End-of-life care receives a significant amount of scholarly and research attention, exploring its most relevant ethical issues. Yet, end-of-life care decision making is fraught with dilemmas and complications. The most pronounced cases involve patients’ right to refuse treatment, assisted suicide, and, most relevantly, withdrawing life-sustaining treatment. With the advancement of medical technologies that change circumstances around natural death and prolong life, medical professionals, patients, and their families are frequently faced with difficult choices (Karnik & Kanekar, 2016). In this regard, Tonya Archer’s case is exemplary, involving such pertinent to end-of-life care notions as futile medical care, doctor-family communication, and autonomous decision-making (Karnik & Kanekar, 2016). These notions will help corroborate Tonya’s family’s right to keep her on life support.
The optimal decision seems to be continuing Tonya’s life-support treatment until her parents understand its futility. Although all medical evidence indicates brain death, patients and their legal representatives have the right to self-determine (American Nurses Association [ANA], 2015). Ideally, a patient should decide what needs to be done to their own person, but in this case, the family has an ultimate say. Medical specialists should provide all the necessary information for the parents to make an informed decision. Continuing life-support as long as needed to show its fruitlessness seems essential in making a shared decision to discontinue the treatment eventually.
The ethical issues relevant to the case study include autonomous decision making, medical specialists’ role and responsibilities, and rationing of end-of-life care and futile treatment. Firstly, autonomy being a paramount ethical principle in end-of-life care should be the basis for resolving the dilemma (Martins Pereira et al., 2018). Although Tonya is not capable of making decisions, this role is assigned to her caregivers. Secondly, physicians have considerable responsibilities in resolving the case, as they should act to Tonya’s and her family’s benefit based on the deontological ethical theory (Karnik & Kanekar, 2016). Lastly, since Tonya’s chances for recovery are nonexistent, institutional futility policies should also be considered.
The complexity of Tonya’s case can be alleviated with the help of deontological theory. Deontological ethics in medicine is patient-centered, as physicians are required to act according to their moral obligation and ensure that their decisions align with a patient’s best interests (Karnik & Kanekar, 2016). According to Skelton (2016), deontological theories offer “the best guide for both patients and policy makers because they allow for maximum freedom in personal medical decisions and protection for all members of society” (p. 1). Thus, physicians are responsible for involving Tonya’s parents in shared decision making and explaining the treatment’s futility. As they fail to convince the parents, they should not proceed to withdraw life-support.
Organizational documents, including mission, vision, and value statements, help medical professionals navigate their working routine and make decisions corresponding to a hospital’s standards. Typically, the statements dictate what employees should strive to accomplish and in what manner (Rego et al., 2016). For instance, a hospital’s value statement might incorporate such notions as adequate care, patients’ well-being, patient-centered care, and a mission statement might accentuate the quality of patient experience. In the case under consideration, these organizational documents should help Tonya’s physicians guide their decisions and mitigate uncertainties about keeping the girl on life support. Hence, medical professionals should consult the statements and reconsider their decision regarding withdrawing life-support.
Moreover, adhering to guidelines and recommendations provided by accrediting bodies plays an instrumental role. According to the Joint Commission International accreditation standards (2017), hospitals are responsible for informing “patients and families about their rights and responsibilities to refuse or discontinue treatment, withhold resuscitative services, and forgo or withdraw life-sustaining treatments” (p. 10). Based on the citation, patients or, as in Tonya’s case, their legal representatives have the ultimate say in withdrawing life-support – it is their right and responsibility. Thus, relying on the Joint Commission recommendation, the physicians should be reluctant to contradict Tonya’s family demands to continue treatment.
The Nursing Code of Ethics developed by ANA also corroborates the decision to continue treatment. The code clearly outlines a patient’s right to self-determination. According to the code (2015), “patients have the moral and legal right to determine what will be done with their own person… to be assisted with weighing the benefits, burdens, and available options in their treatment” (p. 13). The role of medical professionals is reduced to assisting the parents in making a decision. The choice to keep Tonya on life-support is less controversial and more in compliance with the code.
In conclusion, keeping Tonya on life support till her parents see the treatment’s fruitlessness seems to be the optimal decision. The decision is supported by The Nursing Code of Ethics and the Joint Commission International accreditation standards. In addition, based on patient-centered deontological ethics, discontinuing life-sustaining treatment without the parents’ consent is ethically dubious. Organizational documents such as vision, mission, and value statements are also likely to contain ideas supporting the decision. The decision to withdraw life-support is a shared one that should not be made without a patient or their family’s involvement and agreement.
American Nurses Association. (2015). Code of ethics for nurses. American Nurses Publishing.
Joint Commission International. (2017). Joint Commission International accreditation standards for hospitals including standards for academic medical center hospitals (6th ed.). Joint Commission International Publishing.
Karnik, S., & Kanekar, A. (2016). Ethical issues surrounding end-of-life care: A narrative review. Healthcare, 4(2), 24, 1–6. Web.
Martins Pereira, S., Fradique, E., & Hernández-Marrero, P. (2018). End-of-life decision making in palliative care and recommendations of the council of Europe: Qualitative secondary analysis of interviews and observation field notes. Journal of Palliative Medicine, 21(5), 604–615. Web.
Rego, A., Araújo, B., & Serrão, D. (2016). The mission, vision and values in hospital management. Journal of Hospital Administration, 5(1), 62–72.
Skelton, L. (2016). Ethical theories and perspectives on end-of-life decisions. Dialogue & Nexus, 4, 1–6. Web.