Asian Bioethics Review

Introduction

Healthcare professionals, including nurses, often encounter scenarios where they question their decisions because their patients’ lives and safety are at stake. In such instances, their strong grounding in the field of bioethics plays an important role to justify the decision taken and maintain a sense of contentment within them. Being thoughtful by applying various ethical principles, theories and concepts, nurses can clarify the ethical conflicts that occur daily and strengthen their skills at resolving them. The following case on end-of-life decision-making will be the centre of our ethical decision-making in this article. This case is analysed through the MORAL model, given by Patricia Crisham in 1985.

“Moral” is an acronym. Here, “M” means to massage the dilemma. Next step “O” is to outline the options. Then “R” means to “Review the criteria and Resolve” it. R is followed by “A”, which means to “Affirm” the position and “Act” accordingly, and finally, “L” means to “Look Back” or evaluate.

Case Scenario

While I was on my clinical practice in one of the Oncology units as a novice nurse, in a metropolitan city of Pakistan, I encountered a case which I could not resist to reflect upon: it was about the ethical issues that arise at the end of life and its solutions. An 80-year-old male patient was admitted to that ward, with metastatic cancer of the stomach. After two days of his stay at the hospital, his condition worsened and he struggled to breathe. Since he had a terminal illness, all treatment options seemed futile. The family, including his four sons, was [End Page 289] with him at this crucial moment. His sons were well-educated and economically stable. At the time of deciding to provide mechanical ventilation to the patient or not, a discourse was generated between the healthcare professionals (HCPs), including the family and me. Two significant arguments emerged—to put the patient on the ventilator according to the family’s wish, or not to put him on the ventilator, which was what the healthcare team wanted. The decision was made and the patient was put on the ventilator. He survived for four days and died.

The concern was whether the decision of putting the patient on the ventilator was a correct one. If the family’s wish was respected, then the patient’s life would have been prolonged, providing them a chance to realise any incomplete desires. Also, since they had a strong emotional bond with the patient, it would give them a sense of satisfaction and relief from psychological distress. Besides, the duration for which the patient would be on the ventilator would prepare them to accept his poor prognosis and limited survival chances. However, by doing so, the rights of all potential patients waiting for the ventilator would be violated.

On the contrary, if the HCP’s wish was considered, the patient would be provided with an opportunity to die a natural death without any artificial equipment of life prolongation. Moreover, one of the potential patients would be able to receive the ventilator. However, the patient in this case might die earlier as a consequence. His early death will take away a chance for the family to complete any unfinished businesses.

Therefore, the issue was whether to respect family’s autonomy, keep the patient on the ventilator and prolong his life, or to listen to the HCPs, withhold the life-sustaining treatment to the patient, let him die, and do justice to all other potential ventilator candidates.

Taking into account the case presented above, this article intends to analyse conflicting ethical principles and theories: the principle of autonomy versus the principle of justice, and the theory of care versus utilitarianism. A religious point of view is also shared.

Role of Early Death Planning: Making Decisions

Although knowing that the time of death is uncertain, we carefully plan for our good living but not for our good death. If careful death planning is done beforehand, during his life, then deaths also, to some practical extent, could be according to our desires. Unfinished business can...