Introduction to Ethics- Final Paper

Case Study

Justify theory, defend it and clearly justify choice of theory for the character.

(APA format)

Must be 4 pages

Dr.Jerome MacDonald : (Utilitarian ) Calculus of felicity

Rodger Weston: (egoist)

Laura Westen: (Aristotle)

Evelyn Swenson:(Kantian)

Dr.Morton Farrell(Evolutionary ethics)

Now you are Jonathan Weston, the oldest son. You have significant influence with your family and your mom, flora, will most likely go along with any recommendations you make.

What are you going to recommend to family? Justify the following three ethical theory’s as if they influenced you in your decision making and recommendation. Explain, articulate how they influenced you in your decision.

Jonathan Westen: Kantian ethics, Virtue ethics, Divine Command theory

Case 3: A case for the ethics committee

(This lengthier case provides the opportunity to try on diverse roles, both familial and professional. Note how different the situation appears from the different role perspectives.)

The scene: Most hospitals have "Ethics Committees," whose job (among others) is to offer advice and consultation to anyone in the hospital who is distressed by the ethical dilemma posed by a case. In the case of Samuel Weston, it is his family who are distressed, and they have asked for an audience with the hospital Ethics Committee, asking others with interests in the case to offer their opinions also. The speaker and narrator is the oldest son of Samuel Weston, the one who requested the meeting. Questions from the members of the Ethics Committee are indicated by parentheses.

Thank you for agreeing to talk to us. My name is Jonathan Weston, and I am the oldest son of Samuel Weston, a patient in this hospital. To make a long and agonizing story very short, after several strokes, my father is now, as they say, "terminally comatose," and some of us think that we ought to pull out all the tubes and call the funeral parlor and the rest of us think that that would be murder, totally inexcusable, and we're not quite sure where to turn right now. I understand that you people are the "Ethics Committee" in this hospital, and that you're supposed to know what to do in these cases. OK, tell us what to do.

Let's fill in some details.

My father was admitted to this hospital on March 3, 1986, when he was 74, almost 75 years old. He was discovered by my mother lying unconscious on the floor in the bathroom. My mother called the police and they brought him here. By evening he had sort of recovered consciousness and knew us, and they'd diagnosed a stroke. There isn't much you can do for a stroke at first, so they just basically took care of him and he got much better. By late April they had him in physical therapy on the Rehabilitation Wing and we were talking about taking him home. He was in very good spirits, joking about fending off rabid dogs with his walker….then he had another stroke in May. The doctors said it was "mild," just a "set-back"….then in July he had another one, and since then he hasn't opened his eyes, or when he does, he doesn't see anything. They say he isn't going to get any better.

For awhile after his third stroke they had him on a respirator, then he "improved" to the point where he can breathe on his own. They're feeding him, and occasionally pumping in antibiotics, with tubes. The doctors say eventually his heart will stop. I have my doubts. His father lived to 98, and Dad's heart has always been enormously strong. With adequate food and water, he might touch 100. The question is, how long should we go on with this treatment? When is enough enough? For the answers that have been proposed, let me introduce the rest of the cast of characters:

Dr. Jerome MacDonald: I've been Mr. Weston's physician for 23 years now, physician and friend, and taken care of the rest of his family as well. I have nothing but affection for the man, and sympathy for Flora Weston and the children in this time of grief and anguish. My role in this situation is now very limited. I cannot, of course, unilaterally make the decision to withdraw nutrition and hydration. I can certainly tell the family that according to all the consultants, their husband and father is surely terminally ill and permanently unconscious, with no chance of improvement, and I have done that. He is not legally "brain-dead"–since he's breathing on his own, the brainstem is clearly alive, and part of the cerebellum as well–but he will not function as a human being again. Nevertheless, he looks human enough–as a matter of fact, he looks like Sam Weston, asleep. I know what torment they're going through, and I sympathize deeply, and I will comply with whatever decision they can reach as a family.
(You know they're badly divided. Can't you give a little more directive advice, maybe a little more forcefully?
I have other patients, you know. I can do nothing for Sam, and God forbid I should get into the middle of that family fight. They don't need a doctor, they need a referee and an umpire and maybe a rule book. All I dare do, in these conditions, is give the medical prognosis and wait for them to come to some conclusion.)

Flora Weston: I can't believe Sam isn't going to get better. He got better last time, didn't he? Because we had hope and were willing to wait! I saw his eyes look at me just three days ago. There has to be hope. We can't live without hope! I don't know what to do. But please let's not give up.
(Did you understand what the doctor said about "total cerebral death" and "terminal irreversible coma"?
No.)

Roger Weston, the younger son: This is ridiculous. Dad spends all his life, sometimes 60 hours a week, just to earn money to leave to his family, and here we are, just about out of insurance, spending $1500 a week on his living corpse. Why are we doing this? He's dead, he's been dead for months! Let's pull out the stupid tubes and let him go. That's the way he would want it, that's for sure.
(Suppose all you had to do was spend a couple of thousand dollars to pull him out of a well, and if you did he'd be in good health for years, and if you didn't he'd die. Would you spend it?
Of course! what do you take me for?
What if it was a hundred thousand dollars, and he'd have to be in bed for the rest of his life, but alert and able to communicate?
Uh, well, sure, if that's what he wanted….
He probably would. What if it was a million dollars?
Now wait a minute! What are you trying to prove?)

Cynthia Weston Green, the older daughter: They're a bunch of cold-blooded murderers, nothing else! I think I knew Daddy better, and loved him more, than all of them put together. I know I haven't seen him much for the last six years when I was in California, but after my marriage failed I just wasn't financially able to come home when I wanted, and I know it was stupid to be too proud to ask for the money, and Daddy has been in my thoughts every minute. I don't care what they say about his medical condition. He's still my father, I still love him, and to talk about depriving him of food and water borders on the sadistic! Where do we get this bit about how it's too troublesome, or expensive, to feed him with tubes? Wouldn't you feed him if he just couldn't move his hands, and you had to feed him with a spoon? I seem to recall that once upon a time I had to be fed with a spoon, as did Jonathan and Roger, and before that we had to be fed with tubes, or nipples, andwe were pretty expensive and troublesome, especially Roger, and Daddy fed us, and paid for us, without complaining. Well, maybe it's time for us to return the favor. Of course he's going to die some day. But while I live, he's not going to die because his children decided to starve him to death when he was too old and sick to complain about it!
(It must have been very hard for you, not being able to be with him all those years. Do you think that your absence–rather, your feelings that you should not have been absent, especially when he was sick–might have something to do with your conviction that he should not be allowed to die?
What would that have to do with it? Do I have to provide reasons for loving my father and for wanting to see him taken care of when he is sick?)

Laura Weston, the younger daughter: I'm not sure I know what Dad would have wanted, but I know that if that were me, in that bed, I'd want to die. I just wouldn't want to hang around in that state. That isn't really life. I'm just not interested in the financial aspect of this dispute. But I know that that is no life to be living, and no human being should be kept around in that state.
(Do you think he is really alive at all?
I don't know.)

Evelyn Swenson, Samuel Weston's nurse: We are dealing here with a patient who needs care. That's my department–not the physician's, who stops by maybe every two weeks to see if he's died yet, and not the family's, who only gather by the bedside to fight with each other. I am not only the servant of the whims and interests of family and physician: I have my own professional ethic to answer to, and that ethic requires me to render the best available care to every patient. Mr. Weston requires bathing, turning, changing, nutrition and hydration, all of which is "nursing care," not "medical care," and which it is my professional duty and competence to provide. I know it would be convenient for everyone if Mr. Weston would just die, but I am not allowed to watch third parties kill a patient for their own convenience. There are lots of places in this world where helpless elderly people are allowed to starve to death; this hospital should not be one of them.
(Mrs. Swenson, you know that the attending physician is responsible for issuing all orders regarding patient care in this hospital, and that nurses are essentially auxiliary medical personnel. Do you really think that it is your role to take a position on this case which is, as far as we can tell, independent of the physician's position and of any position the family might reach?
I am not sure that you realize that Nursing is an independent profession with its own code of ethics and its own professional obligations to its clients. Of course there are times when, for the sake of the patient, and out of respect for the patient's autonomy, it is proper to terminate burdensome and painful medical treatment–especially publication-oriented experimental treatment! But this patient is in no pain, and has not indicated that he wishes us to stop feeding him. The only reason to "let him die with dignity," as they say, at this point, is to save the family money. That's not a good enough reason.)

Dr. Morton Farrell, administrator of the hospital: You know, the reason we provide these enormously expensive hospitals and treatments is so that living people who have suffered some trauma, or have some acute illness, can be saved–can receive the tremendously complicated care that will cure them, make them well. Weston isn't going to get well. He isn't even going to get measurably better. I know we invite his imminent death–the rest of his death, really–if we take out the feeding tubes. But what a terrible waste of resources it is to keep him going like this! When the insurance is gone, the hospital pays through the nose; the family can be billed, but usually won't pay, and then the public pays to keep him here. The family complains about the $1500 per week they have to pay. Now that the DRG has expired (the amount of money that Medicare will pay for patients in his Diagnosis Related Group–patients who have what he has), it's costing the hospital $5000 per week to keep him, and we can't even bill the family for that! And for what? I'll be glad to see him out of here, one way or another.
(Thank you for your candor, Dr. Farrell. Why don't you just arrange to have him discharged for administrative reasons?
Because the family has to agree on a discharge plan, for starters, and they won't. And because we'd have the socks sued off us by the hysterical daughter. And God only knows what that nurse would do.)

Mr. Gregory Little, Esq., the family attorney: I'm hardly in a position to say very much, since Mr. Weston, anticipating no such accident, had no opportunity to set his affairs in order, including the making of a "Living Will" or assignment of durable power of attorney. He told me on several occasions that he would not wish to live with artificial life support, should he be rendered incapable of communicating. Does nutrition and hydration count as artificial life support? Food and water seem natural enough, but tubes don't. What counts as artificial in this case?
(Should the tubes be removed, and Mr. Weston die, would you suggest to the family that an action in malpractice might be appropriate?
That's not the kind of law I do, and it would not be appropriate for me to comment on that matter in any case.)

Jonathan Weston, again: OK, people, there you have it. I have to make the decision, except that if I make it the wrong way, some other family member–not my mother, of course, but my sister or brother easily–will complain, hold a press conference, probably sue…. What do you think I should do?
(Mr. Weston, do you have a spiritual advisor?
A what?
A clergyman of some sort–priest, minister, rabbi–whose opinion on the matter you think we should hear?
Uh, no, we weren't the churchgoing type.)
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