Q2: Ethics and End of Life

Anna is 52 year old pianist. For the last

ten years she has been suffering

increasingly from severe rheumatoid

arthritis, resulting in constant intensive

pain despite treatment with anti-

rheumatic drugs and opioids. Moreover,

the medication has had significant side

effects including liver damage, bone

marrow suppression and being prone to

respiratory infections. One evening her

daughter, Maria, finds Anna rather

unwell and drowsy at her home and

brings her to accident/emergency

department of the local hospital. Anna is

sleepy and confused, unable to

communicate meaningfully with the

medical team. Upon examination she is

found to have pneumonia requiring

intensive treatment with antibiotics,

hydration, and as the condition escalates

her respiratory distress additionally

requires ventilation in the intensive care

unit.

After discussing Annas condition with

her husband and daughter the following

day, the doctors learn that Anna signed

an advance directive two years ago (they

bring signed copy of this document). In

this document Anna states that she does

not wish to undergo any life-prolonging

treatment if she ever needs one. Maria

also tells the doctor that her mother

found her pain unbearable, and could

not reconcile with slowly losing her

abilities and being dependent on others

in everyday life. Moreover, she also

r e m e m b e r e d t h a t A n n a s m o t h e r

suffered from the same condition that

ultimately caused her death and that

Anna often stated she would not like to

end up like her. Maria therefore wonders

whether the doctors might help in some

way to make her way out easier if they

think that her death is imminent.

However, Annas husband, Martin, is

strongly opposing the idea that the

advance directives should be respected

and urges the doctors to continue with

the treatment necessary to make Anna

well again. He is of the opinion that by

not treating her the doctors would be

accomplices in Annas death.

Discuss the ethical and legal issues

involved in this situation. In particular,

address the following:

How should the doctors respond to

Annas family, where Annas husband

disagrees with her wifes wishes, while

their daughter seems sympathetic and

inclined to respect these? What options

are available? And what principles

should guide the doctors in

communication with Annas family?

 Martin believes that by not providing

treatment the doctors would actively

participate on Annas death. Do you

agree with that? Why or why not?

Maria is hoping that the doctors might

help Anna in a way that she does not

suffer while dying. What role does

compassion play in medical care

towards the end of life? How would

that play out in this situation?

What is the role of advance directives

for patients treatment? How does the

respect to patients autonomy

translate into clinical situation like

this? What are the ethical principles to

consider? What is the legal position on

this case?

 What is the right thing to do? Why? Is

there any tension between what is

ethical and what is legal?15