Present the problem: A 78 year old woman who has had prior issues with her health including diabetes, heart disease, and two heart attacks has recently just had a stroke which has made her semicomatose and paralyzed. She is only kept alive by a feeding tube which seems to be extending the dying process. Her three children want to cut off nutrition so she can be put out of her misery but the physician disagrees. Is it unethical to starve a patient to death?
1. I think it is morally legitamate to withold nutrition in this case because the nutrition is just simply making the inevitable dying process longer and more painful. 2. I think if all three of her children are coming together on an agreement, then they truly know what is best for their mother and what their mother would want. 3. I think it should. The feeding tube is the only thing keeping her alive at this point and its the same thing as resuscitation.
1. I think it is morally legitimate to with the nutrition because it is within the patient's request and would shorten the dying process.
2. I think the family has a right to make decisions for the patient if the patient had not declared their requests beforehand, but should not override a patient's request. In this case, the family is defending the request the patient already made - to be put on the 'do not resuscitate' list.
3. I believe the refusal of resuscitation should be considered an indicator the patient would refuse nutrition, as my position above demonstrates. The patient is being kept alive solely through the nutrition being fed to her, and has no hope of recovering from her condition, so in this instance I believe the two are the same.
How is saying that you do not wish to be resuscitated an indication that you have requested the dying process to be shortened by not receiving substance through a feeding tube?
I would consider the intent of a DNR to be to shorten the dying process. Since it is stated the patient will likely not recover from her twilight condition, and it seems the family wishes for her to be removed from the life sustaining equipment, I would say it is ethical to stop the nutrient feedings.
1. I believe it is morally allowed to decrease the nutrition. Today in class, we had talked briefly about how towards the end of life, basic nutrients aren't needed as much as they are in a healthy, sustained life. It is also what Mildred's children request. However, I do feel that there are more morally acceptable approaches to letting Mildred die, as in euthanasia through lethal injection. It would result in a quicker and therefore, more painless death.
2. I believe that they do. I stated before in the case of the pregnant wife on life support that if the individual doesn't have specific instructions on what they wish to happen, the individual(s) closest to that person should be the one to decide. If the children were indeed close to their mother and knew her as well as she knew herself, they should have the authority to decide.
3. Although they are much different, since the ceasing of nutrition will lead to death, and the DNR is instructions for after death, they are still similar. I think generally, there probably would be a positive correlation in the relationship between the two.. Meaning, if an individual chooses to have a DNR, it is likely they would choose to cease nutrition or other means to reach death quicker than suffering.
I agree. A DNR would be similar to refusing treatment of keeping someone alive. A DNR basically says that they do not want any extreme measures taken to save them. If they don't want to have extreme measures taken to save their life, they certainly wouldn't want a feeding tube and life support to draw it out longer.
1.Yes i think it is legitimate because it is the only thing that is keeping her alive and her children don't want her to suffer anymore. 2. Yes, only because the patient is not conscience if the patient was alert she could make her own decisions for herself. 3. Even though they seem very different they are alike because the patient is stating that if it comes to them being keep alive by only nutrition or being brought back to like that they would rather just go ahead and die then be keep alive without being able to led a normal life.
1. I believe that it is right to remove the feeding tube. It is only extending the dying process and putting the patient through a lot of suffering. 2. I believe the family does have a right to make decisions for the patient. They knew her better than the doctors did so they know what she would truly want. 3. I believe the tube should come out. It is only extending her life for a short amount of time and it seems as though the patient would not want it because the family so strongly believes that she wouldn't.
1. I do not think that it is morally legitimate to withhold nutrition from Mildred. She made known that "in such a circumstance she would not want to be resuscitated". This implies that in the instance of having a feeding tube she would not want to be resuscitated, not that she would want it removed. Furthermore it implies that she had considered the possibility of needing life support and had not explicitly stated that she did not want it. She only stated that in the circumstance of being on it she would not want to be resuscitated. 2. Despite thinking that the family's decision is morally wrong I do believe that they have the right to make the decision for the patient. Since the patient has not explicitly stated what they wanted it would fall to those who are closest to the patient to decide what they would want. 3. No it shouldn't. There is a large gap between not wanting to be resuscitated and not wanting any nutrition. One implies that the patient is ready to die when that time comes while the other is hastening the dying process. These are different enough that it would be impossible to tell whether or not a patient with a DNR would refuse nutrition.
I do not believe it is morally legitimate to withhold nutrition in this care. Mildred D. although semi-comatose and paralyzed still has some hope of recovery naturally although slim. Therefore in this case although the family has the right to make a decision for the patient the refusal of resuscitation should not be considered an indicator that the patient would also refuse nutrition.
1. I do not believe that is morally legitimate to withhold nutrition. Event though in class we talked about how if your body is unable to hold the nutrition it should be withheld, I do not believe it is morally right to stop that so the patient can die sooner. 2. Since the patient is unable to speak for herself at this point, I think the family does have a right to make a decision for her. 3. I do not believe that the refusal of resuscitation also means the refusal of nutrition. I understand that Mildred D does not want to be resuscitated, but she did not explicitly state that she didn't want any form of help at all. As the doctor, I would still provide nutrition since she did not make that clear, but I do believe the family has the final say on what to do.
I agree that starving the patient is morally reprehensible and isn't appropriate to use in this situation. I do see though where the children are coming from. They aren't choosing to starve their mother to make her suffer or to make her feel pain, they're doing it because it's what they believe their mother would have wanted them to do.
1. I think that the doctor should be overruled and should do what her children wishes. Mildred even stated before that she wanted a DNR. I know I would not want to see my Mother go through that if I were in that situation. Additionally, there might be some other possibilities in replace of "starving" her. The doctor should respect the mother's and her children's wishes because it's not only what the patient wants, but is the best procedure for the patient. 2. Yes, I believe they do have the right. They know their mother best and knows what would be most appropriate for her situation. She even decided on a DNR so that should be enough to let the physician know what her desire is. 3. They definitely are different, but I feel like if she has a DNR she would likely refuse nutrition.
1. I believe it is morally legitimate to withhold nutrition from the patient in this case. Judging from what we know about Mildred’s character, she does not seem like the type of person who would want to exist in this “twilight zone” that she currently inhabits. I see it as morally wrong to keep her in a prolonged situation that appears to me one she does not desire. If she doesn't want to be resuscitated, I see it as though she has accepted her impending death and would not appreciate having it drawn out like this.
2. The family should have the right to make such a decision for the patient. Since Mildred is not able to make the decision herself, her family likely has a stronger idea of what would make her more comfortable in this situation—putting her individual needs before doing whatever the doctor recommends.
3. I believe it makes sense to assume that the refusal of resuscitation may also be considered an indicator that a patient would refuse nutrition as well. Mildred’s family, in this scenario, knows her best—if I knew that she wouldn’t want to be resuscitated, I could only assume that the situation she’s currently in is one that’s undesirable to her. Her condition is slowly deteriorating, and with the dying process expected to be a long one, continuing her suffering for any longer than need be seems unnecessary.
1. I do not think it is legitimate to withhold nutrition from the patient in this case. It is not as if the patient is brain-dead and on life support; she is still alive but needs to receive nutrition through the NG tube. This is not the same thing as being resuscitated. Starving her to death would be immoral. 2. The family does not have the right over the life and death of this patient. Though the situation must be very difficult for them, this does not give them the right to make the decision to end their mother's life under such circumstances. 3. Refusal of resuscitation is totally different than refusal of nutrition. The patient has not gone into cardiac arrest; she had a stroke and is still alive. Withholding nutrition from her is would be a deliberate action that would kill this living woman. Therefore her refusal of resuscitation should not be considered an indicator that the patient would refuse nutrition if she could make that decision for herself.
1. No, I don't believe it is morally legitimate to withhold nutrition. It is wrong to starve someone to death, even if they are not competent or awake. The patient may still feel everything that is happening to her, making it even more wrong to withhold nutrition from her. 2. I don't believe that the family has the right to make a decision that is morally wrong for the patient because it would harm the patient. 3. No, it should not be an indicator. Refusing resuscitation is completely different from refusing nutrition. If the patient needs to be resuscitated,it would mean that she would die anyways. That is not the case with nutrition.
1.Yes i think it is legitimate because keeping somebody alive is morally wrong since that is the only thing keeping her alive 2. Yes, the patient has no ability to think or make her own decisions but if she was a reasonably prudent person could make that decision 3. although they seem complete opposites both are oddly similiar they both have the thought that if being brought back or being kept alive automatically that she would rather die
1. Yes it is morally legitimate to stare this patient to death. It is what her children want and they are the decision makers in this situation. 2. Yes the family has all the right to make the decisions in this situation because the patient cant make it for themselves. 3. Yes if the patient has signed a DNR waiver then they dont want to be kept alive by any form of artificial living.
1. I do agree with the doctor that starving her would be a bit unethical. I see it as unethical because it could take a number of days for her to actually die and even though a considerable portion of her brain has been destroyed there's no possibility of knowing whether or not she can still feel pain. There are a number of other humane methods that could be used. 2. Despite my thoughts against it I still do believe that the family has the right to make this decision for the patient. It's their mother and they believe that what they are doing is best for her. 3. No, I don't believe that a DNR is necessarily an indicator for the refusal of life sustaining nutrition. A patient may not have as serious a condition or be in an indefinite coma so nutrition will be required in order for the patient to recover.
1. I believe as harsh as it sounds it is morally legitamate to withold nutrition in this case because the nutrition is just what is keeping the woman alive which is causing her more pain. 2. I think if all three can willingly agree that cutting of the nutrients is best for their mother than that is the action that should be taken as they would know what their mom would want. 3. I think it should because the tube is what keeps her alive and a an order to DNR is a patient willing to be let go as removing the tube would willing end life.
Present the problem: A 78 year old woman who has had prior issues with her health including diabetes, heart disease, and two heart attacks has recently just had a stroke which has made her semicomatose and paralyzed. She is only kept alive by a feeding tube which seems to be extending the dying process. Her three children want to cut off nutrition so she can be put out of her misery but the physician disagrees. Is it unethical to starve a patient to death?
ReplyDelete1. I think it is morally legitamate to withold nutrition in this case because the nutrition is just simply making the inevitable dying process longer and more painful.
2. I think if all three of her children are coming together on an agreement, then they truly know what is best for their mother and what their mother would want.
3. I think it should. The feeding tube is the only thing keeping her alive at this point and its the same thing as resuscitation.
1. I think it is morally legitimate to with the nutrition because it is within the patient's request and would shorten the dying process.
ReplyDelete2. I think the family has a right to make decisions for the patient if the patient had not declared their requests beforehand, but should not override a patient's request. In this case, the family is defending the request the patient already made - to be put on the 'do not resuscitate' list.
3. I believe the refusal of resuscitation should be considered an indicator the patient would refuse nutrition, as my position above demonstrates. The patient is being kept alive solely through the nutrition being fed to her, and has no hope of recovering from her condition, so in this instance I believe the two are the same.
How is saying that you do not wish to be resuscitated an indication that you have requested the dying process to be shortened by not receiving substance through a feeding tube?
DeleteI would consider the intent of a DNR to be to shorten the dying process. Since it is stated the patient will likely not recover from her twilight condition, and it seems the family wishes for her to be removed from the life sustaining equipment, I would say it is ethical to stop the nutrient feedings.
Delete1. I believe it is morally allowed to decrease the nutrition. Today in class, we had talked briefly about how towards the end of life, basic nutrients aren't needed as much as they are in a healthy, sustained life. It is also what Mildred's children request. However, I do feel that there are more morally acceptable approaches to letting Mildred die, as in euthanasia through lethal injection. It would result in a quicker and therefore, more painless death.
ReplyDelete2. I believe that they do. I stated before in the case of the pregnant wife on life support that if the individual doesn't have specific instructions on what they wish to happen, the individual(s) closest to that person should be the one to decide. If the children were indeed close to their mother and knew her as well as she knew herself, they should have the authority to decide.
3. Although they are much different, since the ceasing of nutrition will lead to death, and the DNR is instructions for after death, they are still similar. I think generally, there probably would be a positive correlation in the relationship between the two.. Meaning, if an individual chooses to have a DNR, it is likely they would choose to cease nutrition or other means to reach death quicker than suffering.
2.
I agree. A DNR would be similar to refusing treatment of keeping someone alive. A DNR basically says that they do not want any extreme measures taken to save them. If they don't want to have extreme measures taken to save their life, they certainly wouldn't want a feeding tube and life support to draw it out longer.
Delete1.Yes i think it is legitimate because it is the only thing that is keeping her alive and her children don't want her to suffer anymore.
ReplyDelete2. Yes, only because the patient is not conscience if the patient was alert she could make her own decisions for herself.
3. Even though they seem very different they are alike because the patient is stating that if it comes to them being keep alive by only nutrition or being brought back to like that they would rather just go ahead and die then be keep alive without being able to led a normal life.
Is it okay to remove the feeding tube if it means that the woman will starve to death in order to die?
Delete1. I believe that it is right to remove the feeding tube. It is only extending the dying process and putting the patient through a lot of suffering.
ReplyDelete2. I believe the family does have a right to make decisions for the patient. They knew her better than the doctors did so they know what she would truly want.
3. I believe the tube should come out. It is only extending her life for a short amount of time and it seems as though the patient would not want it because the family so strongly believes that she wouldn't.
1. I do not think that it is morally legitimate to withhold nutrition from Mildred. She made known that "in such a circumstance she would not want to be resuscitated". This implies that in the instance of having a feeding tube she would not want to be resuscitated, not that she would want it removed. Furthermore it implies that she had considered the possibility of needing life support and had not explicitly stated that she did not want it. She only stated that in the circumstance of being on it she would not want to be resuscitated.
ReplyDelete2. Despite thinking that the family's decision is morally wrong I do believe that they have the right to make the decision for the patient. Since the patient has not explicitly stated what they wanted it would fall to those who are closest to the patient to decide what they would want.
3. No it shouldn't. There is a large gap between not wanting to be resuscitated and not wanting any nutrition. One implies that the patient is ready to die when that time comes while the other is hastening the dying process. These are different enough that it would be impossible to tell whether or not a patient with a DNR would refuse nutrition.
I do not believe it is morally legitimate to withhold nutrition in this care. Mildred D. although semi-comatose and paralyzed still has some hope of recovery naturally although slim. Therefore in this case although the family has the right to make a decision for the patient the refusal of resuscitation should not be considered an indicator that the patient would also refuse nutrition.
ReplyDelete1. I do not believe that is morally legitimate to withhold nutrition. Event though in class we talked about how if your body is unable to hold the nutrition it should be withheld, I do not believe it is morally right to stop that so the patient can die sooner.
ReplyDelete2. Since the patient is unable to speak for herself at this point, I think the family does have a right to make a decision for her.
3. I do not believe that the refusal of resuscitation also means the refusal of nutrition. I understand that Mildred D does not want to be resuscitated, but she did not explicitly state that she didn't want any form of help at all. As the doctor, I would still provide nutrition since she did not make that clear, but I do believe the family has the final say on what to do.
I agree that starving the patient is morally reprehensible and isn't appropriate to use in this situation. I do see though where the children are coming from. They aren't choosing to starve their mother to make her suffer or to make her feel pain, they're doing it because it's what they believe their mother would have wanted them to do.
Delete1. I think that the doctor should be overruled and should do what her children wishes. Mildred even stated before that she wanted a DNR. I know I would not want to see my Mother go through that if I were in that situation. Additionally, there might be some other possibilities in replace of "starving" her. The doctor should respect the mother's and her children's wishes because it's not only what the patient wants, but is the best procedure for the patient.
ReplyDelete2. Yes, I believe they do have the right. They know their mother best and knows what would be most appropriate for her situation. She even decided on a DNR so that should be enough to let the physician know what her desire is.
3. They definitely are different, but I feel like if she has a DNR she would likely refuse nutrition.
1. I believe it is morally legitimate to withhold nutrition from the patient in this case. Judging from what we know about Mildred’s character, she does not seem like the type of person who would want to exist in this “twilight zone” that she currently inhabits. I see it as morally wrong to keep her in a prolonged situation that appears to me one she does not desire. If she doesn't want to be resuscitated, I see it as though she has accepted her impending death and would not appreciate having it drawn out like this.
ReplyDelete2. The family should have the right to make such a decision for the patient. Since Mildred is not able to make the decision herself, her family likely has a stronger idea of what would make her more comfortable in this situation—putting her individual needs before doing whatever the doctor recommends.
3. I believe it makes sense to assume that the refusal of resuscitation may also be considered an indicator that a patient would refuse nutrition as well. Mildred’s family, in this scenario, knows her best—if I knew that she wouldn’t want to be resuscitated, I could only assume that the situation she’s currently in is one that’s undesirable to her. Her condition is slowly deteriorating, and with the dying process expected to be a long one, continuing her suffering for any longer than need be seems unnecessary.
1. I do not think it is legitimate to withhold nutrition from the patient in this case. It is not as if the patient is brain-dead and on life support; she is still alive but needs to receive nutrition through the NG tube. This is not the same thing as being resuscitated. Starving her to death would be immoral.
ReplyDelete2. The family does not have the right over the life and death of this patient. Though the situation must be very difficult for them, this does not give them the right to make the decision to end their mother's life under such circumstances.
3. Refusal of resuscitation is totally different than refusal of nutrition. The patient has not gone into cardiac arrest; she had a stroke and is still alive. Withholding nutrition from her is would be a deliberate action that would kill this living woman. Therefore her refusal of resuscitation should not be considered an indicator that the patient would refuse nutrition if she could make that decision for herself.
1. No, I don't believe it is morally legitimate to withhold nutrition. It is wrong to starve someone to death, even if they are not competent or awake. The patient may still feel everything that is happening to her, making it even more wrong to withhold nutrition from her.
ReplyDelete2. I don't believe that the family has the right to make a decision that is morally wrong for the patient because it would harm the patient.
3. No, it should not be an indicator. Refusing resuscitation is completely different from refusing nutrition. If the patient needs to be resuscitated,it would mean that she would die anyways. That is not the case with nutrition.
1.Yes i think it is legitimate because keeping somebody alive is morally wrong since that is the only thing keeping her alive
ReplyDelete2. Yes, the patient has no ability to think or make her own decisions but if she was a reasonably prudent person could make that decision
3. although they seem complete opposites both are oddly similiar they both have the thought that if being brought back or being kept alive automatically that she would rather die
1. Yes it is morally legitimate to stare this patient to death. It is what her children want and they are the decision makers in this situation.
ReplyDelete2. Yes the family has all the right to make the decisions in this situation because the patient cant make it for themselves.
3. Yes if the patient has signed a DNR waiver then they dont want to be kept alive by any form of artificial living.
1. I do agree with the doctor that starving her would be a bit unethical. I see it as unethical because it could take a number of days for her to actually die and even though a considerable portion of her brain has been destroyed there's no possibility of knowing whether or not she can still feel pain. There are a number of other humane methods that could be used.
ReplyDelete2. Despite my thoughts against it I still do believe that the family has the right to make this decision for the patient. It's their mother and they believe that what they are doing is best for her.
3. No, I don't believe that a DNR is necessarily an indicator for the refusal of life sustaining nutrition. A patient may not have as serious a condition or be in an indefinite coma so nutrition will be required in order for the patient to recover.
1. I believe as harsh as it sounds it is morally legitamate to withold nutrition in this case because the nutrition is just what is keeping the woman alive which is causing her more pain.
ReplyDelete2. I think if all three can willingly agree that cutting of the nutrients is best for their mother than that is the action that should be taken as they would know what their mom would want.
3. I think it should because the tube is what keeps her alive and a an order to DNR is a patient willing to be let go as removing the tube would willing end life.