Question

A patient is in a coma that appears irreversible. His mother, who is his surrogate, firmly believes that he will recover and that God will work a miracle if everyone will just wait long enough. She wants everything done for the patient, including resuscitation if he arrests. She insists that he stay in the hospital, and is very upset that he has been transferred out of the ICU and his care moved to comfort measures, rather than aggressive treatment. The mother does not speak English but seems strong in her religious beliefs. The physicians for the patient are very upset and concerned about continuing to provide care that they believe is futile. The patient is developing a serious pneumonia, and the mother wants it treated aggressively. The physicians are reluctant. Analyze this case from the ethical principles of justice, benevolence, nonmalfeasance, and autonomy.

Answer 1

The ethical principle of justice says that faired medical decisions to be taken. That is the equal distribution of resources and treatment for all patients. In this case, the physician has to be taken decisions based on patient's rights and obligations. A patient is in irreversible condition, then treating the patient unnecessarily by wasting available resources is not fair. The physician has to take a moral decision in favor of patient rather than his mother's wishes.

Beneficence is doing good for the patient. The physician must work with the intention of doing good for the patient. Here, the patient must analyze the patient's circumstances before making a decision. Treatment doesn't work for this patient. So following life-saving measures will not do good for the patient.

Non-maleficence is not to harm the patient. The physician must consider that the patient or relatives must be harmed by the decision. The treatment decision must do greater good for the patient rather than harm. Here, treating a comfort zone will be the greater good for the patient. Aggressive treatment will only harm the patient. So the physician takes decisions according to it by making a better understanding of his mother.

Autonomy is the individual rights of the patient in taking a decision over the treatment. The patient has the right to accept or refuse the treatment. Here, the patient was not in the state of making treatment decisions. In that case, family members can make a decision over treatment. His mother's decision is not acceptable as he has no hope of a cure. His mother's religious belief must be converted into a positive way that God wishes for a miracle that can happen even without aggressive treatment. So hurting of patient unnecessarily will harm the patient.

According to the ethical principles, the physician's decision to comfort treatment is right rather than aggressive treatment.