Do you think Ms. Robaczynski killed Mr. Gessner? Why or why not?
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Nurses are now frequently involved in heated debates on the topic of withholding or withdrawal of treatment, and the case of Ms. Robaczynski clearly demonstrates how controversial and multidimensional the issue is.
I would not state dogmatically that the nurse in the given situation can be called a killer, taking into consideration the hopeless condition of the patient. Yet, this does not imply that she acted ethically. The major mistake she committed in this situation was neglecting cultural, religious, and moral factors that could arise when the family of Mr. Gessner learned about his disconnection from the respirator (leaving alone legal implications that were inevitable). The central aspect of treatment withdrawal is ongoing communication with the family, since it is highly important to receive their consent and prepare them for the loss.
I believe that withholding treatment is an acceptable option when any further interventions are evidently futile and only add more suffering to the patient. In the present case, it is specifically indicated that the quality of life of Mr. Gessner was totally unacceptable as all the systems of his organism had already failed before the respirator was disconnected. A peaceful death was the only possible solution that could relieve the patient from a painful agony. This means that the nurse acted logically though, unfortunately, was not consistent. The first step she should have taken was to contact the family and explain that the state of the patient did not allow any further treatment.
They should have been given time to collect information, consult specialists, prepare for emotionally, and finally give their consent. It should not be forgotten that, no matter how grave the condition of the patient may be, most religions are opposed to wrongful death, which means that some religious families would never accept this course of actions. Moreover, if the patient had been conscious, it would have been obligatory to obtain his agreement to withdrawal of treatment. Thus, in my opinion, Ms. Robaczynski is guilty of unethical behaviour and neglect of duties but not of murder as her intentions were obviously good as well as her decision was well-grounded and merciful.
Would you view Ms. Robaczynskis actions differently if Mr. Gessner had asked to be disconnected from his respirator? Why or why not?
Taking into account the above-mentioned reasons, I would not view Ms. Robaczynski’s actions much differently if Mr. Gessner had asked to be disconnected from his respirator. I would still believe that this was the only right decision to make. However, I would perceive the approach as much more reasonable and ethical.
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Still, if we step away from the subjective emotional perception of the situation, we will see that from the perspective of the law, there was still nothing illegitimate in the nurse’s actions even without the patient’s direct request to switch off mechanical ventilation. The point is that euthanasia does not equal withdrawal of treatment when it is performed according to good medical practice by a specialist with the presence of solid reasons. In this case, the law attributes the cause of death to the patient’s condition but not to the decision made by a health care professional. Therefore, if a written medical verdict is present to verify the actions of Ms. Robaczynski’s, it means that she cannot be charged with murder. Neither should we forget that Mr. Gessner was totally unable to communicate with anyone, so it would have been ridiculous to expect that he could ask to be disconnected from the respirator.
My attitude to the nurse would not be different also because I understand how difficult and stressful such decisions may be and I would not like to find myself in the position of a person who has to choose between merciful killing and merciless treatment.