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Ethical Reasoning

What elements are relevant to the choice in this new situation? Clearly it is of great importance that the patient has emphatically expressed his own wishes in the matter. At this point the staff is provided with the strongest sort of consent element: an informed judgment to refuse treatment made by the patient himself [Item 1]. This consideration heavily favors the judgment of the further resuscitation would be morally wrong. In legal terms resuscitation would constitute a battery, and the moral assessment here would concur with the law.

Furthermore, the patient has supplied a clear and emphatic personal assessment of his quality of life [Item 6]. An observer might not agree with this assessment [Item 7] but there is little (if any) basis for preferring an external assessment to the patient’s own in this case. A quality-of-life judgment is made up of at least two elements: 1) a prediction about what future life events are in prospect for the patient, and 2) an evaluation of these life events based on the patient’s fundamental values. 

In some cases an observer might be in a better position than the patient himself to make judgments of the first type—e.g., a physician making a technical prognosis based on her past professional experience with similar cases. There might even be some situation in which an observer can ascertain the patient’s fundamental values better than the person himself—e.g., a friend who knows that the person is likely to get over his broken heart and find a new romantic interest in time, whereas the lovestruck one insists, “There will never be anyone else for me.” However, neither of these sorts of situations apply in the present case. This patient is likely know his central values, and he understands the prospects for satisfaction of those values. Thus his own quality-of-life judgment must prevail.

What (if anything) would favor a decision to resuscitate under these  conditions? There is the considering that the immediate condition is probably reversible [Item 13], although the fact remains that the underlying conditions are not. A strong sanctity-of-life principle [Item 43] would emphatically favor resuscitation. There is enough ambiguity in the law on these matters [Item 41] to make one nervous about any decision reached, but one is more likely to encounter civil suits and/or criminal prosecution as a result of non treatment than from an error in the opposite direction.

However, disturbing as this legal situation might be, protecting oneself from suit is not as weighty a factor in moral terms as the consent and quality-of-life elements. Thus, the weight of moral considerations in these circumstances would make non resuscitation not only moral permissible, but even morally obligatory.

The “time to heal” is past, instead, it is now “a time to embrace,” “a time to love,” and otherwise a time to comfort and sustain this patient as he faces the inevitable “time to die.”

Read on to see what was actually done in this case.