The fictional case shows a conflict of views of Dr. Rosenberg and Mrs. Jones’ son Franklin.
I do not see any religious context in the doctor’s suggestion to admit antibiotics and perform a temporary dialysis. Although one of the commenter, Dr. Reichman, states: “One principle of Jewish medical ethics is the sanctity of life and the obligation to preserve it” (AMA), it is a fundamental definition of medicine in its essence, regardless of religion: promotion and preservation of health. Therefore, Dr. Rosenberg ethically justifies his choice of action. Moreover, there must be no religious conflicts in any treatment scenario in order to provide equal treatment to all patients, to refrain from potentially illegal actions and from losing the medical license.
There is one son who relates the past experiences of a relative on dialysis, and he seems to feel that antibiotics and dialysis are futile. I cannot find any ethical justification of the son’s request of the proposed treatment removal. There is no evidence the patient is terminally ill or dying. It is hard to watch a beloved family member suffering from illness, but, as with any strategy, the rationality should prevail over emotions. In this case, the rational decision it to perform life-saving procedures like antibiotics and dialysis. Dr. Rosenberg statement is unbeatable: “According to the principles that guide my practice of medicine, I cannot withhold life-saving treatment from any patient — especially antibiotic therapy and temporary dialysis, both treatments with uncontroversial efficacy.” (AMA)
“It is clear that this conflict with the treatment recommendations, but it is unclear whether the son has the authority to make decisions that could terminate his mother’s life prematurely” (Sandra Gadson, MD), – I fully agree. As with several euthanasia court trials we are acquired in this course, the U.S. Supreme Court requires at least an oral advance directive from the patient, here Mrs. Jones. Like in Cruzan or Schiavo cases, own, prior, competent refusal of life sustaining treatment before treatment withdrawal is required in order to discontinue the treatment (Beauchamp). The present case does not provide us information, whether Mrs. Jones instructed to maintain or withhold the life-saving procedures.
If, by any new evidence of Mrs. Jones’ (still unconscious, thus, not-autonomous patient) views on her life-sustaining treatment expressed prior to the intensive care facilities, the antibiotic therapy and dialysis are denied, it will be a voluntary passive euthanasia. In case of absence of the patient’s advance directive, the postponing of treatment would be considered a non-voluntary passive euthanasia.
Dr. Gadson provides a rational explanation of Dr. Rosenberg potential actions: “Congestive heart failure, sepsis, and acute renal failure are not necessarily long-term and are treatable with antibiotics”, and concludes: “If her clinical condition continues to deteriorate, bringing about clinical brain death, then options for withdrawal of treatment would be appropriately discussed with the family.” (AMA) Once again, this comment coincides with my views on the given situation.
- American Medical Association (AMA), Virtual Mentor, End of Life and Sanctity of Life, May 2005, Volume 7, Number 5;
- Beauchamp, Walters, Kahn, Mastroianni, Munson. Bio-Medical Ethics PHI 227, Northern Virginia Community College, Thompson Publisher, 2011, Two Supreme Court cases, pp. 123-128;
- Beauchamp, Walters, Kahn, Mastroianni, Munson. Bio-Medical Ethics PHI 227, Northern Virginia Community College, Thompson Publisher, 2011, Cruzan v. Director, MO Department of Health, pp. 139-144;
- Beauchamp, Walters, Kahn, Mastroianni, Munson. Bio-Medical Ethics PHI 227, Northern Virginia Community College, Thompson Publisher, 2011, Case Presentation: Terri Schiavo, pp. 145-150.