Danae Dukes

Medical Ethics Final

Mr. Stone is a happily married 53-year-old man with no distinct health
problems besides his ongoing cardiac issues that include, but are not limited
to, hypertension and cardiomyopathy in the last ten years. During this
doctors appointment, he is diagnosed with heart failure, and told that he will
need a heart transplant. There are no available hearts at the time, and his
cardiologist, Dr. Holmes suggests the implantation of a left ventricular
assistive device (LVAD) until a heart becomes available for transplant. Mr.
Stone is well educated on the risks and benefits of the surgery, provides a
copy of his advanced directive that shows a Do Not Resuscitate order, and
undergoes anesthesia. At the end of his surgery, Mr. Stone has a seizure that
leaves him unconscious and admitted to the intensive care unit. Mr. Stone
also developed pneumonia during this time period, and was placed on a
mechanical ventilator to keep him alive. The pneumonia did not improve
over the next couple of weeks, and Mr. Stones lungs were irreversibly
damaged, which made him ineligible for a heart transplant. Upon finding this
information, Dr. Holmes told Mr. Stone about the ineligibility for a transplant.
Mr. Stone was also told that he will need to be on a mechanical ventilator or
have a tracheotomy in order to breathe, while also continuing to suffer from
heart failure. Mr. Stone told his doctor, Dr. Holmes, You and I both know Ill
be stuck like this for the rest of my life. I dont want to. This will blow our
savings, and I want my wife to get on with her life. Can you turn off the
machine in my chest and let me be? This opens the case for debate on the

ethicality of turning off the machine and letting the patient, Mr. Stone, pass
away. Patient autonomy arguments lead to the belief that the patient should
be able to make the decision to end his life by turning off the ventilator that
is keeping him alive.
The first question that will be addressed is the medical indications of
the case. The patient, Mr. Stones medical problem is something that is
terminal. In fact, the patient has two medical conditions that he is facing. The
first is heart failure with the need for a transplant that Dr. Holmes had told
him about before the surgery. The second medical issue is the lung damage
that he incurred from the pneumonia and mechanical ventilator. The heart
failure is a terminal illness that is going to lead to the end of the patients
life. The patient is also going to continue to suffer the closer that they get to
death. According to the American Heart Association, symptoms of end stage
heart failure include, but are not limited to, heart arrhythmias, shortness of
breath, edema, and fatigue. Having these symptoms are not a way for
people to live their life. The treatments that are used for heart failure include
having a low sodium diet, mild exercise, and the implantation of a LVAD,
which is the procedure that Mr. Stone underwent that landed him here in the
first place. The other medical condition that Mr. Stone is suffering with is
irreversible lung damage. He will not be able to live without mechanical
ventilation or having a tracheotomy. He will always be dependent on
something else breathing for him. He will not be able to do any strenuous
activities, including working, for the rest of his life. Mr. Stone will not be able

to do the mild exercise that would help his heart failure because it would not
be good for his lungs. There are no other treatment options for his lung
damage.
Mr. Stone may be able to benefit from nursing care by having help with
his ventilator and monitoring his heart and lung function very closely.
However, since the cardio and pulmonary systems are so closely related,
there are many ways that his condition will go downhill quickly, even with
nursing care. The patient should be able to make the decision to stop the
mechanical ventilation and end his life with medical indications of the case
evaluated.
The next thing that will be addressed is patient preferences. The
patient has been fully informed throughout the entire process. He was
informed about the risks and benefits of surgery, the need for the LVAD, as
well as the need for the mechanical ventilator or tracheotomy. The patient
shows understanding that without the use of the mechanical ventilator that
he will not survive. He knows that the end of his life will come because he
will not be able to breathe on his own, nor will his heart be able to continue
to function without oxygen. The patient does not seem to be incompetent, as
he discusses the risks of the surgery as well as his advanced directive with
the doctor prior to the procedure. The patient has also expressed prior to this
situation that he does not want to be resuscitated in the case of cardiac
arrest so that he does not put any burden on his family. Since the patient has
expressed this, he does understand the implications of death and the end of

life. The patient expresses the fact that he does not want to go on with the
treatment and management of his heart failure and his irreversible lung
damage as it will create a burden on his family. Since the patient has
expressed his preferences and is mentally competent to make his own
decisions, the patient should be able to make the decision to end his life by
stopping the mechanical ventilator.
The next thing that will be assessed is the question of quality of life.
With any treatments for Mr. Stone, he will no longer be able to return to the
life that he had prior to his surgery. Because of the lung damage that Mr.
Stone got from surgery related complications, he will not be able to breathe
without a mechanical ventilator. This limits what he is going to be able to do
with life. He will not be able to work again, nor will he be able to do things
that he enjoyed prior to this life changing event. Mr. Stone will not be able to
do any strenuous activity because of his diminished lung function as well as
his failing heart. He will not be able to travel very easily because he will have
to take much medical equipment with him. He will struggle financially due to
high medical bills as well as not being able to work, leaving his wife to be the
sole wage earner. While Mr. Stone will not have the best quality of life, there
are also reasons why he would want to live, such as to be with his wife,
Martha, and to spend time with her. On some levels, turning off the
mechanical ventilator could be considered suicide, since Mr. Stone would
essentially be ending his life by stopping the machine that is breathing for
him. However, since Mr. Stone is mentally competent to make his own

decisions, he should be able to stop the ventilator by his own accord.

According to the quality of life that Mr. Stone would have living with his
continuing heart failure without the ability to have a transplant, as well as his
diminished lung capacity, he should be able to stop the mechanical
ventilation that is keeping him alive and end his life peacefully and without
suffering.
The final question that will be addressed is the contextual features of
the case. Mr. Stone is currently in the intensive care unit of the hospital
where he had his surgery. The doctors that are caring for Mr. Stone have the
intent to keep him alive as one of their patients. The legal and ethical
ramifications of the hospital and their staff are to do everything in their
power to keep the patients that they care for alive. The only thing that they
will not do for patients to keep them alive is anything that is explicitly written
out in the patients advanced directive. Other than that, they are going to do
everything in their power to keep the patient alive and get them back to
their baseline of health, or perhaps even better than that. There also may be
a legal obligation in place by the hospital or their staff that requires staff to
not stop life saving measures without following certain steps such as
declaring brain death. However, because Mr. Stone has listened to the
medical implications of his condition, stated his own preferences and being
considered mentally competent to do so, analyzing the quality of life that he
will have after learning about his condition fully, and knowing about his
condition prior to having surgery, Mr. Stone should be able to override these

hospital policies and live the remainder of his life the way that he wants to,
which is without a mechanical ventilator and slipping peacefully away,
ending his life.
In the end, Mr. Stone should be able to make the decision to end his life
by stopping mechanical ventilation that is keeping him alive. He has been
educated on the medical implications of his case, shown that he is mentally
competent and educated enough to provide his own preferences,
understands the quality of life that he will have if he continues the limited
treatment that he has, and has also recognized the contextual implications
associated with his case. These reasonings and implications allow Mr. Stone
to make his own decisions for ending his life by stopping mechanical
ventilation. These significant findings may also work for future cases of
people wanting to pull the plug to end their conscious suffering. In cases
like these that present themselves in the future, people will be able to use
Mr. Stones experience to make ethical decisions for themselves. Hospital
staff will also be able to use Mr. Stones case as a precedent of what to do in
situations like these. As the ethics have been evaluated, Mr. Stone can make
this decision for himself, and it will ultimately better him in his own wants
and wishes, by letting him slip away and not be a burden on his family, as
well as not suffer.
Works Cited
AMA Journal of Ethics. (n.d.). Retrieved May 02, 2016, from
http://journalofethics.ama-assn.org/2007/02/ccas2-0702.html

Living with Heart Failure and Managing Advanced HF. (n.d.). Retrieved May
02, 2016, from
http://www.heart.org/HEARTORG/Conditions/HeartFailure/Living-with-HeartFailure-and-Managing-Advanced-HF_UCM_477835_Article.jsp#.VybKeIs-CT8
Paradigm (4 Boxes): Bioethical Tool. (n.d.). Retrieved May 02, 2016, from
https://depts.washington.edu/bioethx/tools/4boxes.html