Module 04 Case Studies Euthanasia, Assisted Suicide, and Palliative Care
After reading chapter 11 in the Tong book, answer the Case Study questions for the four case studies at the end of the chapter, pp. 285-288. Post your answers here. Connect your answers to the readings.
Case Study #1
Q. a
On Mr. Najiri’s case, physician may have raised a serving no usefulness purpose of medication to Mr. Najiri’s condition that justifies discontinuation of artificial means of life support due to Shiite Muslims belief. However, the physician justified his/her position that Mr. Najiri’s brain dead means no life, and no medical treatment is possible according to main stream American values when he/she said that “in the United States brain death is death” {Tong, 2007 p.286}. Regardless of Shiite Muslim faith, since Mr. Najiri is in America and physician has pronounce his brain dead and further ruling out that since Mr. Najiri’s brain is dead “the hospital will no longer continue to support his cardiac functions artificially”. {Tong, 2007 p.186}. Because professionally physicians are trusted by American community to evaluate and treat patients and that only a physician can pronounce death, on Mr. Najiri’s case the family members would have to abide by physician’s decisions or transfer him to another hospital outside of America for further treatment that can fulfill their faith and belief of death.
Q. b
When medical uselessness becomes not a sufficient guide for end of life decision making, many people relay on their faith and spiritual beliefs as an alternative concept or value that should guide their decisions making process. However, professionalism and legal concepts emerge when there are tow parts (family members) that have different opinions on how process decision making. Often, if divisions happen, each part involved tends to have major philosophical difference and they gather surrogates to support their values and beliefs. This makes it difficult for parties to reach unanimous decisions without rule of the court, such as Terri Schiavo’s case. In Najiri’s case the medical uselessness on the Shiite Muslims’ belief about death cannot have stand when the professional that are the only one can pronounce death declare their love one death. According to their faith Najiri is not dead, but according to American standards that rule out who is dead and who is not, Mr. Najiri is dead. This is not only division between American medical uselessness as a sufficiency guide for MD to rule out death, it is also a spiritual belief/faith division on what is death and when can someone be pronounced dead. Mr. Najiri’s case brought a challenge to America that not only MD can pronounce death to the Shiite Muslims in America.
Q. c
I don’t believe that Mr. Najiri’s physician feels guilty of cultural imperialism. In America we trust medical doctors to evaluate our people, by treating them with best of their knowledge that is vested to them, also to pronounce them dead. Because, if it was not for medical doctors to pronounce someone dead, many people could not be resuscitated; rather been buried alive or killed innocently. I have lived with Muslims, no to condemn them but when someone dies; it doesn’t take hours before buried because their faith tells them to bury the dead before sun-set. To them not MD pronounce death, what if someone just had minor stroke, or cardiac arrest? If no one will give him/her CPR and get buried within hours, live people will be buried alive. But in America, one has to be pronounced dead by MD, and if someone falls CPR must be applied by professionals to resuscitate those who go to the temporary cardiac arrest and or stroke, because they are not dead. Therefore Mr. Najiri’s physician is not imposing any culture imperialism to Najiri’s family, rather it is a power that is vested to him by American society that license his professionalism to use his/her own discrete that reflect American value that “brain death is a true death”. {Tong, 2007 p.286}
Case Study #2
Q. a
I believe that Rhonda’s decisions to refuse Chemotherapy treatment should be respected by her parents. Her parents are to represent her best wishes because she is a minor. As a man of faith, I believe that Rhonda’s decision is rooted from her faith and trust in God, because she said that she has “reconciled herself to be with God” {Tong, 2007, p. 286}. In Rhonda’s case parent should understand and respect their children’s inner decisions and not their private interests. I can see Rhonda’s point of deciding not to take treatment that is as painful as Chemotherapy while she is going to live at maximum of one year. What is the point of her undergoing such painful treatment for a very terminal disease she got?
Q. b
However, legal system directs the healthcare providers, physicians, to follow directives of minors through parents or guardians unless otherwise parents or guardians are proven incompetent. In Rhonda’s case I believe that physicians should examine competence of her parents and do what is necessary for Rhonda and not for parents if there is evidence of split interests; because if any it will demonstrate incompetence. Also to put in mind “Do no Harm to patients” while making these decisions. However, in the mean time a physician should have Rhonda and her parents/family to consult counselor and resolve their hard feelings about their beloving child. It is true that parents can get hit hard with case like Rhonda and it is confusing, sometimes counseling can be of a great help. Also if they have counselor from their church or temple, it can help them to reevaluate their decisions and clear their doubts or resolve their conflict of interests. However, as a physician, he/she should lay out to them the best of her profession about process of Rhonda’s illness and what are the cons and pros.
Q. c
I believe that minors should be allowed to make these decisions, of ending their lives, with guidance from parents/guardians just like the way they negotiate making many of their (minors) decisions in the school choices and extracurricular activities. Some states prosecute 15 or 16 or 17 years old as adults. If such a matter of ending life arises, then patients of age 15 or 16 or 17 years old from these states should be allowed to end their lives as adults. If these states wont allow them it will portray them operating with double standards and legal system is there to correct and put landmarks on such actions. If she lives in the state that prosecute 15 years old as adults, or 15 years old can move out by their own by choosing who or what parent she/he should live with in case of separation, then Rhonda should be allowed to make her own decisions if her parents cannot agree with her, autonomy. Legally her parents are to represent her wishes, but there is clash of interest and so long her state allows 12 or 15 years old to choose what parent a minor should live with, then the same, Rhonda can chose what is best for her life.
Case Study #3
Q. a
No, I think that the Oregon’s law is not justified in the main stream American communities. I believe that Oregon’s Death With Dignity Act is not moral because there is only one person who can physically initiate taking life, and that is God only. What is the different between a physician who injects lethal injection and killed a person who want to die and the person who is not a doctor but assisted a friend of a family member who is suicidal by puling a trigger or using lethal injection? America society is a great with strong moral convictions. This makes it hard for Oregon law not justified because it seems that only suicidal people will be covered by law by getting free pass to kill themselves by assisted “Death with Dignity Act” {Tong, 2007 p.187}. According to my beliefs physician assisted suicide don’t really constitute a dignified death. To me a dignified death is a death that happens naturally or in a coincidence that is not self assisted knowingly that you are facing death for such actions. The provisions for the Oregon law make it really difficult for someone who is not suicidal to apply this law. Have being said so, I strongly believe that most people who applied successful the Oregon law are suicidal, and it there was no such law they could take their lives by any means anyway.
Q. b
The provisions for the Oregon’s Death With Dignity Act safeguard against possible abuses of this law and other suicidal laws to the people who are suicidal, because people who are not suicidal will not use the law anyways. Who in the right mind will consult his/her physician fulfilling the seven Oregon’s Death With Dignity Act if one is not suicidal? For example, provision number 5 requires that possible candidate for this act must be referred for psychological examination if either physician believes that the patient’s judgment is impaired by a psychiatric or psychological disorder {Tong, 2007 p.179}. This provision forgot that serial/psycho killers such as Green River, BTK, Columbus shooting, and VT shooting and so on all visited physicians and they could not predict that these individuals are suicidal and could harm themselves and or others in the community. I believe that people who subscribe in this act need mental, psychological and social help. This law should have, in stead, used to measure and identify people who need mental, psychological and social help by documenting subscribers,. Then they could be getting help by appointing psychologists and counselors who can develop ways to help them in stead.
Q. c
I don’t believe that physician assisted suicide should be legalized throughout the United States; because the act does not represent main stream American values. The text book said that between 1998 to 2004, among thousands Oregonians who subscribe to assisted suicide only 208 qualified {Tong, 2007 p.279}. America value life, and consider life is precious, what kind of role model will be set for the world to follow? We will be sending mixed signals, telling other countries that don’t kill your people, yet we set laws that make us killing each other. Killing is a killing; no body can kill someone and resurrect the same dead person days or months later? Therefore we cannot make jokes and have easy decisions about something we cannot make, replace or even preserve on our own terms, common sense. That’s why life is precious and we, Americans, innocent protects lives.
Case Study #4
Q. a
Sure, the attending physician should put Mrs. M into a ventilator immediately, and do what is necessary in his/her physician powers to treat Mrs. M. it is health care provider’s ethical and value, that “Do no Harm” to patients or clients. Remember that Mrs. M had denied the DNR offer that she was given while hospice attended her. Ventilator will help Mrs. M to breath, common sense that should be the first thing the physicians should do from the first place.
Q. b
No body can tell for sure what is likelihood of Mrs. M case whether to become a medical uselessness or to heal from breast censer, or bone and lung metastases. Life is faith, she believe that she need life, she can get one, what is important is for her not to be denied services that she is requesting so long that by law she can. We have people who are cancer survival while they were told by their physicians that they will not last for long. For example, I have my uncle who had cancer his physician told him that to go home and wait to die; he survived from it 25+ years now. The same uncle, in 1994 he got a bad accident that broke his spinal code several times; he was given 6months to live by his physician. 4 months after not only he lived but he was walking and traveling overseas about 5times, he is still alive working and driving. Therefore I believe that life is miracle and faith, every one sees and believe in and knows when it ends, and they will let it go if that is the case.
What the physician who is attending her need to do in case situation worsen, is to do what is likely to easy her pain, to do not inflict pain or refuse her with treatment that she is asking and most likely wont put her desperate and already delicate life in jeopardy. For example ventilator won’t cause any harm to her, therefore she should get that treatment. Most important is for the physician not to show sympathy to her rather empathy. Not to look down to her with attitude that she is dying and what the heack. That will be wrong, immoral and unethical in the helping profession. There is no enough until when it is enough, every body is unique and we need unique ways of getting things done, and physician should understand that by using professionalism of the healing field.
Q. c
I believe that Mrs. Be should devised if she would like to0 continuer with Chemotherapy, but with physician’s guidance and detailed explanation of the pros and cons. About who makes payment and what physician decides what medicine is functional and what is useless are not connected in this case. In this case there is fundamental disconnect between patient and her physician. Patient is willing to do anything to leave and physician is rejecting patient’s will of fight for her life by any means because of some medical uselessness that physician think that are the major cause. I think the physician doesn’t believe in miracles, but the patient does. Who is to determine that no life, again, not a doctor or a patient but almighty God. Doctor verifies that no life in the body, but cannot for sure and certain, always say there will be no life and become true. There are some with big faith, can prove the physician wrong, miracles.
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