Introduction
Yusef Camp is a nine-year-old child who has been brain dead for four months. Several compounding factors have developed: one of his feet has become gangrenous, and maggots have infested his respiratory tract. However, his father insists that treatment should not be stopped, and the boy may recover from his coma. This situation raises interesting ethical questions, as Yusuf is extremely unlikely to recover, and continuing treatment consumes a significant amount of time and resources that would be better used to help other patients.
Ethical Concerns
At the time of the situation, local legislation had no law to authorize death pronouncement based on brain criteria alone. Because of this, the hospital staff could not discontinue treatment. However, other signs of physical deterioration suggest that the patient has died. The gangrene in the patient’s foot, as well as the maggot infestation of his respiratory tract, are indicative of decomposition.
Extrapolating these symptoms would allow physicians to conclude that even if Yusuf were to recover his brain function, his quality of life would be extremely low. Furthermore, modern studies posit that “death is not a single event but a process, and … it is not necessary to wait for the death of the whole organism … to be certain” (Smith & Citerio, 2017, p. 1384). These notions are strong arguments in favor of the futility of continuing Yusuf’s treatment.
The father’s requests for continuing life-saving treatment have a religious element. Patient-centered care requires this side of the issue to be considered in addition to other aspects of the case. Although no authoritative opinion exists on the matter, Shiite scholars suggest that such decisions should be made by “those who were well-informed about saving lives, implying that physicians were best positioned in this regard” (Chakraborty et al., 2017, p. 614). Therefore, their opinion can provide some grounds for overriding the Muslim father’s refusal to withdraw life-prolonging treatment.
Another major consideration in Yusuf’s case is the cost of his treatment. Maintaining a patient on life support is a significant strain on the hospital’s limited resources, and one can argue that said resources would benefit other patients more. However, this concern is secondary compared to the primary question of the futility of continued treatment. In Yusuf’s case, one can argue that continued treatment contradicts the principle of beneficence, as it prolongs the patient’s suffering and gives his family false hopes. Furthermore, it contradicts the principle of justice, since the same resources are ultimately wasted on an effort that serves no benefit.
Considering other patients’ wellbeing is, therefore, included in the ethical considerations regarding providing futile treatment. The physician is to make the final decision in this matter, as “Physicians are under no ethical obligation to render interventions that they judge have no realistic likelihood of benefit to the patient” (American College of Emergency Physicians [ACEP], 2018, p. 1). Ultimately, while the practical side of Yusuf’s issue cannot be brought into argument directly, it is indirectly considered in the decision of whether his treatment is futile.
Yusuf Camp’s case raises several complex ethical questions related to when a patient is considered dead, to what extent surrogate decision makers’ wishes should be followed, and when treatment becomes futile. Ultimately, these difficult decisions need to be made by a physician based on the treatment’s goal and the likelihood that it will be achieved. While surrogate decision makers’ personal and religious preferences need to be considered, physicians are not obligated to continue treatment that is deemed futile. This decision takes other patients’ wellbeing into consideration, as well, by ensuring that hospital resources, including health care providers’ time, are not wasted on procedures that are extremely unlikely to bring any benefit.
References
American College of Emergency Physicians (2017). Nonbeneficial (“Futile”) Emergency Medical Interventions. Dallas, TX: Author. Web.
Chakraborty, R., El-Jawahri, A. R., Litzow, M. R., Syrjala, K. L., Parnes, A. D., & Hashmi, S. K. (2017). A systematic review of religious beliefs about major end-of-life issues in the five major world religions. Palliative and Supportive Care, 15(05), 609-622. Web.
Smith, M., & Citerio, G. (2017). Death determined by neurological criteria: the next steps. Intensive Care Medicine, 43(9), 1383-1385. Web.