Question

Question: What are the bioethical dilemmas in the fact pattern below?

Fact Pattern

Barbara and Yvette are partners. At the start of their relationship, they agreed to

marry only when all same-sex couples in every jurisdiction could do the same. Just last

month, the couple finally and excitedly began to plan their wedding.

Barbara and Yvette periodically discussed death over the course of their 15-year

relationship. Both expressed a strong opposition to “being kept alive by artificial

measures in the face of medical futility.” For Barbara, her quality of life hinges on her

ability to talk and write music; for Yvette, it is her ability to dance and walk.

Mosher

1

Barbara and Yvette get into a terrible car accident. Other than some minor cuts

and bruises, Barbara walks away unscathed. Yvette—the driver—is comatose and

incapacitated. The doctors believe Yvette will come out of her coma; however, they

suspect she may suffer long-term cognitive deficits due to cerebral hypoxia. They are also

uncertain if she will regain the use of her legs.

Yvette’s only family is her sister, Melody. While the two are friendly, they have

never been particularly close. After the accident, Barbara calls Melody. Melody arrives at

the hospital and demands that the medical team keep Yvette on the ventilator. Melody

argues that Yvette not only has a valid medical care directive, but that Yvette designated

Melody her health care proxy, not Barbara. Melody also claims that while Yvette may

have told Barbara something else, Yvette’s medical care directive states that in the event

of serious illness or injury, Yvette wanted all aggressive therapies and life-sustaining

measures to be completely exhausted before “pulling the plug.”

After 48 hours of searching and inquiring with Yvette’s lawyer, friends, distant

family, primary care doctor, other health care providers and bank, Yvette’s medical care

directive and other documentation are nowhere to be found. Barbara and Melody cannot

reach an agreement as to what “Yvette would have wanted.” Yvette’s physicians are

reluctant to remove the ventilator. Not only are the doctors troubled by the Barbara and

Melody’s divergent beliefs about Yvette’s end-of-life care wishes, they remain unsure

about Yvette’s prognosis.

Answer 1

The case is a complex one when it comes to the ethical dilemmas. There are many aspects of the case which questions the ethical capacity of the case. To pull the plug off or not is a matter of ethical concern. In order for someone’s plug to be pulled off during comatose and non-responsive, there are some documents that are mandatory like Healthcare surrogate designation which gives another person the power of attorney to decide when one is not capable of deciding for self. Also, a living will declaration is an important document which an individual makes when they are able to decide for self which states that in case one is terminally ill or unconscious or not able to communicate, they would want to discontinue their treatment for sustaining life. Although Yvette might have discussed the fact that she would not want to be kept alive with artificial treatment, without documents and power of attorney, Barbara cannot make the decision on her behalf. This would not be ethical for Barbara to make the decision.

Another ethical dilemma is that since Melody claims she has documents where Yvette has mentioned that she wants all therapies and life-sustaining treatment to be done before pulling the plug, but without the documents, her statement also cannot be considered. Hence, the physicians will not be able to pull the plug as the statements by both Barbara and Melody cannot be considered to be true. Hence, physicians will have to continue doing the treatment until there is no hope for recovery.