Ethical Dilemma in End-of-Life Care: A Case Analysis of Dr. Claudio de la Rocha

QUESTION

Case Scenario

Case 1: Dr. Claudio de la Rocha

In October 1991, Ms. A, who had lung cancer and had been placed on a respirator at the former St. Mary’s Hospital in Timmins, Ont., informed family members that she wanted a breathing tube removed so that her suffering would end. They supported her decision and conveyed it to de la Rocha. In accordance with standard practice, he removed the tube and administered 40 mg of morphine in 3 doses to ensure that she did not experience a suffocating feeling. He broke with standard practice, however, by then administering potassium chloride, causing her heart to stop. In April 1993 he was convicted in criminal court of administering a noxious substance. His sentence was suspended, however, and he was given 3 years’ probation. In an April 1995 hearing before the Discipline Committee of the College of Physicians and Surgeons of Ontario he was charged with professional misconduct because of the conviction in court, as well as failure to maintain the standard of practice. He pleaded guilty to the first charge and the college did not proceed with the second. His penalty was a 90-day licence suspension that would be lifted if he wrote a guideline on withdrawing life support from terminally ill patients.2

Introduction – first paragraph that engages the reader’s attention and gives an overview, background, significance, and ethical dilemma of your topic.

i. Introduction “grabs” the reader and very effectively tells the reader where the paper is headed.

c. State your researched case scenario validated by formal literature reference.

Identify the ethical dilemma.

i. Personal experience can be added to your case scenario for comparison but should not be the focal point of the case scenario.

d. Identify your thesis statement using your case scenario relating to your topic.i. Your argument and justification of your position should be included, including APA format reference.

As a Filipino

e. State your point of view based on a reflection of your personal values on the ethical issue/dilemma presented. (i.e., can be ½ page or 1 page)i. Explain how your values/beliefs/culture, media and/or religion play a role in your ethical concern/issue

ii. Integrate how your values/beliefs/culture, media, and/or religionsupport or do not support your ethical issue/concern

iii. Then explain how the ethical issue you described above specifically links to social justice or any laws relating to your issue.

iv. Explain any existing laws, if applicable and how that affect your ethical concern/issues.

Identify how 2 different Ethical theories would have the opposing views with your topic. (i.e., can be ½ page or more)

i. Use the assumptions of two ethical theories; (deontology, utilitarianism,etc.) to explicate the ethical concerns within the contemporary issue. This is the concern you introduced in your introduction.

ii. Then choose one ethical theory, including your rationale, to justify your argument.

Identify how two or three Ethical Principles are conflicted in your ethical dilemma essay.(i.e., can be ½ page or more)

i. Use the assumptions of two or three ethical principles (veracity, beneficence etc.) to explicate the ethical concerns of this issues.

ii. Then choose two or three ethical principles, including your rationale, to justify your argument.

h. Identify relevant nursing standards or codes (CNO) (i.e., can be ½ page ormore)i. How is the nursing profession involved in this issue?

ii. Use the CNO, CNA, RPNAO to demonstrate how the nursing profession and/or standards/guidelines are engaged in addressing the ethical concerns arising from your issue.

iii. Identify legal considerations (RHPA, Nursing Act, Criminal Code, HumanRights, etc.)

Ethical Action: Identify and Describe the ethical framework that best fits with your ethical concern/issue. (i.e., can be ½ page or more)

i. Use your ethical decision framework to describe how you would work through the ethical concern/issue.j.

Conclusion – last paragraph, provides a summary of the most salient points.(i.e., can be ½)

i. Conclusion is persuasive, insightful, and clearly expressed. Does not raiseany new points.

ii. Conclusion draws on research data as well as substantial information and ideas already presented throughout

iii. Areas for future exploration or inquiry are relevant and insightful.

Summarization of key principles and theory, including implications for nursing practice.k References- last page

ANSWER

Ethical Dilemma in End-of-Life Care: A Case Analysis of Dr. Claudio de la Rocha

Introduction

This essay explores an ethical dilemma in end-of-life care through the case scenario of Dr. Claudio de la Rocha. In 1991, Dr. de la Rocha administered potassium chloride to a terminally ill patient, leading to her death, after removing her breathing tube and providing morphine. This case raises significant ethical questions about the role of physicians in end-of-life decision-making and the use of life-sustaining treatments. The ethical dilemma revolves around the balance between respecting patient autonomy, promoting compassionate care, and adhering to professional standards.

Identify the Ethical Dilemma

The ethical dilemma presented in this case is whether Dr. de la Rocha’s actions were justified in hastening the patient’s death to alleviate suffering and honor her wishes to end life-sustaining treatment. On one hand, there is the principle of patient autonomy, where the patient’s informed choice should be respected, especially in the context of terminal illness and unbearable suffering. On the other hand, there are concerns related to the ethical principles of beneficence and non-maleficence, where physicians must act in the patient’s best interest and refrain from causing harm.

Thesis Statement

The case of Dr. Claudio de la Rocha highlights the complex ethical dilemma surrounding end-of-life care decisions, involving patient autonomy, compassionate care, and adherence to professional standards. While hastening death to alleviate suffering may be seen as an act of compassion, it also raises concerns about the ethical boundaries of medical practice.

Personal Reflection on the Ethical Dilemma

As a Filipino, my cultural background places significant importance on family values and respecting the wishes of the elderly. This perspective aligns with the principle of patient autonomy, where individuals have the right to make decisions about their own health and medical treatments. In this case, my values support the idea of honoring the patient’s wishes to end life-sustaining treatment to relieve suffering.

However, my ethical concern arises when considering the potential conflict with the ethical principle of non-maleficence. Administering potassium chloride to intentionally hasten death raises questions about causing harm and the potential for abuse in end-of-life care decisions. Therefore, I believe it is essential to carefully consider and balance the principles of autonomy, beneficence, and non-maleficence in such situations.

Opposing Ethical Views

Utilitarianism, as an ethical theory, might support Dr. de la Rocha’s actions, as they aimed to relieve the patient’s suffering and improve overall well-being. Utilitarianism evaluates actions based on their potential to bring about the greatest good for the greatest number of people. In this case, hastening the patient’s death could be justified as it spared her from prolonged suffering.

In contrast, deontology may argue against Dr. de la Rocha’s actions, as they violate the duty to respect patient autonomy and the prohibition of causing harm. Deontological ethics considers actions as intrinsically right or wrong, irrespective of their consequences. In this context, hastening death may be seen as a violation of the duty to preserve life and respect the patient’s right to make decisions about her own healthcare.

Conflicting Ethical Principles

The ethical dilemma presented in this case involves a conflict between the principles of patient autonomy and non-maleficence. Respecting the patient’s autonomy means honoring her wishes to discontinue life-sustaining treatment, while non-maleficence implies avoiding causing harm to the patient. Balancing these principles requires careful consideration of the patient’s values, beliefs, and the potential consequences of medical interventions.

Relevant Nursing Standards and Legal Considerations

The College of Nurses of Ontario (CNO) emphasizes the importance of respecting patient autonomy and promoting patient-centered care. Nurses are required to engage in ethical decision-making and uphold the principles of beneficence, non-maleficence, and justice in their practice. The nursing profession is actively engaged in addressing ethical concerns in end-of-life care by providing guidelines and education to support compassionate and patient-centered care.

Ethical Action

The ethical framework that best fits with this ethical concern is the principle-based approach. By using a principled ethical decision-making framework, healthcare professionals can systematically analyze the ethical dilemma and arrive at a morally justified course of action. In this case, the principle-based approach would involve a comprehensive assessment of the patient’s values, beliefs, and best interests, while considering the potential consequences of medical interventions.

Conclusion

The case of Dr. Claudio de la Rocha exemplifies the complex ethical issues surrounding end-of-life care decisions. Balancing patient autonomy, compassionate care, and adherence to professional standards requires thoughtful and principled decision-making. By using ethical frameworks and principles, healthcare professionals can navigate these dilemmas to provide the highest quality of care while respecting patients‘ wishes and values.