Margaret is a 95-year-old woman who now lives with her son, Dan. Margaret has suffered multiple strokes – one that caused her to lose most of her short and long-term memory. Other than memory loss, she is in good condition for her age. She has a good appetite, can walk with assistance, and interacts well with others. Her interaction is, however, characterized by an inability to remember who she or others are. She has only immediate awareness and cognition. She repeats questions that have already been answered. She can express wishes – but does not appear to be able to reason through a complex problem.
Before Margaret had her stroke, she had expressed to Dan that she never wanted to be kept alive through the use of artificial supports, feeding tubes, or things like that. She felt that she had lived a long life and that, if something should happen, she would like to be allowed to die gracefully. She asked Dan to be her health care agent, authorizing him to make health care decisions for her – even end-of-life questions about removal or refusal of life support. She never signed a living will. She signed a form designating her son as health care agent (with authorization to make decisions even involving the refusal or removal of life-support systems).
Recently, Margaret has begun to refuse to eat. When she eats, it does not stay down. She appears to have suffered another stroke – reducing further her capacity to think, express wants, and interact with others. She sits for hours in an almost catatonic state – responding to very few questions or statements by others. Dan takes her to the doctor who, after several tests and scans, diagnoses a partial blockage of her esophagus. She also has developed pneumonia. He says there are three things that can be done: nothing, an operation of the blockage, or the insertion of a feeding tube in her stomach. If nothing is done, she will die within several weeks from lack of nutrition and hydration. The physician doesn’t ask for Dan’s consent to treat the pneumonia – he simply orders the antibiotics.
Dan requests that an operation be done to open up her oesophagus. When surgeons visit, they decline to operate saying that with an individual of her age and condition, she would never make it through the operation. So, Dan is left with doing nothing or authorizing the insertion of a feeding tube. He consents to treating her pneumonia with antibiotics.
He asks more questions and finds that since she is in good physical condition, she could live indefinitely with the feeding tube. The physician says that it is not painful nor is it particularly bothersome to individuals who have it. The physician recommends inserting the feeding tube.
Questions for discussion:
According to our text, what is the purpose of making advance directives?
What kind of advance directive did Margaret give (written or verbal; statutory or non-statutory)?
What are the differences between active and passive euthanasia (in other words - is there a moral difference between letting someone die and doing something more intentional to hasten death)?
Do we have an obligation to always prolong life? Why/why not?
How do we balance non-malfeasance, beneficence and respect for autonomy?
What should Dan do in this case and why?
What approaches might the physician take -and which do you think are more appropriate?