Some Issues Raised:
Roberta W. is a 67-year-old unmarried female. A retired teacher,
she is care for by her brother and his wife in their home. Roberta W. suffers
from severe emphysema and related heart problems. She also suffers from
a collection of nagging medical problems, including bloatedness, hemorrhoids,
and a hernia. She is largely confined to her bed. Occasionally she feels
well enough to sit up for an hour or so, by eating, going to the bathroom,
and personal grooming are experienced as exhausting and burdensome. Roberta
W. is weary of the circumstances of her life, and she regrets being a burden
to her brother and his wife, although they do not seem to resent the demands
placed on them by her care. Roberta W.'s prognosis is somewhat unclear,
and she may well live for several years in her present state, but she continually
says that she would rather be dead. At one point when her hernia was especially
bothersome to her, she had a conversation with her physician, Dr. R. He
said that the hernia could easily be corrected by surgery, but that is
was very unlikely that she would survive the surgery because of her emphysema
and heart problems. She said that she wanted the surgery anyway. "If I
die, fine; if I survive, at least I have one less problem." Dr. R. responded
that no responsible surgeon would perform an operation in such circumstances.
A short time later Roberta W. asks Dr. R. to admit her to the hospital.
Her plan is to stop drinking and to refuse any form of medical hydration,
but she wants to be in the hospital so that any discomfort can be controlled
through medication. She has read that patients who refuse all hydration
will usually die within a week or so.
Some Discussion Questions:
1. Describe Ms. W.'s phenomenology (facets of dignity) here.
2. Has Ms. W. developed any virtues which can guide her through
her difficulties?
4. What is the extent of the legitimate exercise of Ms. W.'s self-determination?
5. Is Ms. W.'s dignity and well-being preserved and promoted by
Dr. R.?
6. Does Dr. R. have a duty to honor Ms. W.'s final request?
7. What ethical principle(s) [autonomy, beneficence, justice, paternalism]
should govern this case?
8. What strategies would you implement to bring this case to a resolution
which maximizes the well-being of the patient?