Barney Says No

Almeda was an eighty-four-year-old woman who lived a retiring life with no family and few friends. She suffered from a disabling stroke three years ago and has been confined to bed in a nursing home. Almeda has lost decisional capacity and left no advance directives. Barney, her long time friend, has been her unofficial substitute decision maker. Almeda has developed a stage IV sacral decubitus, now colonized with multiple resistant staphylococcus areus and pneumonia with heart failure. Now she is on the intensive care unit.

For two week, Almeda has been on the ventilator and fed with a gastric feeding tube. During this time, she has been treated with high dose cardiovascular drugs and Vancomycin antibiotic. There has been no progress in the heart failure or pneumonia. Although stoic, Almeda shows clear signs of pain when move about for care.

The nurses and attending physicians have approached Barney on the numerous occasions to raise the question about stopping aggressive curative treatment and moving toward palliative care. Barney has always insisted that he sees more potential Almeda’s condition. When asked what the right goal for Almeda ought to be, he answered, “It would be good if she could sit up and watch a little television.” Almeda’s renal function has now become seriously impaired and requires renal dialysis. With the prospect of a dialysis, the nursing staff asked for a meeting with the attending physician and Barney to discuss treatment redirection from curative to palliative care.

Moral Problem

“Whether Barney has autonomy or not?” Moral Analysis: Move to palliative care Palliative care is needed by all those suffering from advanced progressive incurable disease. It is provided by relatives or other informal cares and by health care professionals both generalist and specialist. Palliative medicine refers to that contribution to the practice and study of palliative care which is made by doctors. The definition which was adopted in 1987, when palliative medicine was recognized in Britain as a medical specialty states that 'palliative medicine is the study and management of patients with active, progressive, far-advanced disease for whom the prognosis is limited and the focus of care is the quality of life'. The Oxford Textbook of Palliative Medicine provides a comprehensive overview of current practice.

The World Health Organization defines palliative care as follows: The active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems is paramount. The goal of palliative care is the achievement of the best possible quality of life for patients and their families. "Curative" means "to have an aim of curing". Said that the patients will recover. "Palliative" means "to have an aim of comforting". Patients in palliative care are in extremis, and not expected to recover.

Advantages

If the physician and Barney discuss about the treatment of Almeda and both of them agreed and in favored about the palliative care, the medication of Almeda will be cut off, because the main goal of palliative care is to stop the suffering of the patient, so it means that Almeda should be more comfortable about this kind of health care. Infact she’s already 84 years old so it means that she’s already want to have rest and peace in her life. According to the case “Almeda shows clear signs of pain when moved about or care” it is absolutely clear in the passage that she’s suffering from her condition and mostly to the medication they give that has no benefit and very useless.

Palliative care is not expensive, unlike the curative care. It can be made available to all those who need it, at home or in hospital. So it means it is much cheaper and more convenient if Barney and the physician both agreed and favored in the palliative care as a kind of health care that will use to treat Almeda.

Disadvantages

In case that Barney still insist about using the curative care for be able to Almeda to recover and the physician still pursue about the palliative care, Barney’s autonomy will not be acknowledge and respected because the physician still pursue things that is opposite about what is Barney’s want to do. Palliative care only has the aim of comforting the patient and to minimize the suffering he/she feels, unlike the curative care it is uncertain or unexpected for the patient to recover, so if Barney and the physician both agreed and in favored about this kind of healthcare, it is possible that Almeda will not be able to recover instead die because of her diseases.

Move to curative care

Advantage

If Barney and the physician both agreed and in favored of insisting curative care, it has more possibility of Almeda to be cured than pursuing the palliative care. Because the main goal of the curative care is to cure and make the patient recover, even in the most painful way of treating patients. In case that Barney still insist about using the curative care for be able to Almeda to recover and the physician agreed to it, and they pursue the curative care, Barney’s autonomy will be acknowledge and respected.

Disadvantage

If the physician and Barney talked and both agreed and in favored about pursuing the curative care, the medication of Almeda will continue and it will make her suffered more. Almeda is 84 years old so using the curative care is very useless and unbeneficial to her body. If they still pursue curative care, Barney, who is in charge of Almeda, will pay bigger because curative care is really expensive.

Bioethical and Catholic principles, rules and theories involve

Autonomy (respect for the rights of the patient) The definition of autonomy is self-rule or independence. The essential philosophy behind this principle is that every individual is an independent human being with a different background. Our individual philosophies on how we wish to lead our lives are shaped by our genetics, our upbringing, our religions, our cultures and our personal experiences. Because of these individual differences, it is not possible for a physician always to “know” the correct management of a medical condition for every patient presenting to them for care. Instead, it is presumed, that by giving an autonomous individual a complete understanding of his/her problem that the individual, more than anyone else, will be better able to decide what the correct treatment is.

The principle of autonomy is based on the Principle of Respect for Persons, which holds that individual persons have right to make their own choices and develop their own life plan (Garrett, 28) (American College of Physicians Ethics Manual, 2, 15.). In a health care setting, the principle of autonomy translates into the principle of informed consent: You shall not treat a patient without the informed consent of the patient or his or her lawful surrogate, except in narrowly defined exceptions (Garrett, 29). However if the patient is incompetent (e.g. comatose, under-age, etc.) he/ she should have this:

First, the medical practitioner must consult the patient’s living will if there is one.

Second, if there is no living will or the living will provides no clear guidance, the medical practitioner must consult a surrogate decision maker: either one designated by a durable power of attorney, or a family member, in order of priority: healthcare durable power of attorney, or guardian; spouse; children of legal age; parents; siblings of legal age; grandparents; grandchildren of legal age; other relative, close friend, or caregiver.