What would you do?

[BluesMan]

What would you do?

 

A 17-year-old male with Cystic Fibrosis presents to the Emergency Department in Respiratory Failure. His condition is critical and he needs to be intubated and placed on mechanical support. (A tube inserted through his mouth or nose into his windpipe and placed on life support machine). He states that he does not want this medical care and that he is ready to let nature take its course.

His mother then arrives and states that she wants everything done, and for you to place him on life support.

[ronthepon]

The paitent is in a weak condition. He is in pain. He is not brave enough to get through all the pain involved in his bad condition.

 

However, years later he might thank the doctor very nicely, if he gets into a better condition.

[Boerseun]

Assisted suicide is a tricky business.

 

In this case, the patient is in pain, as Ron said. Being in pain, would he be qualified to make a rational decision? So we dope him up to ease the pain - would he still make the same decision? Would his mental state change?

 

Would it be correct to abide by his wishes as a permanent solution to a potentially short-term problem?

 

On the other hand, I'd be pretty miffed if it was me and nobody listenend to me.

 

I don't know - plenty people have grappled with this same question for years without finding a satisfactory answer.

 

From a genetic point of view, sure - let him die.

From a resource point of view, same - let him die, the Earth is overpopulated as it is.

From a moral point of view? I don't know. Would it be to his benefit or to ours if we don't let him die? Do we actually care about him as an individual, or only about ourselves and a possible guilty conscience? :)

[InfiniteNow]

The only people who suffer after someone's death are those left behind. The mother clearly has a vested emotional interest in keeping her son alive (as well as an evolved tendency to assist in his survival... more often than not). Also, the patient is still young (and I would say the same even if he were in his 20s) and won't always have the perspective on life to make the "right" decision.

 

However, ultimately it's his choice. If he wishes to be released permanently from his suffering, then so be it.

[TheFaithfulStone]

Never trust a seventeen year old.

 

And never get involved in a land war in Asia.

 

Go with the Mom.

 

TFS

[Tormod]

17 - still a minor. The mom's in charge.

[EWright]

Assisted suicide is a tricky business.

 

In this case, the patient is in pain, as Ron said. Being in pain, would he be qualified to make a rational decision? So we dope him up to ease the pain - would he still make the same decision? Would his mental state change?

 

Would it be correct to abide by his wishes as a permanent solution to a potentially short-term problem?

 

On the other hand, I'd be pretty miffed if it was me and nobody listenend to me.

 

I don't know - plenty people have grappled with this same question for years without finding a satisfactory answer.

 

From a genetic point of view, sure - let him die.

From a resource point of view, same - let him die, the Earth is overpopulated as it is.

From a moral point of view? I don't know. Would it be to his benefit or to ours if we don't let him die? Do we actually care about him as an individual, or only about ourselves and a possible guilty conscience? :cup:

 

This is not a matter of assisted suiced from what I've read here. Nor is it a huge moral dilema. If he was an adult he would have the choice as many adult patients instruct that medical personell Do Not Resuscitate them. As Tormod points out, it is a matter of who's choice it is in this case, and he is correct. Although, personally I find it unfortunate that the decision is not his own.

[cwes99_03]

In some states 17 is not just simply a minor (US law). The only reason I chose mom is that the question did not stipulate that the teenager had signed a durable power of attorney. Best to be safe as a doctor than sorry. You could be misreading what his intentions are, after all he is in respiratory arrest

[CerebralEcstasy]

One would have to be familiar with the laws of the province, state or country in which this patient resides.

 

If the patient resides in a province/state or country which allows them to make such decisions regarding their own medical care - Then you would adhere to the patients orders.

 

If they fall under the category where they are considered a minor, then you would adhere to the guardian/parents instructions.

 

Please consider the following article.

http://www.pitt.edu/~cep/81dyingyoung.html

[cwes99_03]

Some teenagers as young as 13 that I know of in the US have chosen not to go through with a procedure even though their parents are divided on the issue. A judge sits down with the teen and determines if the teen understands the consequences of the actions and determines if their understanding is based upon correct information, and then rules. It is up to the judge to make such a decision and they usually side with a doctors recommendation unless their are extenuating circumstances.

[CerebralEcstasy]

Some teenagers as young as 13 that I know of in the US have chosen not to go through with a procedure even though their parents are divided on the issue."

Here in Canada it is similar.

 

Though there have been some special circumstances where the judge has forced treatment even though the patient's religious beliefs do not permit them to accept treatment.

 

Here we get into all sorts of ethical debates, and whether or not the doctor the judge, or family has the right to supersede the patients rights, in order to satisfy their own agenda.

 

Bethany Hughes, the young Jehovah's Witness lady from Calgary, AB springs to mind. Unfortunate for all parts, she wasn't able to adhere to what she held dear, and even after she was forced to have a transfusion she still died.

 

Personal beliefs of doctors, judges and family should not interfere with treating a patient in the fashion he/she demands. We can only counsel, what we think to be the wisest course of action, and then leave the patient to decide whether or not they will take that advice.

[cwes99_03]

I agree, but unfortuneately we agree to the minority opinion most times.

 

Too many people feel that they are smarter than the rest of the world. They believed that young Bethany could not possibly be making an informed decision because she "chose to die" (or chose to live in accord with her religious beliefs) against her doctor's beliefs.

 

We may wish to cite her death as evidence that the doctors were wrong, however, they will equally cite that if they had had a chance to treat her immediately instead of waiting for some court's decision that she would still be alive today.

[Jules Grimm]

I believe that it is the patient's right to decide what happens to their body and their life. I agree that all parties should have a chance to give advice, but i believe that in the end the patient should be given the right to make their choice and have it honored.

[Zythryn]

I do believe in a persons right to decide their own fate.

 

However, I believe the decision should be the parents if the patient is a minor in the state/province in question.

 

I also believe that a decision made under pain should not necesarily be followed. If the person had instructions written up while not under pain/duress, that would be different.

 

Very difficult question, great topic!

[cwes99_03]

Zyth. Who get's to choose in the eventuality that the parents are now separated/divorced/remarried?

 

I believe that each case will get weighed, that there is no hard and fast law.

 

Even under extreme pain I have had the occasion to make clear decisions about my health. I put a spike through my hand once when I fell on a piece of farm machinery in the junk pile. I was able to calmly remove the metal, clean the wound, bandage it and have a doctor take a look at it. Each person reacts differently to mental and physical distress.

[Zythryn]

Zyth. Who get's to choose in the eventuality that the parents are now separated/divorced/remarried?

 

Legally, I believe the law does clarify that. Although the earlier mention of a case being decided by a judge may be more common when the parents are divorced.

 

Even under extreme pain I have had the occasion to make clear decisions about my health. I put a spike through my hand once when I fell on a piece of farm machinery in the junk pile. I was able to calmly remove the metal, clean the wound, bandage it and have a doctor take a look at it. Each person reacts differently to mental and physical distress.

 

Very true, people do react differently than others to the same events. I suspect many would panic in the same situation.

 

I have wanted to die twice, once when the woman I thought was my soul mate dumped me, and once when I had a migrain that caused such pain as I had never experienced before.

 

Both were fleeting thoughts and I am glad I didn't act on them. I don't think someone should be aided in ending their life because they are not thinking clearly.

 

Because someone can't read someone elses mind, we have no idea if someone is or is not able to clearly consider the possibilities, so I would argue that we err on the side of life.

[cwes99_03]

I understand your feelings there. The first case on this thread deals with someone with cystic fibrosis. They will never be able to live again (with current technology) without a machine doing their breathing for them. They realize that they would be dead without the machine and do not want to be kept alive. To me this is an informed decision.

The JW girl in Canada may have also been making an informed decision. Can't say without reading the actual article stating the situation. The judge decided he did not believe she was. In that matter, what makes the judge and doctor a better decision maker than the parents?

In the case of a split household, the judge has the hardest job of all, because he has to side with one parent or the other. Now he has a whole host of other factors to weigh. Which parent may be more informed? Is there a particular rift between the parents that may be causing them to fight over this issue (a horrible situation since it isn't about the parents but about the child)? Are there any religious issues involved on behalf of one or the other parent? If both parents have religious issues look back to the previous questions, to redetermine which parent you believe would be making the best decision on behalf of the child.

Notice I didn't include the judges own preferences, nor did I include the doctors preferences. No one in my opinion should be penalized for seeking medical advice. Nor should a doctor be able to force his own views or opinions on someone's medical health. It is an unfortuneate event, but if the person were to want to die, and were litterally dieing, the only pause would be to determine that the desire to die was truly being communicated.