1. In the first example given, should health care professionals honor the patient's refusal of the blood transfusion? Why or why not?
2. Should the 67-year-old man receive chemotherapy to treat leukemia? How would you defend your position with ethical argument?
extremities, and loss of hair—would cause undue suffering because the patient would be unable to understand why they were occurring.
In other instances the medical team caring for a patient may recommend that lifesaving treatment be withheld or withdrawn because it no longer provides a meaningful benefit to the patient. This was the case when an 85-year-old woman tripped on a rug, tumbled to the floor and broke her hip. During hospitalization, she developed respiratory failure requiring tracheal intubation (feeding tube placement) and placement on a mechanical respirator. Subsequently, she suffered a cardiac arrest, requiring emergency resuscitation. Following this episode, the patient never regained consciousness, and was eventually determined to be in a permanently unconscious state known as "persistent vegetative state." After months of meeting the family's request to continue lifesaving medical treatment, the medical team recommended withdrawing life-sustaining treatment and letting the patient die.
In some cases government decisions determine who receives lifesaving treatment. This can occur when state or federal governments restrict public funding for medical services. In Oregon, for example, a law was passed in 1988 that the state would no longer use public (Medicaid) funds to pay for heart, liver, pancreas, or bone marrow transplants for the poor. The state decided instead to use the $1.1 million it spent annually on organ transplantation toward a program of prenatal care.
While is it widely held that under certain conditions lifesaving medical treatment can be ethically withheld or withdrawn, people may disagree about the
3. What are some of the ethical issues raised by the Oregon plan to eliminate Medicaid funding for certain organ transplantation procedures?
4. Should the feeding tube and respirator keeping the 85-year-old woman alive be withdrawn? Why or why not?
Nancy S.Jecker is Professor of Medical Ethics at the University of Washington School of Medi-cine,Department of Medical History and Ethics.She is also Adjunct Professor at the University of Washington School of Law and Department of Philosophy. Dr. Jecker has written or edited three books and over 90 articles and chapters on ethics and health care. Her articles have appeared in The Journal of the American Medical Association, The Hastings Center Report, Annals ofInternal Medicine, The Journal of Medicine and Philosophy, and other publications.
justification for withholding or withdrawing treatment in particular cases. This leads to reflection on the ethical values underlying such decisions. These values are often expressed in the form of health-care principles, which require health providers to respect patient autonomy, benefit the patient, avoid harming the patient, and justly allocate scarce medical resources. A standard approach to justifying ethical judgments in these particular cases is to show that one's position is supported by ethical principles. The principles, in turn, may be justified by showing that they follow from an ethical theory that is itself widely held or from a common morality that we all can accept.
Whether in our professional lives, as members of a health care team, or in our personal lives, as patients or decision makers for family members, we each will face ethical decisions about medical treatment. If we engage ourselves fully in these choices, they are sure to challenge some of our deepest beliefs about the meaning and value of human life.
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