Jason Liang

Medicine: Ethical Conduct

Case 2.
Key Issues:

 Patient autonomy
 Decision made by next of kin (NOK) or the individual appointed health care power of
attorney (POA)
 Beneficence – doing good for the patient
This case comes through with conflict from both medical professionals and the family. As the patient
is incapable of making decisions for her own health care due to a severe stroke that has impaired her
brain function. Therefore, the next of kin or appointed individual with the legal power of attorney
should decide her medical wishes on her behalf – as the patient does not have documents stating her
end-of-life wishes. If an individual has the medical power of attorney, they overrule the next of kin’s
decisions.
The conflict of interest is between the next of kin individuals, where the son and the daughter are not
in agreement on their mother’s treatment plan. The son that arrived first believes that it is in the
patient’s best interest to have no medical intervention or treatment if she were to suffer from heart
failure and is in an irreversible state or arrests (A DNR - Do not resuscitate order). However, the
daughter of the patient disagrees and wishes to consent to all treatment to save and extend her
mother’s life.
Since the patient has suffered a massive stroke that has caused irreversible damage to the brain, there
are no possible treatment options or promising signs of recovery. For the ‘good’ of the patient, it is up
to the family to decide the plan of action should she suffer from a medical complication: a DNR order
or undertaking all required treatment to extend the patient’s life.

Final Verdict:
The son of the patient understands that it is highly unlikely that her mother will recover and regain
brain function. At this point, the patient should be declared brain dead. The son wants to limit the
suffering of her mother even on life support. However, the daughter of the patient believes that
extending her life should be the main objective, even though the patient will not recover brain
function. The decision is not dependent on doctors, but on the individual holding the medical power
of attorney or the next of kin of the patient. If there is no appointed individual holding the medical
power of attorney, the next of kin decides upon the medical decisions of the patient. The next of kin is
the eldest adult daughter or son of the patient, which is determined between the 4 children of the
patient. However, the doctors should discuss options with the sons and daughters to attempt to come
to an agreement before acting on a specific treatment plan.