Case Study: End Of Life Decisions—George Is A Success 039605

Case Study End Of Life Decisionsgeorge Is A Successful Attorney In Hi

Case Study: End of Life Decisions George is a successful attorney in his mid-fifties. He is also a legal scholar, holding a teaching post at the local university law school in Oregon. George is also actively involved in his teenage son’s basketball league, coaching regularly for their team. Recently, George has experienced muscle weakness and unresponsive muscle coordination. He was forced to seek medical attention after he fell and injured his hip.

After an examination at the local hospital following his fall, the attending physician suspected that George may be showing early symptoms for amyotrophic lateral sclerosis (ALS), a degenerative disease affecting the nerve cells in the brain and spinal cord. The week following the initial examination, further testing revealed a positive diagnosis of ALS. ALS is progressive and gradually causes motor neuron deterioration and muscle atrophy to the point of complete muscle control loss. There is currently no cure for ALS, and the median life expectancy is between 3 and 4 years, though it is not uncommon for some to live 10 or more years. The progressive muscle atrophy and deterioration of motor neurons lead to the loss of the ability to speak, move, eat, and breathe.

However, sight, touch, hearing, taste, and smell are not affected. Patients will be wheelchair bound and eventually need permanent ventilator support to assist with breathing. George and his family are devastated by the diagnosis. George knows that treatment options only attempt to slow down the degeneration, but the symptoms will eventually manifest. He will eventually be wheelchair bound and be unable to move, eat, speak, or even breathe on his own.

In contemplating his future life with ALS, George begins to dread the prospect of losing his mobility and even speech. He imagines his life in complete dependence upon others for basic everyday functions and perceives the possibility of eventually degenerating to the point at which he is a prisoner in his own body. Would he be willing to undergo such torture, such loss of his own dignity and power? George thus begins inquiring about the possibility of voluntary euthanasia.

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The case of George, a middle-aged attorney diagnosed with amyotrophic lateral sclerosis (ALS), presents a complex and ethically challenging scenario concerning end-of-life decisions. ALS is a devastating neurodegenerative disorder characterized by progressive muscle weakness, paralysis, and eventual loss of respiratory function, typically leading to death within 3 to 4 years after diagnosis. Given the incurability and the profound loss of autonomy associated with the disease, patients like George often contemplate options such as palliative care, voluntary euthanasia, or physician-assisted death to maintain dignity and control over their lives.

In discussing end-of-life choices, it is essential to consider the ethical principles of autonomy, beneficence, non-maleficence, and justice. Autonomy—the patient's right to make decisions about their own body and life—is central to contemporary bioethics and supports the argument for voluntary euthanasia or physician-assisted death when patients are competent and fully informed. George’s scenario exemplifies this principle, as he is keenly aware of his prognosis and the potential decline of his physical and mental faculties, which fuels his desire to avoid a fate of complete dependence and loss of dignity.

Beneficence and non-maleficence, principles that demand healthcare providers aim to do good and avoid harm, also play pivotal roles in end-of-life decisions. Treatments aimed at prolonging life in ALS primarily focus on symptom management and slowing disease progression. However, these interventions can sometimes be burdensome, extending suffering without the prospect of meaningful recovery. For George, considering voluntary euthanasia may align with beneficence if it alleviates his impending suffering and preserves his dignity. Conversely, healthcare providers must accede to the principle of non-maleficence by ensuring that any actions taken do not inflict additional harm or violate legal and ethical standards.

Legal frameworks surrounding euthanasia and physician-assisted death vary considerably worldwide. In Oregon, where George resides, the Death with Dignity Act permits physician-assisted death under specific conditions, but euthanasia remains illegal (Oregon Health Authority, 2020). Under Oregon law, a competent terminally ill patient with a prognosis of six months or less can request and receive prescribed medication to hasten death voluntarily. However, the act of euthanasia, involving a physician actively administering a lethal substance, is prohibited. This legal context significantly influences how patients like George can pursue their end-of-life preferences.

The ethical legitimacy of voluntary euthanasia hinges upon rigorous safeguards, including competency assessments, informed consent, and clear intentions to prevent misuse or coercion (Beauchamp & Childress, 2013). For George, his personal values, life philosophy, and understanding of the legal environment shape his decision-making process. Counselors and healthcare providers can support him by providing comprehensive information about his options, risks, and potential outcomes, ensuring his autonomy is respected and that his choice is well-informed.

Furthermore, the psychological and emotional aspects of living with ALS cannot be overlooked. Patients often grapple with anticipatory grief, depression, and feelings of helplessness (Lund et al., 2018). Support from mental health professionals, support groups, and spiritual advisors can help individuals like George cope with these challenges. Addressing the psychological dimensions is a vital component of patient-centered care, ensuring decisions align with the patient's values and emotional well-being.

In conclusion, George's case exemplifies the complex interplay of ethical, legal, medical, and emotional factors involved in end-of-life decisions for ALS patients. While current laws in Oregon permit physician-assisted death, voluntary euthanasia remains illegal. Respecting patient autonomy, providing comprehensive information, and safeguarding ethical principles are essential to navigating these difficult choices. Ultimately, the decision to pursue a hastened death must be made with careful consideration, compassionate support, and adherence to legal standards to uphold the dignity and rights of individuals facing terminal illness.

References

• Beauchamp, T. L., & Childress, J. F. (2013). Principles of Biomedical Ethics (7th ed.). Oxford University Press.
• Lund, S., Daly, J., & Waugh, E. (2018). Psychological aspects of living with ALS: Coping mechanisms and mental health. Journal of Palliative Medicine, 21(2), 232-238.
• Oregon Health Authority. (2020). Oregon Death with Dignity Act: 2020 Data Report. Oregon Government.
• Krementz, D., & Sterk, S. (2019). Ethical dilemmas in assisted dying: International perspectives. Ethics & Medicine, 35(4), 245-253.
• Quill, T. E., & Lo, B. (2014). Support patients wishing to hasten death. New England Journal of Medicine, 370(24), 2247-2251.
• Appelbaum, P. S. (2017). Ethical issues in end-of-life care. The Psychiatric Clinics of North America, 40(3), 635-651.
• Sulmasy, D. P., & Snyder, L. (2016). Understanding patients' perspectives on end-of-life decisions: A qualitative analysis. Journal of Medical Ethics, 42(11), 674-679.
• Chochinov, H. M., & Kristjanson, L. J. (2018). Dignity and dignity preservation in terminal illness. Journal of Palliative Medicine, 21(7), 991-996.
• Williams, J. C. (2015). The ethics of assisted dying. Journal of Medical Ethics, 41(9), 644-649.
• Karnik, N., & Weiss, M. (2020). Legal and ethical considerations in euthanasia and assisted dying. Journal of Law, Medicine & Ethics, 48(3), 408-418.