Trishviola Joy C.

Rabisanto June 5, 2020

BSN II – B Ma’am Sy
CHAPTER 9
EXERCISES

A. The case involves a young, ventilator-dependent quadriplegic patient who, after

being shunted about to various facilities, sought to have his ventilator unhooked.
The court recognized him as a competent adult and allowed the withdrawal of his
life support. In this case, neither the court, the health care providers, the right-to-
life movement, nor the churches came forward to argue that the ventilator should be
continued. After he had gained permission to withdraw from life support, the
patient decided against the action and remained on the ventilator. The question that
this case brings forward is whether the young man’s demands to have the “right to
die” was real or just another way of saying “do you care about me?” A secondary
question that is equally problematic is whether the acceptance of his request was
based on a respect for his personal autonomy, or was it just an answer to “do you
care about me?” question with a “NO” respond to the idea our current acceptance
of “a right to die” especially for those who are unconscious and need a proxy
decision maker, is rather slippery slope that may in the future be used not to protect
individual autonomy or privacy but rather as façade to rid us of individuals whose
lives we do not value.
In every situation wherein life support is on the line, there will always be a
decision to make and whatever choice wins, we—health care providers, family of the
patient and the patient himself have different take on it. In ending a life support, the
health care team chooses the best option based on how they assess the current situation of
the patient, while the family on the other hand, differs since they all have different
perspective due to emotional or personal issues even grudges. In that case the “right to
die” can be a slippery slope since there are many people that are involved in the decision-
making process that can rather go bad, or just be what it should be. It brings out the
emotion of each person included so it can be used not to protect the autonomy or privacy
of the individual and worse comes to worst, if we are not that kind hearted, it can be used
to get rid of those individuals whose lives we do not value.
B. Differentiate between the various lines of reasoning and arguments needed to decide
the following types of cases in regard to withdrawing or withholding care:
1. Persistent vegetative state cases
2. Profoundly retarded patient cases
3. Baby doe cases
4. Informed nonconsent cases

Which of these case types is best served by proxy judgements, and if so, what form:
best interest or substituted judgement?

Informed nonconsent cases is the best served proxy judgements and it falls into
the best interest form. As for my opinion, the health care team is there for you to be
better, if you’re in the verge of dying, you may have lost your faith about living, but what
if after they gave you another chance to live and it is the best life you had? I mean, if you
are in that point of your life wherein you thought everything might fall apart, you cannot
think properly that you tend to decide on something that can cause you harm or even
death, and that’s where the proxy comes in and makes decision for your betterment.

C. The philosopher Joseph Fletcher issued a paper listing the characteristics of a

person. The following are taken from his positive criteria.
1. Minimal IQ: mere biological life, before minimal intelligence is achieved or after
it is irreversibly lost, is without person status.
2. Self-awareness: the development of self-awareness in babies is what we watch
and take such joy in. on psychotherapy, the lack of self-awareness would
represent grave pathology.
3. Self-control: an individual not only not controllable by others (without
restraint), but also not in his own control.
4. A sense of time: memories, a feeling of now, and expectations for the future.
5. The capability to release others: interpersonal relationship seems essential to
bring a person in any meaningful sense.
6. Concern for other: extra-ego orientation is a vital characteristic of a “real
person”
7. Curiosity: a person is a learner: total indifference is inhuman.
 8. Communication: utter alienation or disconnection from others is not a
characteristic of humanity.
9. Neocortical function: personal reality is dependent upon cerebral function: it
forms the basis between life in a biographical and biological sense.
10. Idiosyncrasy: humans are distinct: to be a person is to have identity, to be
recognizable or callable by name.

Rank-order the list from most important to least important in your view of what
makes up a person. Check those that you would consider to be essential in regard to
personhood. If you feel that a particular characteristic is essential, you must be
willing to deny those who do not possess it the rights and privileges of person status.
In regard to the personhood criteria that you have selected, state how this would
affect your decisions in the following cases.

Nancy Cruzan

Elizabeth Bouvia

Baby Doe

Baby K

In regard to KoKo the Gorilla, who uses sign language to communicate with
humans and appears to have a kitten that she cares about and misses when it is gone, what
is her level of personhood?

If an angel or alien appeared out of the sky and had all the elements that you said were
essential to being a person, would the alien have all the rights and privileges of a person?

7) Minimal IQ: mere biological life, before minimal intelligence is achieved or after it is
irreversibly lost, is without person status.

1) Self-awareness: the development of self-awareness in babies is what we watch and

take such joy in. on psychotherapy, the lack of self-awareness would represent grave
pathology.
2) Self-control: an individual not only not controllable by others (without restraint), but
also not in his own control.

6) A sense of time: memories, a feeling of now, and expectations for the future.

5) The capability to release others: interpersonal relationship seems essential to bring a

person in any meaningful sense.

4) Concern for other: extra-ego orientation is a vital characteristic of a “real person”

10) Curiosity: a person is a learner: total indifference is inhuman.

3) Communication: utter alienation or disconnection from others is not a characteristic of

humanity.

8) Neocortical function: personal reality is dependent upon cerebral function: it forms the
basis between life in a biographical and biological sense.

9) Idiosyncrasy: humans are distinct: to be a person is to have identity, to be recognizable

or callable by name.

 Nancy Cruzan
As for this case, the capability to relate to others would totally be fit this situation.
You should learn how to understand and be at the situation of others before
making a decision on judging them.
 Elizabeth Bouvia
Elizabeth’s case was an informed nonconsent case wherein the healthcare team
showed how they are concerned for her. They’ve given everything just to make
her live even without her consent.
 Baby Doe
In this case, concern for others also controlled the whole situation wherein the
whole situation was then brought out to the topic because the parents refused to
have the baby live, and the other party opposed when the baby died.
 Baby K
In baby K’s case, the capability to relate to others is also the criteria that comes
into my mind in assessing the situation.
 In regard to Koko the gorilla, maybe 70%/100% is her level of personhood.

In the case of the alien, yes, he would have the rights since he knows how to mingle,
communicate, and understand the feelings and beliefs of people.

D. Assuming that Baby Doe would have grown up to know himself, know those around
him, walk, talk and play, and perhaps even go to school, was the decision not to
provide the surgery ethical? Regardless of how you answer, justify your decision
using ethical criteria. Also note that legal decisions are ethics neutral, and vice
versa: something truly can be legally correct, medically correct, socially correct, and
morally reprehensible. Ask Dr. Mengele (nazi war criminal who performed ghoulish
experiments in the death camps), for he surely felt the relative to his society, what he
was doing was socially, medically, and legally correct.
Yes, the decision not to provide surgery is ethical since it is the Doctor who
knows how the baby will live his life when he grew up just like what happened in the
situation above. It is ethical since he knows what he does and it is medically correct since
it his own perspective as a doctor and it is legally too.

E. Mr. Martinez was a 75-year-old chronic obstructive pulmonary disease patient. He

was in the hospital because of an upper respiratory tract infection. He and his wife
had requested that CPR not be performed should he require it. A DNR order was
written in the charts. In his room on the third floor, he was being maintained with
antibiotics, fluids, and oxygen up, and this caused him to go into respiratory failure.
When found by the therapist, he was in terrible distress and lay gasping in his bed.
Should Mr. Martinez be transferred to intensive care, where his respiratory failure
can be treated by a ventilator and his oxygen level can be monitored? Whatever
your answer, provide an ethical rationale.
As for my opinion in this matter, a DNR order was written in the charts and it is
the patient’s right to die peacefully without second thoughts since it is an informed
consent. He chose to decide on the DNR order in order to pass away peacefully even if it
means not having the chance to live again. He probably knows that he has a chance of
surviving if the health care team provided resuscitation, but he still refused to do so. So
he should not be transferred to the intensive care. That is why we have the so called
“patient’s rights”.