Glenn Ross, an alert fifty-five-year-old man, was diagnosed

Glenn Ross, an alert fifty-five-year-old man, was diagnosed with inoperable pancreatic cancer. His prognosis was poor; he was given about six months to live. He underwent several series of chemotherapy treatments, but they were of no benefit. He continued to lose weight, suffer from nausea, and become weaker. After three months of chemotherapy treatments, he stated that he wanted no further treatment. His son arrives at the hospital and demands that his father be placed on chemotherapy immediately. He threatens to sue the physician for withdrawal of care.

Analyze this case with the following criteria 

1. Identify the relevant facts relating to all aspects of the case being discussed.

• Medical facts
• • Diagnosis/prognosis (chance of recovery).
  • Course of present illness/hospitalization.
  • History of treatments and results.
  • Possible treatments with their potential benefits and risks.
  • Status of daily living skills (ambulation, feeding, hydration, communication,

and so on)

• • Patient’s emotional state.
  • Patient’s decisional capacity (competence).
    • The level of decisional capacity for any particular patient falls somewhere along a continuum from fully capable (awake, conscious of one’s environment, capable of expressing one’s wishes, and stable) to totally incapable (in a persistent vegetative state or an irreversible coma).
      • A patient’s decisional capacity may also falls somewhere between the two extremes:
      • For example:
        • A patient who is aware and informed, yet is distraught or confused.
        • A patient who is otherwise aware and informed, yet changes his mind constantly and is inconsistent.
        • A patient who be stable and aware yet is not fully informed.

• 2. Patient’s beliefs and wishes.
• • Patient’s wishes.
  • Cultural and religious beliefs that are relevant to decision-making.
  • Interested parties (who has something to gain or to loose)

• 3. Society at large
• • Institutions-Hospitals, medical professions.
  • Individuals—their rights, duties, competence, values, and authority.
  • Adult or minor children.
  • Surrogate/proxy (someone who has been designated to make decisions of behalf of the patient in case the latter is incapacitated).
  • Significant other.
  • Health care providers.
  • Conflicts among these individuals or between any of them and the patient, if any.

• 4. Legal/administrative concerns.
• • Financial considerations.
  • What the law says.
  • Hospital policies.

 

2. Identify the ethical issues/conflicts.

• Articulate the problem.
• What makes the situation an ethical problem:
• When decision-makers sense that there is something wrong, yet are unable to identify the moral problem or when they do not know which moral principle or value applies.
• Conflict over the application of an ethical principle.
• Moral dilemmas.
• A choice must be made between two (or more) possible courses of action all of which appear at first glance to be moral.

Example: in the case of a terminally ill patient both to keep the patient alive and to let him die are both morally right one based on the belief that it is

morally right to preserve life, the other on the belief that it is morally wrong to

prolong suffering.

• There is a conflict between two different moral principles. To choose one is to infringe on another.

Example:

The patient refuses treatment and is aware that, as a result, he will die. The physician feels that he has a duty to continue to treat cure and prolong life. This a case of conflict between autonomy and beficence.

 

 

3. Identify options

• List the different courses of action that are available.

For example:

• Treat aggressively: initiate new therapies, perform surgery, resuscitate if patient goes into cardiopulmonary arrest.
• Continue present level of treatment: maintain current level of medication, maintain all presently used, and maintain current CODE status.
• Provide palliative care: use medications for pain control, do not initiate therapy if condition deteriorates, and do not resuscitate (DNR) CODE status.
• Withdraw life-sustaining treatment: discontinue curative medications, disconnect the ventilator, discontinue artificial feeding and hydration, and do not resuscitate
• Identify the potentially positive and the potentially negative consequences of each course of action for the patient and for all the interested parties.
• Rank the different options from an ethical point of view:
• Identify the basic moral principle of moral theory that underlies each option.
• Find out which course of action results in the greatest good (consequentialism-beneficence) and the least harm (consequentialism-nonmaleficence) while at the same time respects the rights, dignity, and integrity of all persons involved (deontology, virtue ethics, autonomy).

 

4. State the most ethically sound option and the justification for it.

Explanation & Answer

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