Dr. Ken Berger Case Summary

A physician must understand that when it comes to deciding to withhold or withdraw life sustaining treatment it is ultimately the patient’s decision unless the patient is not competent enough to make this choice. I believe that a person can lose their life at any point. Death is certain and no one can run from it. In my opinion, a patient’s autonomy is of utmost importance anytime during healthcare however the physician can name some recommendations of what would be the best option for the patient. When it comes to patients they deserve to be treated with respect and ultimately be treated as an end not as a means to an end.

Today, medical interventions have made it possible to save or prolong lives, but should the process of dying be left to nature? (Brogden, 2001). Phrases such as, “killing is always considered murder,” and “while life is present, so is hope” are not enough to contract with the present medical knowledge in the Canadian health care system, which is proficient of giving injured patients a chance to live, which in the past would not have been possible (Brogden, 2001). According to Brogden, a number of economic and ethical questions arise concerning the increasing elderly population. This is the reason why the Canadian society ought to endeavor to come to a decision on what is right and ethical when it comes to facing death.

The law effectively covers situations in which a patient can personally consider the effects of terminated treatments, but does not provide for situations in which the patient is incompetent to inform agents of their desires. Conflict occurs when the court requires evidence for consent to end lifesaving medical treatment, which could be otherwise avoided should the Act be amended to accommodate the needs of the patient (for example, conversations held in passing being held as evidence). The Act should be amended to allow families to make the judgment rather than the patient themselves (such as in Re BWV, Ex Parte Gardner (2003) 7 VR 487, 491[19]). Although it is possible to make decisions on a patient’s behalf, clarification by the Victorian state is needed. The legislation fails to make distinctions between the patient’s desires and what is in their best

Advance Directives by the patient designates no feeding tubes, artificial ventilation, or CPR. Concerns regarding alteration of mental status consequential to his illness provoke the physician to seek consultation from the designated Power of Attorney. Nursing responsibilities compel the nurse to consider if the proposed actions of Dr. G violate the patient’s rights of self determination and confidentiality and prompt the nurse to advocate for the patient’s desires regarding medical treatment. Health care providers have a responsibility to honor the patient’s autonomy and provide quality medical care (Badger, 2009 p122). Providing artificial nutrition and ventilation transgresses the patient’s directives and is unethical. The physician appears to be asserting a paternalistic approach in deciding what is best for this patient. Should the interventions be temporary and provide resolution of the condition, the physician can defend his actions as being healing and beneficial. However, there is a chance that the interventions may be permanent and futile; avoiding passive euthanasia and terminal dehydration, serving only to prolonging the illness. Violating the patient’s directives of care by performing invasive procedures can lead to legal incriminations of assault and battery.

The Superior Court of Los Angeles County became a pivotal case in a patient’s right to refuse treatment. In the initial case Ms. Bouvia and her legal team sought a court order to have the NGT removed and to stop all medical treatments she did not consent to. She argued that this treatment would not be a cure for her condition and would not improve her quality of life. The hospital staff argued the interest of the state prevailed over a patient’s right to refuse treatment. They noted that the state and healthcare teams viable interests include: “(1) preserving life, (2) preventing suicide, (3) protecting innocent third parties, and (4) maintaining the ethical standards of the medical profession, including supporting the right of physicians to effectively render necessary and appropriate medical services” (Liang & Lin, 2005). Additionally they sighted Ms. Bouvia’s failed previous attempt to “starve herself to death” in 1983 with the assistance of her medical team. The court denied her request citing these key interests and the fact that medical professionals felt that Ms. Bouvia could live 15-20 additional years with supplemental nutrition justified the state’s interest in preserving her life. The court also stated that any other decision would be condoning a medical team to aid and abet suicide.

Forcing terminally ill patients to suffer straight up to their last days is unacceptable and provisions can be made in order to allow competent patients to have a choice at the end of their lives.

Keeping a person alive by excessive treatment might devastate the family and make the dying suffer tremendously in the end. “Advance medical technology that seems to one person a godsend, extending life, may seem to another a curse that only prolong dying. Dignity can be devalued amid technology focused solely on the biological organism.”

For many years, medical assisted death has been disagreed upon with the Canadian Quebec legislation, Bill 52, An Act respecting end-of-life care. Terminal ill patients have been fighting rights with their incurable conditions which caused them unbearable suffering. In many situations, death is always unacceptable since life was given for a reason. We all must pass away one day, although for some individuals, death can be measured by time due to tragic news that they have been informed about. In means of measuring time, we would all like to know when and how our death would be given. “Living is not good, but living is well. The wise man, therefore, lives as well as he should, not as long as he can...He will always think of life in terms of quality not quantity…Dying early or late is of no relevance, dying well or ill is…life is not to be bought at any cost. – The Stoic philosopher Seneca (4 B.C.- 69 A.D).” (Shneidman, 2001, p. 5). Sue Rodriguez, who was an advocate for medical assisted death, fought for legal rights in 1993. She was diagnosed with Amyotrophic lateral sclerosis (ALS) in 1991. In a video to the Parliament, she poured her heart out. “If I cannot give consent to my own death, whose body is this? Who owns my life?” (CBC Radio-Canada, 1993). She lost the battle against Supreme Court Canada to legalize assisted death under the Criminal Code of Canada. In 1994, Rodriguez was given a “constitutional exemption” which allowed assisted death under many conditions. In

Ms. Mahoney is a 53-year-old female here today to discuss laboratory testing and the stress going on in her life.

As you know, the applicant recently completed the AME with Dr. Weiseltier. As predicted earlier, the lipoma on the applicant’s back was found to be non-industrial. The AME found that the applicant did not sustain injuries to any body part other than the left scapular area. Under the strict ratings, Dr. Weiseltier found 0% whole person impairment.

Striving to preserve or a extend a life of one person (the young) for a long time is a worthy effort, however doing so at the expense of refuting any chance of living to another (by denying resources to the old) is contemptible. Physicians at the bedside cannot treat

With major advancement in medical treatments, it is now possible to keep a patient alive, which would not have been possible in former times. This has made end of life issue one of the most controversial issues in healthcare. Medical improvements have set the stage for ethical and legal controversies about not only the patient’s rights but also the family’s rights and the medical profession’s proper role. It is critical that any decision made in such situation is ethical and legal to preserve the rights of the patient and also protect the healthcare institution involved. It is very important when making decisions to discontinue treatments to make sure all other alternatives have been explored.

1) Patients have the right to make their own informed decisions about if and how they die. When a chronically ill patient decides life is no longer worth living because of the insurmountable pain they are in, who are we to tell them differently? There are cases where attempts to cure are doing more harm than good, not only mentally and physically to the patient, but emotionally to his family and loved ones as well.

Curative care is directed towards seeking a cure for an existing disease or medical condition. Through technology and medicine it prolongs life. Paul Jewell’s (2005) article on the sanctity of life states that this notion of the sanctity of life is promoted as an ethical standard, a conduct to professional practice and legislated constraints. His article further suggests that medical practitioners are expected to work in ways that correspond to common social expectations and legal restrictions. Thus, signifying that the main concern should be the wellbeing of the patient. Within the Australian Medical Association’s code of ethics, it is stated that there is a responsibility to preserve life, however, where death is deemed to be pending and where curative or life-prolonging treatment is absent, one must try to certify that death transpires with dignity and relief through palliative care (AMA, Code of Ethics, 2004). It is through the reasons listed above and a basic understanding of human rights that insist that all individuals should aim to be cured. Curative methods such as chemotherapy are expensive procedures. According to Simoens et, al. (2010), the smallest proportion of hospital costs are in the palliative care unit. For some this may be a motivation to choose palliative over curative, however, the value

The autonomy of a competent patient is an issue not often debated in medical ethics. Refusal of unwanted treatment is a basic right, likened to the common law of battery, available to all people capable of a competent choice. These fundamental rules of medical ethics entered a completely new forum as medical technology developed highly effective life-sustaining care during the 20th century. Several watershed cases elucidated these emerging issues in the 1960’s and 70’s, none more effectively than that of Karen Ann Quinlan. Fundamentally, this case established that a once-competent patient without the possibility of recovery could have their autonomy exercised by a surrogate in regard to the