapacitated patient. There is a need to find a guardian who would make decisions as close as possible to what the patient would have wanted.

Those most suitable would be family members, but with these decisions comes much strain and stress (Kluge, 63). Besides the emotional stress and strain the financial costs to keep these patients alive are astronomical. In the well known case of Nancy Cruz an, the Missouri woman who was kept alive for seven years with the help of a respirator, medical costs ran $130,000 annually (Wagner, 36). Medical budgets are not limitless nor are family budgets, so society ends up paying for hospitals and services through taxes. This is what happened in the Cruze n case; the state of Missouri ended up paying the medical bills.

Eliot Stater said, "Death... costs nothing; the life costs not only money but the preemption of precious medical, nursing, social and educational resources" (Kluge, 61). These precious resources could be used to help those that are less fortunate and are in desperate need of medical attention. Terminally ill patients kept alive artificially are using resources that could be put to better use, possibly saving a person's life. If euthanasia were ever to be legalized, certain safeguards would need to be taken. There are may dangers in deciding who has the right to decide whether one lives or dies. Statutes would have to be set to distinguish the difference between euthanasia and murder (Kluge, 64).

Murder is wrong and is punishable by death and some people believe mercy killing is the same as murder, but patients do have the right to their own bodies and they also have the right to privacy. Taking these rights away is against the law. This society believes that life is worth protecting. Humans have an immortal soul and are made in the image of God, but now society is faced with these questions: What rights do the families have? Does this society have the right to play God and say these people should continue suffering? Is euthanasia right or wrong?

Society needs answers to these questions (Kluge, 141). It is necessary for society to. ".. recognize and respect that moment in illness when it no longer makes sense to bend every effort to cure or to prolong life and when one must allow patients to do their own dying" (May, 662). Society needs to allow these people to make their own decisions and allow the comatose patient to "die with dignity". Society needs to give the patient the control over the quality of his or her life. To live a life as a human vegetable is undignified and dehumanizing. The Florida Supreme Court, in a ruling on a case regarding guardianship of comatose patient Estelle M. Browning, stated his or her person" (14-90).

Something must be done to make sure patients have this control. Safeguards must be taken to make sure all wishes of the incapacitated patients will be carried out. Society also has the obligation to make sure families won't be torn apart due to conflicts arising in the care of the incapacitated. Families need to be prepared for what is ahead in taking care of the comatose. There needs to be a oneness of family to help them decide what is right and in the best interest of their loved one. Their motivation must be one that comes out of love and concern.

A heavy burden falls on the family, not only of a physical nature but mental as well. Deciding not to prolong a loved one's life is not an easy decision. Families deal with depression and conflict even when they know they acted on the best interests of the patient (Kluge, 76-77) Another feeling that comes with the decisions of disconnecting of life-support is guilt. Being responsible for ending a persons life can have a mental impact on that person (Ell man 47). Feelings of whether the decision made was correct or not can lead to these guilt feelings. Educating families and informing then of their rights may case these feelings that accompany their decisions.

Preparing for the future is something that everyone needs to do. Two options that are available to everyone are living wills and power of attorney. Before following through with either of these options people need to be educated as to what they are and how they can save them from needless pain and suffering. Hospitals need to be equipped with personnel that can counsel patients and inform them of their options. Committees need to work with doctors and families to decide if and when death may be in the patients' best interest. Education Patients, staff and the community can save many people from needless suffering (Capron, 36).

The living will is the best assurance that a patient would be allowed to die free from any invasion by the medical field. Although many people say they wouldn't want to be kept alive by artificial means a study done in 1988 showed that only 15 percent of Americans have made out a living will. A living will is a document that gives legal direction setting forth circumstances under which a person would not want to be kept alive. This includes artificial means such as respirators and feeding tubes. A patient must be very specific in the terms of the living will. The Declaration of Living Will states that being of sound mind a person willfully and voluntarily makes known that their wishes not to be kept alive by artificial means.

If also states: If the time comes when I can no longer take part in decisions for my own future, let this statement stand as a testament of my wishes: If there is no reasonable expectation of my recovery from physical or mental disability, I, request that I be allowed to die and not be kept alive by artificial means or heroic measures. Death is as much a reality as birth, growth, maturity and old age - it is the one certainty. I do not fear death as much as I fear the indignity of deterioration, dependence and hopeless pain. I ask that medication be mercifully administered to me for terminal suffering even if it hastens the moment of my death. (Kluge, 42-43) Living wills also need to be altered according to different conditions in different states.

Additions need to be made to cover specific details concerning ventilators and nutrition tubes. As stated earlier, 40 states and the District of Columbia honor living wills permitting people to designate under what condition they want to be treated and when they would prefer to die. Even with a living will some doctors and hospitals still have the right to refuse to honor those wishes even when death is imminent. A safeguard for patients goes into effect in December of 1991 called the Patient Self Determination Act of 1990. This law states that nursing facilities and other health care providers will be required to discuss state laws regarding living wills and other advance directions with new patients.

They also will be required to outline facility policies governing these issues. This is to protect the medical field from any unnecessary law suits due to miscommunication (Riley 16). Power of Attorney is another way to make sure the requests of patient's are kep. Power of Attorney is a right given to a person of the patients choosing to make personal care and medical decisions if the patient should become incapacitated or unable to make these decisions. Illinois and Wisconsin have jurisdiction with durable Power of Attorney statures that allow guardians to make medical decisions including decisions to withdraw or withhold life support.

The guardian can act when the patient cannot make his or her own medical decisions (Riley 16). In the case of Gary Fickle, Power of Attorney was given to his parents which enabled them to withdraw his life support. Like the Living Will, Power of Attorney needs to have supplementary notations made to it concerning items not specifically covered by one's home state. Not all states have a durable Power of Attorney. Some states only give proxy and general Power of Attorney. Proxies are able to only make decisions on a specific act or condition and a general power of attorney makes no mention of medical decision (16).

Documentation of desires not to prolong life through the living will or power of attorney will not completely solve the problems arising over the "pulling of the plug" or allowing the incompetent patient to die but these safeguards will help to make sure the wishes of the patient will be carried out. Until the day comes when everyone has made previous decisions and provisions concerning their healthcare and death plans, and alternate guardian needs to be appointed that could act on behalf of the incapacitated. A family member would be the most likely to make decisions within the best interest of a patient. Although it will never be an easy decision to decide the death of loved one agonizing pain of seeing one you love deteriorated day after day brings more pain. We may never understand why something like this has to happen but Solomon, the great prophet of biblical times, states: To every thing there is a season and a time to every purpose under the heaven: A time to be born a time to die... (Ecclesiastes 3.1, 2) Gary Fickler was a young man whose life touched many hearts.

It was his time to die but the hurt that his family went through waiting for the cessation of his life was more unbearable than his death. Dr. Christian Barnard said, "Where there is no more joy in living, no further hope of joy and no wish to continue, there can be little problem in arriving at a decision" (98). The decision Mr. & Mrs. Fickler had to make in ending their son's life was the hardest thing they ever had to do. Society needs to make sure that families faced with these decisions are given love and support.