Margie Wilson, a 95 year old woman and patient at Golden Oaks Rehabilitation Center located on the grounds of Marion General Hospital, is dealing with some difficult times after losing her son, Williams, this past week. Within the past five years, she has also had to deal with the passing of her husband of 68 years, Earl, and another son who died in a motor vehicle accident, Jacob. Margie is having a very difficult time taking this all in and is not feeling alone. She has come to the conclusion that she no longer wants to live her life alone.
She wants to end her life and is requesting that the one thing that’s keeping her alive, her pacemaker, be disconnected. Two years ago Margie suffered a heart attack that almost took her life, which resulted in her having the electronic pacemaker implanted. The pacemaker keeps Margie’s heart rhythm at 100% pace, which is what keeps her alive. With all her family gone, she has no desire to live anymore and is requesting that her pacemaker be removed so that she can be reunited with her family.
Margie has spoken with Cindy Macklin, the Nursing Home Administrator, and has told her what she would like to happen. She has requested that Cindy call Dr. Vigay, who is the cardiologist surgeon who originally implanted the pacemaker. Dr. Vigay was stunned because in the 20 years of his practice he has never had a request from his patents. He has pretty much declined her request and has asked that she allow time to get her past her current state of mind and back to normal. Margie is now extremely upset and determined and is now requesting to see the Golden Oaks social worker, Jane Robison, MSW.
Jane meets with Margie for more than an hour discussing and exploring all her options. In this case, there are morals and conflicts involved. There are certain ethical, moral and legal conflicts that need to be determined. Morals are beliefs and values that conform to normal standards of what is right and wrong and deal with people’s habits of conduct (www. ehow. com). The moral principles of ethics that are involved include: Beneficence – doing good, demonstrating kindness, showing compassion, and helping others Nonmaleficence – avoiding the infliction of harm
Justice – the duty to be fair in the distribution of benefits and risks Autonomy – recognizing an individual’s right to make his or her own decisions The morals that are in conflict are nonmaleficence, justice and autonomy. The top priority of the doctors, nurses, social worker, and ethics committee is to make sure that nonmaleficence is not being implemented while considering Margie’s right to make her own decision about wanting to live and the risks and benefits that could go along with Margie’s request to remove her pacemaker. The dilemma here consists of Margie wanting her doctor to assist with taking her life by removing her pacemaker.
Margie has lost her desire to live because of the loss of her family and wants to be with them. There are several ethical theories that play apart in this dilemma. Normative Ethics – the attempt to determine what moral standards should be followed so that human behavior and conduct are morally right (Pozgar, p 369). Consequential Ethics – emphasizing that the morally right action is whatever action leads to the maximum balance of good over evil (Pozgar, p. 369). Utilitarian Ethics – doing the greatest good for the most people (Pozgar, p. 370).
Deontologic Ethics – focusing on one’s duties to others and others’ rights including telling the truth and keeping your promises (Pozgar, p. 371). As the ethics committee chairman, we do agree that there is a dilemma here. We are all on the same accord and have been informed with all the information about the case. Dr. Vigay, Jane Robison, Cindy Macklin, and I have all come together and presented all the information and facts that we know about the dilemma to the members of the committee to ensure that no one was left out about any details of this dilemma.
Dr. Vigay informed the committee that removing Margie’s pacemaker would violate the ethics principles of beneficence, nonmaleficence, and justice. If he followed through with Margie’s request, he would be going against helping others, avoiding or causing harm to patients, and disregarding the benefits and risks of Margie by performing the requested actions. Jane Robison has expressed that doing what Margie has requested would not be good for Margie nor her profession due to the ethics standards that are withheld for all the patients.
She believes that with time Margie will have a change of heart and appreciate her life being spared. Cindy Macklin is in agreement with everyone else in not assisting Margie with taking her life due to overwhelming circumstances she has faced within the past few years. Therefore, after all the recommendations and suggestions from all involved and the members of the ethics committee, Margie’s request to have her pacemaker removed has been denied due to the all the ethical standards and the fact that it is not right to allow or assist anyone in taking their own life.
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