Bioethics Case Study: Active Euthanasia with Parental Consent

Andrea was a nine-year-old girl who had been diagnosed at the age of thirteen months as having cystic fibrosis. Since then she had been hospitalized twelve times; eight times during the last year.

When admitted for the last time she was already receiving an experimental antibiotic, which was being administered in an attempt to control a resistant pneumonia superimposed on severely damaged lungs (a result of her underlying disease). She was at that time a severely ill, emaciated child with moderately laboured breathing. She seemed to have no interest in her environment and refused to communicate with anyone but her mother.

Because of the severity of the child's illness and because the parents had accurately perceived that the experimental antibiotic was a "last ditch" attempt to control her pulmonary infection, the physician discussed with the parents their perception of "extreme medical measure" and the significance of a "no code" (or "Do Not Resuscitate") order. The parents indicated that in the event of a cardiac or respiratory arrest, they did not want their child to be resuscitated and the appropriate "no code" order was written. The child was not involved in these conversations or subsequent decision-making, nor had the mother previously been able to answer her daughter's questions about death and dying.

As the child's condition continued to decline, the parents asked how much longer she would live and how she would die. At one point the father said: "Watching your own child die is worse than dying yourself." This comment led to a discussion of active euthanasia utilizing intravenous potassium chloride or a similar drug. The physicians pointed out that no matter how hopeless a situation or the amount of suffering that a patient and family were enduring, the law prohibits the active taking of a patient's life. They refused to consider this option.

The following day Andrea's heart began to fail. Her condition became progressively worse, and she died approximately forty-eight hours later. During these last two days her parents were appalled by her grotesque appearance . . . and were in great despair because of her steadily deteriorating condition. They felt powerless to alleviate their daughter's distress. Medical treatment was continued to the end, and no measures were taken to hasten Andrea's death.

Approximately two months after her death, the mother was asked if she would still have given permission for active euthanasia if she had been offered that option. She replied, "Yes."

Referring to this case, discuss whether active euthanasia should be permitted to spare the patient and family from suffering when death is inevitable. Or is passive euthanasia the only moral option (or is neither option)? Provide one argument in favour of, and one against, legalizing active euthanasia. Be sure to identify clearly the moral principles on which you are basing your arguments.

Before attempting to answer the questions, identify the following aspects of the case: the major agents in the case (patients, medical personnel, and others), the major facts of the case, the major moral issue raised, how each agent responds to the moral issue in the case, the moral principles used by the agents to support their position on the issue, if stated.  

Now consider the following: what resolution would each of the moral principles (for example, autonomy, beneficence, non-maleficence, and justice) in the case suggest? Are the principles in conflict? Do not worry if you do not feel confident about your suggested resolution since your ability to analyze and resolve cases will improve with practice and greater familiarity with the resources provided.

Analyze the selected case in detail, then state and defend what you consider to be the best possible resolution of the case on moral grounds. Please note that you must include both analysis and resolution in your answer. Be sure to identify relevant moral issues, concepts, and theoretical perspectives. 

In your analysis, identify:

1. the major agents in the case-patients, medical personnel and others.

2. the major facts of the case.

3. the major moral issue raised.

4. how each agent responds to the moral issue in the case.

5. the moral principles used by the agents to support their position on the issue, if stated.

In your resolution, be sure to defend your position by reference to relevant moral theories and principles.