HSC312 Ethics of Healthcare
Autonomy and Terminal Illness
Professor Michael Senf
I do not think the attending physician should write a DNR order without informing the patient. The patient’s autonomous decision should be respected. Although an autonomous choice is one made from available options, but that this patient's demand for care is unrealistic, Sally has the right to a diagnosis and treatment, if consented to, the physician has a duty to treat. Autonomy is the capacity to take decisions and undertake activities when armed with knowledge about the causes of the illness, sufficient information thereof and in the absence of duress, either internal or external. With autonomy we express our system of values and what is good for each patient is decided. The more chronic the illness of patients and the more their treatment is under question, the more autonomy is called for; this becoming greater the more information is available. Pain is no longer a symptom to be endured by the patient. If Sally wants pain relief, the physician has an ethical and an almost certain legal obligation to provide it. Pain relief may hasten the death of a terminally ill patient. Provided the intent is to relieve pain, the hastening of death is neither ethically nor legally wrong. Sally stated that she was in pain and out of breath and she wants treatment to help with these issues as well as to prolong her life on earth. Although aware of his wife’s condition, Sally’s husband stated he wants his wife to be comfortable which is a reason for the physician to respect and honor Sally’s decision and prevent further stress and aggravation which could lead to her being uncomfortable. The doctrine of futility seems to be the reason for the physician’s decision to want to write a DNR. Even if futility can be established for denial of treatment of Sally’s primary disease, there may still be a duty to treat other medical problems that may exist such as her shortness...
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