1. Presentation: a. Problem: John H. a 59 year old male has pancreatic cancer (that has spread). His condition is worsening and John wishes to not receive any further treatment from his Dr. W (primary doc) or Dr. R (oncologist). His doc's and John agree that he sign a DNR, do not resuscitate, form. John later begins to bleed internally and asks the doctor's if they can do something. Dr. W reminds John that he signed a DNR form and believes nothing should be done. Whether or not John is competent or not is unclear. However, Dr. R wants to step in and help even though the DNR form was signed. John will die of blood loss if nothing is done. b. Should John die of blood loss because he signed a DNR form, even though he wants to be treated? (follows what Dr. W said) OR Should Dr. R step in and treat the internal bleeding knowing John signed the DNR form? c. moral facts: Should the doc let John die from internal bleeding (NOT his terminal diagnosis) OR should the doc ignore the DNR and treat John's symptoms (blood loss) and let him eventually die from his terminal illness? b: non-moral facts: DNR- legal documentation of not bringing the client back to life. 2. Analysis: a. moral values: Doctor's integrity- signed legal documentation that no measures should be taken. Patient's integrity- John has a decision to die of his terminal disease or blood loss. Compassion- Dr. R feels that he should step in, let the patient die of terminal illness and not blood loss. Manage his symptoms and not let John die being anxious/ in pain. Responsibility- Doctor's responsibility to be an advocate for the patient? Doctor's responsibility to follow legal orders/ documentations? b. non-moral values: Intellectual- Does Dr. W believe that no matter if John's internal bleeding is treated or not, he will still die? Does Dr. R believe that there is hope and that John will not die of her internal bleeding but will later die from his terminal illness? Does Doctor's Word and Documentation trump Symptom Management and Patient's want to be treated after signing DNR? c. Value Conflicts: - Justice: what is fair? Letting John die or treating his internal bleeding? - Beneficence: Should Dr. W do good in his profession and follow legal documentation? Should Dr. R do good and follow what he thinks is morally right? Autonomy- Should the doctor's respect John's DNR or his oral request for help? Which of John's wishes should be respected? d. Theories: -Kant (adherence to duty is heart of morality).. Doctor's duty is to save lives. -Ross (prima facie).. Would higher duty be the patient or the legal documentation. e. Options: The decision on whether Dr. W should do nothing or Dr. R should step in is based on both theories. 1. Dr. W& Dr. R do nothing and let John die of internal bleeding; following DNR document. 2. Dr. R steps in and treats John's symptoms ultimately letting him die of his terminal illness (why John signed the DNR in the first place) g. Solves moral problem: Dr. R listens to John's orla request for help, denying the DNR and helps treat the internal bleed. - being an advocate for the patients wishes. - allowing the patient to still be in some control or situation. - bleeding is not pancreatic cancer/ treat symptoms/ allow John to be comfortable
- hope this makes sense! if I left something out, please bring it up and discuss it :)
I think the biggest problem with this case is the idea of competence and the legality of spoken word. On one hand, a patient should never be held to a former view on which he/she has recently changed his/her opinion. However, the question of competence is important because in any other case, competence would be a key factor in whether his statement would be accepted or not. Because this case has to do with this man's life, I would suggest that the doctors treat the patient. The only other factor that would make me change my mind is if the family had input and could say that the man is not competent enough to make that decision. The reason the family might know that is because they would know to what extent the man was determined to sign the DNR from the beginning. They would also be able to provide insight on the competence of the man. I understand the hesitation of Dr. W, but if there is a possibility of competence, there is no reason to not comply with the patient's new wishes.
I think both doctors should step in and treat him. Many people think they will be ready when it is their time to go but when it comes down to it, they get scared. If Dr. W doesnt want to treat him then Dr. R should step in and help. The internal bleeding probably happened unexpectedly and he didnt want to ultimately die from it. I think the patient should be treated if he wishes. You can't deny him just because he signed a form, he clearly didnt expect this.
The doctors cannot treat the dying patient by contract. So neither should do so. The do not ressusitate form must be honored in the favor of the patient and the doctors. No one wants to die but everyone has to no matter how it comes. The patient was not ready for the consequences of his actions when he signed the DNR.
I think the doctor's should treat John. It says that John requested he not be resuscitated if he should go into cardiac arrest, which is a different situation than having internal bleeding. I think the internal bleeding is a totally different situation that he did not expect and the doctors should step in and treat the patient.
I believe that Dr. R is right and something should be done. John H. wants to die from his disease not from internal bleeding. I understand where Dr. W is coming from because a legal and signed document should be understood; however, John is asking them to help him. John being able to ask for help shows he is somewhat with it and should be taken seriously. Morally both doctors should help John.
I agree with everyone else about the Doctors stepping in to help John H. Since it is not clear whether John is competent or not, I don't think it is right to risk saving his life over uncertainty. He signed the DNR for his terminal disease not knowing that bleeding internally is in his near future and he would probably die from that before the cancer. Stepping in to help him would be the moral thing to do in this situation.
I don't think that when John signed the DNR, he meant to include internal bleeding in the scenarios through which he should not be helped. Personally, when I think of DNR, I think of me being unconcious and dying, and the doctors just letting me go without trying to wake me up or keep me alive. John is already awake, he may not be fully aware of everything that he's saying, but I don't think that that makes him unable to ask for his own life to be saved. Not to try to save John's life after he explicitly asks for it would be very immoral on the part of both doctors. The fact that this case is hard to answer really emphasizes the importance that proceedures have taken in our medical culture, but procedures should never trump the doctor's ability to provide the best help that the patient desires. Contract shouldn't matter in this case. And as far as the question of whether or not John is aware of his request should be a "act now, ask questions later" kind of thing. It would be better to apologize to John for saving his life because he didn't actually mean that he wanted to be saved than to apologize to John's family because he let John die when John was asking for help.
1. Presentation:
ReplyDeletea. Problem: John H. a 59 year old male has pancreatic cancer (that has spread). His condition is worsening and John wishes to not receive any further treatment from his Dr. W (primary doc) or Dr. R (oncologist). His doc's and John agree that he sign a DNR, do not resuscitate, form. John later begins to bleed internally and asks the doctor's if they can do something. Dr. W reminds John that he signed a DNR form and believes nothing should be done. Whether or not John is competent or not is unclear. However, Dr. R wants to step in and help even though the DNR form was signed. John will die of blood loss if nothing is done.
b. Should John die of blood loss because he signed a DNR form, even though he wants to be treated? (follows what Dr. W said) OR
Should Dr. R step in and treat the internal bleeding knowing John signed the DNR form?
c. moral facts: Should the doc let John die from internal bleeding (NOT his terminal diagnosis) OR should the doc ignore the DNR and treat John's symptoms (blood loss) and let him eventually die from his terminal illness?
b: non-moral facts: DNR- legal documentation of not bringing the client back to life.
2. Analysis:
a. moral values: Doctor's integrity- signed legal documentation that no measures should be taken. Patient's integrity- John has a decision to die of his terminal disease or blood loss. Compassion- Dr. R feels that he should step in, let the patient die of terminal illness and not blood loss. Manage his symptoms and not let John die being anxious/ in pain.
Responsibility- Doctor's responsibility to be an advocate for the patient? Doctor's responsibility to follow legal orders/ documentations?
b. non-moral values: Intellectual- Does Dr. W believe that no matter if John's internal bleeding is treated or not, he will still die? Does Dr. R believe that there is hope and that John will not die of her internal bleeding but will later die from his terminal illness? Does Doctor's Word and Documentation trump Symptom Management and Patient's want to be treated after signing DNR?
c. Value Conflicts: - Justice: what is fair? Letting John die or treating his internal bleeding? - Beneficence: Should Dr. W do good in his profession and follow legal documentation? Should Dr. R do good and follow what he thinks is morally right? Autonomy- Should the doctor's respect John's DNR or his oral request for help? Which of John's wishes should be respected?
d. Theories: -Kant (adherence to duty is heart of morality).. Doctor's duty is to save lives.
-Ross (prima facie).. Would higher duty be the patient or the legal documentation.
e. Options: The decision on whether Dr. W should do nothing or Dr. R should step in is based on both theories.
1. Dr. W& Dr. R do nothing and let John die of internal bleeding; following DNR document.
2. Dr. R steps in and treats John's symptoms ultimately letting him die of his terminal illness (why John signed the DNR in the first place)
g. Solves moral problem: Dr. R listens to John's orla request for help, denying the DNR and helps treat the internal bleed.
- being an advocate for the patients wishes.
- allowing the patient to still be in some control or situation.
- bleeding is not pancreatic cancer/ treat symptoms/ allow John to be comfortable
- hope this makes sense! if I left something out, please bring it up and discuss it :)
I think the biggest problem with this case is the idea of competence and the legality of spoken word. On one hand, a patient should never be held to a former view on which he/she has recently changed his/her opinion. However, the question of competence is important because in any other case, competence would be a key factor in whether his statement would be accepted or not. Because this case has to do with this man's life, I would suggest that the doctors treat the patient. The only other factor that would make me change my mind is if the family had input and could say that the man is not competent enough to make that decision. The reason the family might know that is because they would know to what extent the man was determined to sign the DNR from the beginning. They would also be able to provide insight on the competence of the man. I understand the hesitation of Dr. W, but if there is a possibility of competence, there is no reason to not comply with the patient's new wishes.
ReplyDeleteI think both doctors should step in and treat him. Many people think they will be ready when it is their time to go but when it comes down to it, they get scared. If Dr. W doesnt want to treat him then Dr. R should step in and help. The internal bleeding probably happened unexpectedly and he didnt want to ultimately die from it. I think the patient should be treated if he wishes. You can't deny him just because he signed a form, he clearly didnt expect this.
ReplyDeleteThe doctors cannot treat the dying patient by contract. So neither should do so. The do not ressusitate form must be honored in the favor of the patient and the doctors. No one wants to die but everyone has to no matter how it comes. The patient was not ready for the consequences of his actions when he signed the DNR.
ReplyDeleteI think the doctor's should treat John. It says that John requested he not be resuscitated if he should go into cardiac arrest, which is a different situation than having internal bleeding. I think the internal bleeding is a totally different situation that he did not expect and the doctors should step in and treat the patient.
ReplyDeleteI believe that Dr. R is right and something should be done. John H. wants to die from his disease not from internal bleeding. I understand where Dr. W is coming from because a legal and signed document should be understood; however, John is asking them to help him. John being able to ask for help shows he is somewhat with it and should be taken seriously. Morally both doctors should help John.
ReplyDeleteI agree with everyone else about the Doctors stepping in to help John H. Since it is not clear whether John is competent or not, I don't think it is right to risk saving his life over uncertainty. He signed the DNR for his terminal disease not knowing that bleeding internally is in his near future and he would probably die from that before the cancer. Stepping in to help him would be the moral thing to do in this situation.
ReplyDeleteI don't think that when John signed the DNR, he meant to include internal bleeding in the scenarios through which he should not be helped. Personally, when I think of DNR, I think of me being unconcious and dying, and the doctors just letting me go without trying to wake me up or keep me alive. John is already awake, he may not be fully aware of everything that he's saying, but I don't think that that makes him unable to ask for his own life to be saved. Not to try to save John's life after he explicitly asks for it would be very immoral on the part of both doctors. The fact that this case is hard to answer really emphasizes the importance that proceedures have taken in our medical culture, but procedures should never trump the doctor's ability to provide the best help that the patient desires. Contract shouldn't matter in this case. And as far as the question of whether or not John is aware of his request should be a "act now, ask questions later" kind of thing. It would be better to apologize to John for saving his life because he didn't actually mean that he wanted to be saved than to apologize to John's family because he let John die when John was asking for help.
ReplyDelete