Blog 6: Pulling the Plug...an End of Life Decision

An article on ABCnews.com stirs up another controversial discussion on end of life decisions. According to the report, a man by the name Jesse Ramirez suffered severe injuries to the brain due to a car accident. As a result, Ramirez was in a coma for over a week. The doctors told his wife that her husband may not recover and that she would need to make an end of life decision for him. After only one week, the wife decided to have her husband’s feeding tubes removed. However, Ramirez’s family members appealed the decision and won. Within weeks, Ramirez regained consciousness and was able to interact with loved ones (Childs, 2007).

One expert in the field suggests that it takes many weeks to make an end of life decision for a loved one. Ramirez’s wife made the decision in just nine days. Experts also believe that spouses are better suited for making end of life decisions than family members because they know more about the loved one (Childs, 2007). On one hand, this fact may be true for some individuals. Spouses often spend more time with one another than with family members and one could argue that a spouse truly knows the wants, needs and desires of his/her significant other. However, does this idea still hold true in times of a spouse’s medical needs? What if a couple never discusses his/her medical wishes with their spouse in relation to end of life decisions and medical care? After all, such a topic is not one that couples often discuss over date night or in passing conversation. Think about it, have you and your significant other ever discussed the possibility of having to end one another’s life during a medical crisis? The answer is probably not.

So, is it safe to assume that all spouses discuss end of life decisions with one another? What is the result if the answer to the above question is no? Such consequences can be seen in such cases as the story above and Terri Schiavo. The decision to end a loved one’s life is anything but easy. How does one know when to “pull the plug” so to speak? Should a family member or spouse base their decision on what the provider recommends? What if the provider suggests that a loved one end the life of the patient but the loved one chooses not to and as a result, the patient wakes up and/or recovers from his/her condition? Could the provider (i.e., doctor) ultimately be charged with malpractice in that he/she recommended an end of life decision when such a decision was not appropriate? In the case of the above story, should Ramirez’s wife be charged with a crime due to the fact that she wanted to end her husband’s life when not necessary? Who should be responsible for making such a difficult and personal decision? Clearly, the above story demonstrates the ethical challenges involved when dealing with end of life decisions.

According to Hofmann & Nelson (2001), “a medical error can be defined as either a mistake in execution or a problem of planning (the intended action itself was not correct).” Based on the definition of a medical error, could it be feasible for a provider to be charged with malpractice who recommends prematurely ending the life of a patient and then his/her patient recovers? In this case, the intended action of ending a patient’s life was not correct. What (if any) implications would there be for this situation? Could the family of the recovered patient sue the hospital, medical provider or the spouse who wanted to make such a decision? Do ethical guidelines exist for assisting a spouse and/or family member with making an end of life decision if the patient does not have a “living will?” Should it be the decision of someone other than the patient to make such a decision? Should family members and/or loved ones even have the “right” to end someone’s life? What if a patient has a living will but the family and/or loved ones take the situation to court and try to have the will amended? If a spouse and the patient’s family are both fighting over a decision, who wins and why? How can one decipher between such legal and ethical decisions? Are they even the same?

The preceding paragraphs should at least cause an individual to begin thinking about end of life decisions. Do you have a living will? Would your friends and/or family know what your medical desires and/or wishes would be if you were injured and in a coma? Have you and your significant other and/or spouse discussed such issues? Do you even know what you would want for yourself if one day faced with a brain injury and rendered unconscious? Confronting these issues may not be easy; generally human beings do not like to think about their own mortality and end of life decisions. However, it is so very important to talk about one’s medical wishes if ever faced with an end of life decision in an effort to avoid legal and ethical complications with loved ones.

References

Childs, D. (2007, June). Pulling the Plug: Ethicists Debate Ramirez Case. ABC News Medical
Unit. Retrieved on June 28, 2007, from http://abcnews.go.com/Health/story?id=3325418&page=1

Hofmann, P. & Nelson, W. (2001). Managing Ethically: An Executive’s Guide. Chicago: Health
Administration Press.