The Distinction Between Acts and Omissions and the End of Life
A 79-year-old man with a history of hypertension and type 2 diabetes collapses while playing golf and is taken to the local Accident and Emergency department, still unconscious. A computed tomography (CT) scan reveals a large hemorrhagic stroke and he is transferred to the neurosurgical unit. He fails to regain consciousness, although he does not require ventilatory support. He receives fluids and parenteral nutrition for 11 days and is regularly visited by his wife and two children. Eventually, senior medical staff discuss with Tony’s family the extensive nature of damage to his brain and the likelihood that he will never regain consciousness. The family is asked to consider the possibility of withdrawing nutritional and fluid support and allowing him to die ‘naturally’. They are warned that this may take some time, as much as a couple of weeks, but that he will not be in any pain. His son approaches you, the FY1 doctor on the ward, during visiting hours and tells you that it is becoming increasingly distressing for his mother to watch her husband die and that, if this is to be the inevitable result, why is it not possible to offer a quicker end to the family’s suffering, such as an injection which would stop his father’s heart.
- What does an ‘act’ and an ‘omission’ mean in relation to end-of-life decisions?
- What are the ethical arguments for and against the distinction between the two?
- What is the legal position regarding acts and omissions?
Apply Theory (Specific Professional Healthcare Competencies + Clinical Medical Ethical Principles) to Practice in order to provide Optimal Patient-Centered Care (OPCC)
Clinical Ethics and Law, Second edition. Carolyn Johnston, Penelope Bradbury, Series editor: Janice Ryme
