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In this case, the three important ethical issues to consider are ethical distress, ethical dilemma, and locus of control. I believe that ethical distress is one of the main ethical issues in this case since the patient desires to remain on a ventilator to avoid losing her life. She makes it very clear to the staff that she wants to live by interacting with them and answering “no” when asked if she wants the tubes to be removed. On the other hand, her primary care physician along with two of her close friends insists that she’d be taken off the ventilator. They believe that she is currently confused, and that she would have never agreed to remain in that situation if she was aware of it. An ethical dilemma is also present when the critical care team believes that beneficence is the right choice, while the patient’s primary care physician believes in autonomy based on the patient’s original will. A locus of control is also seen in this case since the primary care physician is the one in control of the situation. While the critical care unit along with the neurologist believe that the patient has the potential to recover from her state, the primary care physician with support from the psychiatrist try everything to comply with the patient’s will. He ended up transferring the patient to another hospital in order to be able to comply with the will since the critical care team would not allow him to do so.
The three ethical principles that seem to be of most relevance in this case are beneficence, fidelity, and autonomy. In regards to the patient, I believe that beneficence and autonomy apply to her situation because she was alert and oriented. Although she was diagnosed as “confused” by the psychologist, she kept answering “no” when asked if she wanted the ventilator to be removed, thus, demonstrating that she understood the meaning of that action. The critical care
References: Dresser, R. & Astrow, A. An Alert and Competent Self: Hastings Center Report, Vol. 28, Issue 1, p. 28, (1998)