Letting die vs. Assisted dying

The Case

In 2009, Michael Scheel and his father decided to oversee the construction of their new house in California. Once they arrived at the site, they parked their car in a creek bed that they considered dry. It is worth noting that it is the common practice in desert areas without good roads or in regions that have dirt tracks. Once they were through with the inspection of the work, the men returned to their parked car. However, the vehicle failed to start; therefore, they resorted to working on the car spark plugs. Unfortunately, there was a damaged gas line beneath the creek bed where the car had been parked. Therefore, when the two men tried to accelerate the vehicle, a spark occurred, causing an explosion that killed Scheel’s father. On the other hand, Scheel sustained second- and third-degree burns to 68% of his body. Before the incident, Scheel was a healthy young engineer and an amateur golf player. As he attempted to crawl from the scene of the accident, the man saw a ranger passing nearby and begged him to shoot him. He made a similar request when emergency paramedics arrived at the scene of the accident.

When the physicians managed to foretell the prognosis, they determined that the patient’s chances of survival accounted for approximately 20 percent. However, paramedics also stated that the quality of Scheel’s life was severely interfered with. He made several requests to die, but the medical staff rejected all of them. In fact, he even tried unsuccessfully to commit suicide. For instance, there was a case when he crawled from his hospital bed and tried to throw himself down the staircase. By the time he left the hospital, the man had a gross infection and hoped that he could die from sepsis, which did not happen. He was again institutionalized in the Park Road Referral Hospital and received treatment during 198 days against his will. Scheel was in a critical condition at the time he was admitted to the hospital, and his mother was to make a decision on his behalf. Therefore, doctors adhered to whatever position she felt appropriate for her son’s care. Notably, the mother was a religious person who believed that only God could begin and end the life of anyone. Consequently, her son’s request to end his life was queer to the woman. Thus, even after physicians proved that Scheel had become competent to make his decisions, the man’s requests were still declined. However, the accident left Scheel severely disfigured and blind, except for his hands that could function partially. Nevertheless, he has become a millionaire after he received compensation from the gas company.

Step 1: Definition of the Problem

1. The identified problem is that Scheel incurred serious second- and third-degree burns to 68% of his body after the gas explosion and felt that he could not survive.

2. The patient felt that owing to the serious bodily injuries that he acquired and the magnitude of pain that he was going through, he could not preserve his existence. Therefore, he wanted to end his life. As mentioned earlier, while still under the wreckage of the car, the man asked the ranger who was passing nearby to shoot him, but the ranger refused. In addition, when the emergency paramedics arrived at the scene of the accident, Scheel made the same request to have his life terminated, which was also declined. At the hospital, he crawled from his bed and tried to end his life at the staircase, but hospital officials noticed his actions and stopped him from committing suicide. At first, the health care professionals believed that even though his condition was grave, it could change for the better. Therefore, they rejected his decision to end his life. However, they may have also declined it because his conditions may have been so severe that a close family member may have been required to make the final decision. It appears that when Scheel was first admitted, the mother or any other close family associate was not around. Thus, the health care professionals did not want to take the responsibility that they believed was not theirs or they may have feared subsequent legal implications.

   According to van Boagert and Ogunbanjo (2010), there are moral and legal controversies surrounding cases where individuals decide that they want to end their lives. For instance, in this case, Scheel has attempted to commit suicide and it is worth mentioning that there are no laws that prohibit people from making away with themselves. Moreover, it is evident that Scheel lacked physical strength; hence he sought the assistance of others and requested his health care providers to help him. Nevertheless, it is illegal in numerous countries to assist other people in dying as it is considered murder (van Boagert & Ogunbanjo, 2010). However, even in countries where the government allows such a practice, it has to take place within a set of the legal framework of the particular country. The person responsible for making a decision, in this case, was the mother though she later turned down the responsibility because of her spiritual beliefs.

3. If the patient was responsible for the decision of “letting die”, it may lead to the analysis of the Scheel’s mental state and the adherence to specific steps before terminating his life. For example, it would be necessary to consider whether a patient is conscious. According to van Boagert and Ogunbanjo (2010), a terminally ill but conscious individual may reject life-supporting intervention, which is the Scheel’s case. The patient may have chosen the option because his medical condition may have left him unconscious at that time. However, the problem arises from the fact that his mother was a staunch believer in God beginning and ending the life of a person. Therefore, she could not decide the fate of her son’s life. It is also crucial to consider the possibility that the patient may have made a will or directed in advance what should be done in case he cannot make a choice. If that was the case, then the health care professionals could have had the legal authority to withhold life-supporting treatments (McCoy, 2010).

   In the case of Scheel, there was no legal document to let him request for terminating his life. Unless there is a living will or an advance directive determined in a court of law, the decisions will be laid in the hands of a proxy (Ost, 2010). Even though courts support the self-determination of competent patients, who have rejected treatment, it still should examine the medical conditions and prognosis before authorizing proxy decisions. Such proxies could be the spouse and the parent of the patient as well as the oldest sibling in the family. Proxies should support and represent what they honestly believe the patient could have chosen if he were competent. Therefore, the dilemma here remains what Scheel may have picked if he were competent. There is still a question whether he could have chosen to die in case he also supported the spiritual beliefs of his mother.

4. Further information is needed to determine whether the patient had prepared a living will or an advance directive regarding what he wanted in case he became incompetent. The lack of this vital information could have been the reason both health care professionals and the mother were reluctant to terminate the life of Scheel when he was terminally ill.
5. The alternative that could have been appropriate to the patient’s goal of dying is court’s decision. There are instances when the court can decide to give a terminally ill patient the right to choose to die. However, first, the court has to check the medical condition and the existence of the will, which indicates that the patient had chosen to die in case he became incompetent. This alternative is critical to the self-determination (van Boagert & Ogunbanjo, 2010).

Step 2: Analysis of Factors to Facilitate Shared Decision-Making

1. In this case, Mr. Scheel was not competent to make decisions to end his life. Apparently, he underwent immense pain that may have compromised his ability to think straight and make informed judgments. It is evident that Scheel may have suffered serious injuries; however, he managed to survive in the end and became a millionaire afterward. These facts make his earlier decision to let him die not well informed.
2. As mentioned above, the patient’s decision was not fully informed. He may have thought that he could not survive because of the magnitude of the injuries that he sustained, thus, he chose the wrong option of dying. On the other hand, the health care professionals were well informed because they may have known that Scheel would eventually recover. In addition, the physicians may have realized the legal implications of their decision to end the patient’s life.
3. There are both clear and unclear ethical components. For the health care professionals, the ethical component that prohibits them from ending the life of a terminally ill patient, guided and restrained them from choosing the patient’s option (death). The medical staff knew what their code of ethics stipulates, thus, they could not violate it. On the other hand, there was no mentioning of any living will or advance decision regarding the treatment Scheel wanted to receive in case he became incompetent. This factor prevented both the proxy (the mother) and the health care professionals from making an uninformed decision, namely the death option.
4. The patient’s family appeared not to have relevant information. While Scheel has chosen to end his life, the mother was not favorable to his decision. It is apparent that if the mother had relevant information that Scheel had prepared when he was competent, then both the mother and the son could have reached a verdict.
5. The patient cannot reverse the decision when he is incompetent. However, he may choose to do so when he can make an independent judgment without the influence of other people.

Step 3: Ethical Issue

1. The patient has the ethical choice to live because the health care professionals who have the relevant knowledge on how to deal with his condition are against terminating his life. However, there might be the possibility that the patient had deposited his will with the appropriate authority regarding the ending of his life in case he became incompetent. In this case, this will should have guided the medical staff in making their decisions.
2. There is the principle of autonomy and self-determination for patients, including those who are terminally ill. The right of such individuals must be respected as they make decisions regarding their lives. Another principle requires physicians to show compassion for others. Even though conventional medicine can alleviate suffering, some patients may undergo psychological pain even when they receive palliative care, as happened with Scheel. Finally, the assisted dying denies individuals the opportunity to live, which could have been the case of Scheel had he been accorded the option of ending his life.
3. The moral principles justified, in this case, include respect for human dignity (Pereira, 2011). The life of the patient remained crucial even though he was terminally ill. Therefore, the health care providers had no right to terminate it if the patient could not make competent decisions. Furthermore, the principle of respect for life is applicable in this case (McLachlan, 2010). Scheel could have died because health care providers could not save his life but not because someone else believed that he needed to pass away because of his condition.

Step 4: Decision Regarding Ethical Choices

1. The patient did not make an informed decision because he was terminally ill during that time. Therefore, his position at the time may have not reflected his values, moral principles, lifestyle, and goals.
2. The nurses and the health care providers were not supportive of his decision. Therefore, they declined to have his life terminated.
3. Moreover, the family was not favorable to his position. When the mother was called upon to decide the fate of his son, she rejected the option of ending his life. She argued that her spiritual belief could not allow her to make a decision that she believed was not hers to make. She argued that God starts and ends the life of every individual.

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Step 5: Implementation of the Moral Decision

There was no implementation of the principle of respect for human dignity. Instead, the principle of respect for life was carried out. Both health professionals and the mother of the patient did not heed the call of the patient to die. The mother believed that she did not have the moral authority to end the life of the son as her spiritual belief could not permit her to terminate the life of another person. On the other hand, the health professionals stuck to their Hippocratic Oath that requires them to save lives. Furthermore, they may have feared the legal consequences. Therefore, none of the groups supported what the patient was advocating for, namely death.