Introduction
This paper pertains to the definition of dying, death, and the ethical issues that doctors must consider when making a diagnosis of a patient. Included in this discussion are the factors such as the patient’s wishes, family’s sentiments, and medical prognosis that aid the physician in understanding the patient’s survival chances as opposed to the possibility of death when weaned from a ventilator mechanism. We shall also discuss the ethical issues involved in the withdrawal of ventilation and end-of-life decisions relating to the healthcare arena.
Main body
A physician cannot predict what factors shall exist once a patient is weaned from the ventilator system. Therefore, there is no definitive method of defining whether a patient is dying or if he will die once he is weaned from the system. If pressed for a definition of death and dying though, it would perhaps be best to define it as the adverse reaction of the patient’s body to being taken off the life support system that aided in his survival over a period of time. However, it is not right to say, nor predict, that all patients who are taken off life support will die or be on their deathbed. Taking a patient off life support also has its own set of ethical issues that doctors must consider and advise the immediate family of the patient about before an End of Life Decision may be finalized.
Some factors that must be considered when taking a patient off a Ventilator, and the possibility of an End Of Life Decision, are the patient’s age, Multiple Organ Dysfunction Scores, the future outlook for the patient’s recovery, the patient’s reliance on life support, and the physician’s understanding of his patient’s views about being placed on life support. Taking a patient off life support is like throwing a pair of dice, if the patient continues to live and improve, everybody wins, if the patient deteriorates to the point of death, then everyone lost. In these cases, the doctor and family members work hand in hand in order to come to a proper conclusion that will hopefully result in the best outcome for the patient.
The main ethical dilemma for a doctor who is facing a patient with diminishing vital signs and an almost certain irreversible death spiral is that he took the Hippocratic Oath to save lives, not end it. A physician is duty-bound to save the life of his patient even when all hope seems lost. It is not his job to decide when the patient shall die, nor is it his discretion to decide when to say that a patient is dying. This is why over time patients came to realize that the only person who should have the proper authority to decide upon their health and potential death is the patient himself. Thus, the emergence of the End of Life Decisions or Living Will.
Conclusion
The weaning of a patient from a mechanical ventilator provides an avenue for debate and discussion wherein only a patient’s views and sentiments regarding his situation should be considered. If all the requirements for weaning a patient from a ventilator exist, be it for the potential survival or demise of the patient, then the withdrawal must take place. Due to the possibility of death, once the procedure is completed, it is therefore imperative that patients and their family members be properly informed of the consequences. Personally, I would follow all the necessary and allowable protocols but, I would put the patient’s wishes above everything else when it comes to the removal of the mechanical ventilator.