It is important to note that any dilemma or problematic situation can be viewed differently depending on the ethical perspective used. The three normative ethical theories are deontological, consequentialist, and virtue theory. The former focuses on the action, the second emphasizes the consequence, and the latter is about a person’s virtue. The given case is a form of ‘do not resuscitate’ or DNR order, where a patient either needs to be saved or left to die as instructed.
The identified ethical issue in the case scenario is whether or not the hospital should put Jo Ellen on life support after being admitted with an overdose of medications mixed with alcohol consumption. Her son provides a notarized advance directive, which is a legal document about a person’s preference for a medical decision when such a decision can no longer be communicated on his or her own (American Cancer Society, 2022). The hospital must choose between helping Jo Ellen or following the patient’s notarized advance directive.
The case can be assessed from the perspective of three normative theories of ethics. The four principles of medical ethics include beneficence, autonomy, non-maleficence, and justice (Varkey, 2020). From the deontological perspective, a hospital and doctors must respect patient autonomy and decision, which means an action is ethical if it adheres to duty and moral righteousness (Frischhut, 2019). Thus, Jo Ellen’s DNR order must be followed and respected, and the hospital must not help her. In the case of utilitarianism, Jo Ellen’s death will cause suffering, and her rescue will bring life and happiness. Therefore, an ethical choice is to maximize pleasure over pain, which means putting the patient on life support (Frischhut, 2019). If the case is viewed from the perspective of virtue ethics, it is about the hospital’s and doctor’s embodiment of virtuous traits manifested in action (Frischhut, 2019). Both choices can be argued as being ethical because saving the patient demonstrates the doctor’s willingness to do good, whereas not saving shows his or her adherence to loyalty to the patient’s medical decision.
The key advantage of the deontological framework is that it provides the strictest and most direct adherence to the action itself or choice for the situation, but it is still questionable if autonomy outweighs beneficence. The utilitarian view’s strength is the fact that it is the simplest decision when focusing on short-term consequences, but its weakness can be found in the inability to assess the long-term ramifications. The advantage of virtue ethics is its flexibility, but it does not provide a clear answer since both options can be argued in support of each choice.
In conclusion, respecting the patient’s autonomy and the notarized advance directive is the right choice. It corresponds to the duty of a medical professional to respect the patient’s choice. In addition, it demonstrates the virtuousness in wisdom and loyalty to Jo Ellen’s medical decision. The main reason is that medicine is a structured practice conducted according to specific rules and responsibilities. A doctor is not free to act on his or her intuition but must follow the principles of medical practice, legal boundaries, and patient decisions. It should be noted that the legal document is substantive evidence to show Jo Ellen’s choice in this regard, and it is not up to the doctor to go against it.
References
American Cancer Society. (2022). What is an advance directive?
Frischhut, M. (2019). Normative theories of practical philosophy. In Markus Frischhut (Ed.), The ethical spirit of EU law (pp. 21-30). Springer.
Varkey, B. (2020). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30, 17-28.