Reference no: EM133304702

Assignment: Mr. Lee, an 84-year old man suffering from Stage IV lung cancer, is in the ICU, following surgery to remove the malignant mass in his brain. Although Dr. Kennedy was able to completely remove the mass, Mr. Lee suffered a cardiac arrest during surgery and has been unconscious and on a respirator for the past month. The medical team feels that his prognosis for regaining consciousness is poor and that he is in a vegetative state. Mrs. Lee, Mr. Lee's high school sweetheart and wife for 65 years, has requested a feeding tube for Mr. Lee and any treatments that can keep him alive. As his healthcare proxy agent, she claims that she knows his wishes, as they spoke extensively about this potential situation before the surgery. Mr. Lee did not leave a living will.

Dr. Kennedy is upset. He believes the respirator is futile and the feeding tube will produce more harm than good, given its propensity for infection. He is concerned that Mr. Lee's care is utilizing precious ICU resources that could potentially benefit someone else. Ethically conflicted, Dr. Kennedy consults with Dr. Johnson, the Lee's family practitioner for thirty-five years. Dr. Johnson is conflicted as well. He was recently contacted by Bill, the Lee's only child, who is very upset about his father's situation. Bill told Dr. Johnson that Mr. Lee stated years ago, to Bill and Mrs. Lee, that he would never want to end his life 'existing' like Terry Schiavo. Believing Bill is probably right, Dr. Johnson goes to see Mrs. Lee who is sobbing and holding Mr. Lee's hand. Through tears, she tells Dr. Johnson that she cannot bear to see Mr. Lee like this, but he had insisted before he went into surgery that she do all she could in order to 'keep him going.'

Without mentioning Bill, Dr. Johnson tells Mrs. Lee that from his knowledge of Mr. Lee, he is surprised that Mr. Lee would make such a request. Mrs. Lee bursts into tears and confides that Mr. Lee made her promise that she would keep him on life support so that she could collect his social security checks as long as possible. He wanted to make sure he could continue 'looking after her.' Knowing the Lee's devotion to each other, and the direness of their financial situation, Dr. Johnson pats Mrs. Lee's hand and tells her that he will do all he can to honor Mr. Lee's wish. Upon hearing the outcome of the discussion from Mrs. Lee, Bill requests an Ethics Consult with the Hospital's Ethics committee.

Question: The Chair asks the group to consider the following questions:

1. Should the respirator sustaining Mr. Lee's life be removed, understanding the reason that Mr. Lee wants to remain on life support?

2. Does the rationale behind one's preferences regarding end-of-life care matter ethically? Should it?

3. Suppose, just before surgery, Mr. Lee had asked Mrs. Lee to do everything possible to keep him alive without explaining his reasons. Do you think a person's wishes change over time?