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Medical Ethics Case Analysis
Transcript of Medical Ethics Case Analysis
Brain Death, Organ Donation, and Family Refusal
Dr. Nguyen, an ER doctor, receives an MVA patient
Patient, Mr. Derek Obeid, is placed on life support
Neurosurgeon saw patient in ED and determined patient brain dead after exam
Intervention would be futile
Pronounced dead after 4 hours of arrival in ED
Driver's license indicated he was an organ donor
Mrs. Obeid's arrived in ED. In disbelief and denial.
'Even if dead, can't cut open and take organs'-Wife
Driver's license can be used as legal instrument/will in state for the signed donor card
1987 Uniform Anatomical Act
In all 50 states, the act was adopted to establish a guideline for organ procurement. The Driver's License would serves as a legal instrument like a will in each state.
Policy quoted the act and protected physicians who retrieved organs over the objection of the family members, as long as they signed donor card or license was present on the deceased. Did not stipulate they MUST override family members' objections. Physicians were free to act in response to circumstances unique to each case
Dr. Nguyen's Situation
Didn't want to give up on retrieving organs
Knew Mrs. Obeid wouldn't change her mind
"Mr. Obeid wanted to help another person live by donating his organs"
1. Could disregard family's wishes and use the license as a legal mechanism to retrieve organs
2. Respect family's wishes against patient's will and preserve the body as is
Brain Death, Organ Donation, And Family Refusal
Medical Ethics Case Analysis
Brain dead: the irreversible loss of all functions of the brain, including the brainstem. The three essential findings in brain death are coma, absence of brainstem reflexes, and apnoea. An evaluation for brain death should be considered in patients who have suffered a massive, irreversible brain injury of identifiable cause. A patient determined to be brain dead is legally and clinically dead.
Double veto: even if the family of the deceased agrees to donate the deceased’s organs, the deceased’s objection will veto its retrieval and even if the deceased agrees to donate their organs, the family of the deceased’s objection will veto its retrieval.
Ethical Argument and Our Conclusion
Hospital grants discretion to physicians that allows them to refute the objection of the family members or abide by their wishes altogether. The physician can use the driver’s license as legal documentation for the attainment of patient’s organs. This documentation is official and can ultimately override the wishes of everyone outside of the patient. It is the case, however, that physicians are granted discretion as to whether they wish to proceed with the removal of the organ.
Wife’s wishes should be acknowledged because her relationship with the patient.
However, not all rights of the patient should be automatically granted by her.
Her relationship is warranted, but in order to maintain the rights of the patient, she should not be allowed to make all final decisions because the patient has not granted his rights to be relinquished specifically to her. Her inability to cope with his potential mutilation could be a consideration that could be legally binding if there were any stipulation such as a written will which grants her permission to do otherwise.
Other individuals that may have rights that are infringed upon include the patients who are contracted with the organ donation organization. These patients ethically have a right to live. This basic principle which grants any person a right to life is infringed upon once the patient’s wife goes against the legal document which grants the organization the rights to the patient’s organs.
Autonomy: A person's rational capacity for self governance or self determination
Beneficence: Provide benefits to persons and contribute to their welfare. Refers to an action done for the benefit of others.
Mr. Obeid was fully capable, when he was alive, of making his own decisions when signing onto a documentation indicating he would become an organ donor. This expresses his autonomy to value his rationale for governance and determination, especially when it will be in benefit of another being.