Question

read the below case and answer all the question

Mrs. Doe is a 33 year old paramedic who has discussed end-of-life decisions including the importance of Do Not Resuscitate orders with her husband. Mrs. Doe (having lost her brother years earlier) expressed to her husband that she never wanted to be kept alive by machines. She also expressed a desire to sign a DNR order but had not done so yet. Eighteen weeks (4 ½ months) into her second pregnancy, Mrs. Doe collapsed on the living room floor. Mr. Doe performed CPR and called 911. She was put on life support after suffering a suspected pulmonary embolism but never regained consciousness and was considered brain dead. Knowing his wife’s wishes, Mr. Doe makes the decision that she would NOT want to be kept alive since her quality of life would never be what it was and wants her removed from life support and be allowed to die with dignity. However, the fetus is still viable with a normal heart beat. If delivered now, the fetus would not be viable, however, if the mother was kept “alive” and the fetus had time to develop to 24-28 weeks; the fetus could survive and be delivered by cesarean. To complicate matters, Mrs. Doe lives in Texas where state law nulls a DNR order if a woman is pregnant because there is a legal duty to keep her alive while the fetus is viable.

1-Do you as the attending physician honor the patient’s wishes and remove life support knowing that the patient AND the unborn child will die or do you follow state law and keep the mother on life support for the sake of the developing fetus?

2- I         WOULD or WOULD NOT        remove the patient from life support?

3-Ethical considerations: What morals and values are you basing your decision on? What is the effect of this action? Will, it set precedence for others? Where is the ethical line drawn when it relates to a medical issue in letting a family member make a decision in such a short time period and under dire circumstances? Should a sense of right or wrong outweigh the rights of a person to determine her own medical care; even if that means consequences for an unborn child?

4-

Legal Considerations:   Please answer the questions based on your decision.

1. Do you believe you have a duty to care? What do you believe is a reasonable standard of care?
2. Are you potentially breaching your duty?
3. Was there potential injuries?

4. Is there a direct cause to your actions and could you foresee that happening?

5-Can your actions be considered negligent

Answer 1

Q. No. 1. Answer :

No, I can not follow the state law and to keep mother on life support, for the sake of developing fetus, because fetus is 4 1/2 month only, still it has to grow up to 36 to 38 weeks of gestational age, if we will support the mother by mechanically, there is no proper supply of nutrients and blood to the fetus to develop properly, because mother is not in consciousness.

So even though fetus grows after the delivery there may be a so many complications like any intrauterine growth retardation, premature delivery, low birth weight, and congenital malformations ect.

So we can not grow properly the fetus with out alive mother.

Q. No. 2. Answer :

Yes, if there is no chance of aliving mother we can remove the mother from life support, because we should not do harm for the client unnecessarily. This is one of the ethical principle that is nonmaleficence.

Q. No. 3. Answer :

* Nonmaleficence is one of the ethical and moral values here, it is one of the benefit to the patient.

And it is precedent to the others also. With out this if the patient attenders want to alive the baby by mechanical support to the mother, there will be a consequences to the baby growth.

Like intrauterine growth retardation, intrauterine death, low birth weight baby ect.

Q. No. 5. Answer :

No, our actions should not be considered as negligent, because we are following Nonmaleficence here, we are not harming the patient and we are going to reducing the complications to the baby also.

So it's not negligent.