Mr. Martinez was a 75-year-old man hospitalized for an upper respiratory infection. He and his wife had requested no CPR. However, his oxygen was increased, causing respiratory failure. The case examines the ethical issues around limiting life support for Mr. Martinez given his directives, quality of life, his family's preferences, and relevant moral principles.

1. Assessment 3: Should We Withhold Life Support? The Mr. Martinez Case –
Assessment 3: Should We Withhold Life Support? The Mr. Martinez CaseMr. Martinez was a
seventy-five-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 and seemed to
be doing better. However, Mr. Martinez’s oxygen was inadvertently turned 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.Write a 2-3 page paper that examines the moral and
ethical issues involved in making a decision regarding limiting life support.End-of-Life
IssuesWith our framework of ethical theories and principles in hand, we begin our look at
some of the critical ethical issues in our contemporary world, starting with end-of-life
issues. This assessment covers ethical questions related to end-of-life care. Passive
euthanasia is the removal or refusal of life-sustaining treatment. Examples of passive
euthanasia include removal of a feeding tube or a ventilator, or forgoing a life-prolonging
surgery. Passive euthanasia is legal in all 50 states, and the principle of autonomy gives
informed patients the right to refuse any and all treatments. Patients who are unable to
make such decisions in the moment (because they are unconscious, for example) might
have made their intentions clear beforehand with an advance directive or similar document.
Things become more complicated, however, when a patient who is unable to make
treatment choices has not made his or her wishes clear, either formally in a written
document, or informally in conversations with family members or friends. Another problem
concerns cases in which there is disagreement about whether the treatment is sustaining
the life of a person in the full sense or merely as a body that, because of severe and
irreversible brain trauma, is no longer truly a living person.Active euthanasia, or assisted
suicide, introduces further difficult moral questions. A patient who has a terminal illness
and who has refused treatments that would merely prolong a potentially very painful and
debilitating death might want the process of dying to be hastened and made less painful.
The patient might want to take his or her own life before the disease reaches its horrible
final stages. Should patients be legally allowed to have help in this endeavor? If suicide itself
is not morally wrong, at least in cases like these, is it wrong for another person to directly
help bring about the patient’s death? Is it wrong for doctors, a role we naturally associate
with healing and the promotion of life, to use their medical expertise to deliberately end a
patient’s life if the patient wants this?Demonstration of ProficiencyBy successfully

2. completing this assessment, you will demonstrate your proficiency in the following course
competencies and assessment criteria:Competency 1: Articulate ethical issues in health
care.Articulate the moral issues associated with limiting life support.Competency 2: Apply
sound ethical thinking related to a health care issue.Demonstrate sound ethical thinking and
relevant ethical principles when considering limiting life support.Explain important
considerations that arise when contemplating limiting life support.Competency 5:
Communicate in a manner that is scholarly, professional, and respectful of the diversity,
dignity, and integrity of others and is consistent with health care professionals.Exhibit
proficiency in clear and effective academic writing skills.PreparationCase Study: Mr.
Martinez.This media piece provides the context for this assessment; make sure you have
reviewed the case study thoroughly.Additionally, it may be useful to think through the
following issues as they relate to Mr. Martinez’s case:Should Mr. Martinez be transferred to
intensive care, where his respiratory failure can be treated by a ventilator, and by CPR if
necessary, and his oxygen level can be monitored?What are the key ethical issues or models
at play in this case study?What are the key end-of-life issues at play in this case study?How
can an understanding of models and best-practice help to guide health care practitioners to
make ethical and legal decisions?InstructionsIn a 2–3 page analysis of the case study,
address the following:The patient’s directives.The patient’s quality of life.The family’s stated
preferences.The moral issues associated with limiting life support.The ethical principles
most relevant to reaching an ethically sound decision.Important considerations such as
implications, justifications, and any conflicts of interest that might arise because of the
patient’s respiratory failure.When writing your assessment submission assume that doctors
cannot contact Mrs. Martinez and must make this choice on their own. To help you reach an
objective, ethically sound decision, draw upon concepts and arguments from the suggested
resources or your independent research. Support your response with clear, concise, and
correct examples, weaving and citing the readings and media throughout your
answer.Submission RequirementsWritten communication: Written communication is free
of errors that detract from the overall message.APA formatting: Resources and citations are
formatted according to current APA style and formatting guidelines.Length: 2–3 typed,
double-spaced pages.Font and font size: Times New Roman, 12 point.ACTIVITY
ONEThinking about Joe’s case, answer the following questions. Choose one per
question.Question 1:Would these actions, even at the patient’s request, be classified as
active or passive euthanasia?Active Passive Correct Answer:PassiveJoe’s case would count
as passive euthanasia, since he’s refusing life-saving treatment. Passive euthanasia is
usually considered an act of omission: to take no steps that would, if taken, prevent a
patient from dying.Inorrect Answer:ActiveActive euthanasia is a deliberate and definite
action that would cause a patient to die. The difference is sometimes put this way: passive
euthanasia is allowing apatient to die, while active is directly causing them to die.Question
2:Does Joe have a right to refuse treatment on the respirator?Yes– The “full recovery” that
his family asks for may not be realistic. Staff consider him competent to make his own
decisions, and legally he may refuse treatment. No– Joe’s family know him better than the
staff, and they should be granted control over the decisions regarding his care. The health
care providers should defer to their wishes in order to avoid a lawsuit. Correct

3. Answer:There is no correct answer.There may not be a clear answer in this case. If Joe is
competent (as we’re told in the study), and there’s a rigorous set of steps in place for staff to
determine competency, then he has a moral right to refuse all treatment, and possibly a
legal right in many, if not all, states. On the other hand, an argument could be made that Joe
can be declared competent only if staff have taken steps to treat his anxiety. ACTIVITY
TWOThinking about Elizabeth’s case, answer the following questions. Choose one per
question.Question 1:Will any of the theories of suicide permit Bouvia to deliberately starve
herself to death?Religious and theological: Human lives belong to God. Human life is so
precious: Life is the greatest of all human goods. Consequentialist: Suicide harms the
community. The Wedge Principle: Suicide harms other individuals. Greenberg’s
Paternalism: These individuals do not really want to die, so efforts to save them are
justified. Correct Answer:There are no correct or incorrect answers.Although active suicide
is discouraged by all of these theories, “All major theories appear to allow room for
exceptions” that may open the door to an ethical acceptance of passive suicide (Garrett, p.
171). In the theories offered in this question, this often involves the concepts of compassion
and mercy for the suffering individual. However, this does not mean that the facility and
caregivers are legally able to condone Bouvia’s requests. (Theories credited to Garret et al,
p. 169-173)Moral theories and ethical principles, and what is their role in health care
ethics.Moral theories are attempts to explain the nature of morality, and to establish
foundations for our own moral decisions and moral judgments about the actions of others.
In doing so, moral theories look either to human nature or to a source beyond human
nature, as religiously oriented theories do. Philosophers have long been interested in trying
to understand morality by moving beyond common sense beliefs about right and wrong and
to find foundations for common sense beliefs that will both correct them, when needed, and
lend them rational support. Here are the moral theories most relevant to health care
ethics:UtilitarianismDeontologyNatural Law TheoryVirtue EthicsEthical principles are not
as foundational as moral theories. Rather they can be grounded in common sense moral
beliefs about right and wrong and also in widely shared values. The fundamental ethical
principles of health care are commonly accepted to be the
following:AutonomyBeneficenceNon-malfeasanceJusticeQuestion 2:Should the hospital
cooperate with her wishes?Yes– “The individual person and not the community is the
intrinsic good” (p. 170 ) Individual autonomy is paramount; Bouvia has the right to make
her own decision to not have her actions interfered with. Court cases have set relevant
precedents. Legally, the patient has the right to refuse treatment. Controlled cooperation on
the part of the caregivers is appropriate in this scenario. No– Because Bouvia admitted
herself to the care of a healthcare facility as a suicide risk, she relinquished some of her
rights. The facility and caregivers have a responsibility to keep her alive. Correct
Answer:No– Because Bouvia admitted herself to the care of a healthcare facility as a suicide
risk, she relinquished some of her rights. The facility and caregivers have a responsibility to
keep her alive.Bouvia admitted herself into the facility as a potential suicide. There’s an
ongoing debate as to whether anyone who is not terminally ill has a right to receive
assistance in ending their own life. Bouvia’s case is complex, since it’s somewhat between
active and passive euthanasia. She’s not asking for assistance in ending her life in terms of

4. receiving and having health care workers administer drugs to her that would end her life.
However, she is asking for help in dying painlessly (starving herself, but with the aid of
painkillers).Moral theories and ethical principles, and what is their role in health care
ethics:Both moral theories and ethical principles can be used in the health care setting to
guide our attempts to reach sound moral decisions and judgments. They support
viewpoints by providing them greater objectivity. By using a moral theory or ethical
principle, one can move beyond merely voicing an opinion. The theories and principles
enable us to construct arguments. When we are able to provide arguments for our views,
we offer reasons, or evidence, for our views that should be compelling to others. In other
words, moral theories and ethical principles in debates in health care ethics can take us
beyond mere subjective feeling and into the realm of rationally supported positions. CASE
ONE“Joe contracts bilateral pneumonia. He is treated with antibiotics and put on a
mechanical respirator. After a few weeks, the pneumonia improves and the physician starts
to wean Joe from the respirator. Even with a gradual approach, the weaning fails and Joe
demands to be put back on the respirator when he becomes terrified at being short of
breath. The physician feels that the ultimate chances of weaning Joe are no more than 20
percent.Joe, 80 years old and accustomed to being in control, becomes discouraged and
increasingly unable to bear the painful medical procedures (constant intravenous feedings,
frequent needle punctures for arterial blood gases, suctioning, etc.) After three weeks of
unsuccessful attempts, Joe refuses to cooperate. He asks that the respirator be disconnected.
“I want to die,” he states. Despite the pain, Joe is alert and aware and is, in the opinion of the
staff, fully competent. His wife and one son keep begging the physicians and nurses to do
something to help Joe recover fully.” (Garrett, Baillie & Garrett, 2001, p. 194)Consider These
Questions“Does Joe have a right to refuse treatment on the respirator? Do the physician and
the nurses have a right or duty to help Joe psychologically and pharmacologically to
overcome his anxiety when taken off the respirator? Do the wishes of the family have
ethical or legal weight in such cases? Physicians are often sued for keeping a person on a
respirator….is the mere fact that the family may sue a justification for not following the
expressed wishes of a competent person?” (Garrett, et al., 2001, p. 194)Ethical
Rationale“There is a dispute as to whether the difference between active and passive killing
is of any ethical significance in the context of euthanasia…This dispute has become an
important issue in the legal discussion of physician-assisted suicide….The terms are, at least
descriptively useful, and since society still accepts the distinction as having some ethical
utility, it is disregarded at one’s risk. …should it be considered that active euthanasia ought,
with suitable safeguards, be made legal?” (Garrett, et al., p. 195, 2001) CASE
TWO“Elizabeth Bouvia was diagnosed as having cerebral palsy at the age of six months. At
age 10 she was placed in an orthopedic hospital, where she remained for seven years.She
earned a B.S. degree in social work, married and for a year attempted unsuccessfully to have
a child. Her husband, whom she had met as a pen pal while he was serving a sentence in jail,
has left her. Elizabeth has dropped out of graduate school because of difficulties in finding a
clinical placement required for her program. As a result of this, the state has threatened to
take away her assistance to transportation.At this time, Elizabeth Bouvia has admitted
herself voluntarily to the hospital on the grounds that she is suicidal, a quadriplegic victim

5. of cerebral palsy and confined to a wheelchair. She has limited control of her right hand and
she needs to be fed. She also has severe progressive arthritis that causes constant pain. Her
condition is in no way life threatening, and she has a life expectancy of 15 to 20 years.She
seems to have plans to starve herself to death in the hospital, away from friends and
relatives. She has refused to eat solid food, The physician has threatened to have her
certified as mentally ill so that he can force-feed her. The hospital also has threatened to put
her out on the sidewalk. The hospital seeks to transfer her to another facility, but is
unsuccessful. In the meantime, the hospital force-feeds Elizabeth. She repeatedly tears the
nasogastric tubes from her nose. The tube is forcibly reinserted each time she removes
it.Elizabeth seeks legal assistance. The American Civil Liberties Union enters the case and
applies for a court order restraining the hospital from discharging her or force-feeding her.
Bouvia testifies that she is no longer willing to live, since she found it disgusting and
humiliating to live so dependent a life. She wants to starve to death while nurses give her
painkillers and keep her clean and comfortable. She has a metabolic condition that causes
her blood to become excessively acidic without food. One internist treating her estimates
that she could be dead within five days because of the condition.The first court decided that
Bouvia had a legal right to starve herself to death at home, but not to demand that a health
care facility help her while she did this. Another court finally decided that she had a right to
hospital care while starving herself to death. Many hearings later, Bouvia was still alive. This
might justify a health care provider who said that Bouvia was only seeking attention and
knew how to work the system.” (Garrett, et al., pp 194-195, 2001)Consider These
Questions“Will any of the theories of suicide permit Bouvia to deliberately starve herself to
death? Is Bouvia competent? Would the hospital be ethical in getting a guardian ad litum
who could then consent to a feeding tube? Would it be ethical for health care providers to
cooperate with someone who is not terminally ill and still has the minimum quality of life,
that is, is able to interact with others?” (Garrett, et al., p. 195, 2001)Ethical RationaleWhat
are the current laws “with regard to the right of non-terminal patients or their surrogates to
refuse treatment or demand withdrawal of treatment, including the withdrawal of nutrition
and hydration?” (Garrett, et al., p. 195, 2001)