Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true patient care case. You vote on your decision in the case and, next week, we'll reveal how you all made the call. Bioethicist Jacob M. Appel, MD, JD, will also weigh in with an ethical framework to help you learn and prepare.
The following case is adapted from Appel's 2019 book, :
Clarence is a 50-year-old outdoorsman who loves fishing, hunting, and horseback riding, but his deepest passion is for wood carving. He works as a carpenter.
One summer, while camping in the wilderness, he contracts a bacterial infection and must be airlifted to a community hospital. By the time he arrives, his blood pressure had dropped so low that he lost consciousness; blood perfusion to his hands and feet has been minimal for hours.
The doctors have grim news for his sisters, Edna and Ethel, who are his only immediate relatives. Even with aggressive antibiotic treatment, which may yet save his life, his hands and feet will have to be amputated.
Edna says, "I guess that's our only choice. Clarence is a fighter. He would have wanted to live at all costs."
Ethel disagrees. "Our brother would never want to live so disabled," she says. "The outdoors and physical labor are his life. You have to stop these aggressive antibiotics, doctor. Let nature take its course. I wouldn't want him to suffer the torture of waking up in this state."
Clarence has no living will or advance care directive. According to the doctors, if the antibiotics work and Clarence ultimately regains consciousness but is unwilling to live in his new condition, there will be nothing they can legally do to help him end his life.
See the results and what an ethics expert has to say.
Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at the Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College.
And check out some of our past Ethics Consult cases:
Stop Treating Ultra-Expensive Patient?