The case of MW presents us with difficult medical, psychosocial, and ethical questions.  However, the question posed for commentary is, “Ethically, should the healthcare professionals have continued to treat MW?”  In response to the question, this commentator responds in the negative: the health care professionals should not have continued to treat MW.  Did MW’s health care providers have an obligation to continue to provide life-sustaining treatment in his case?  There are three principal reasons why they did not: (1) the treatment in question seemed to be nonbeneficial from a medical point of view, (2) there was uncertainty whether MW was indeed experiencing pain and therefore suffering, and (3) the treatments in question (therefore) seemed disproportionate.  Accordingly, MW’s and his parents’ obligation to preserve his life had reached its limit, therefore the correlative obligation of health professionals to provide life-sustaining treatment had likewise reached its limit.

To begin, the case narrative suggests that MW’s medical condition continually deteriorated despite aggressive interventions; although some treatments may have been working empirically (e.g., ventilatory support enabled gas exchange), the treatments did not seem to reverse his underlying medical problems and (by implication) were not benefiting him from a medical point of view.  The interventions MW received were not healing him to any meaningful level of recovery.  In this sense, one may have considered the treatments medically futile.  From this standpoint, medicine had reached its limit according to its own reason for being (Walter, 79-80).

However, the case narrative also suggests that futility was one of the conditions the hospital’s ethics advisory committee noted as grounds for foregoing or withdrawing such life-sustaining treatment.  In this case, the ethics committee qualified its recommendation for deference to parental wishes in cases of disagreement and if there existed a lack of consensus among caregivers that the treatments in question were truly medically futile.  In this case, the providers continued treatment, which suggests that the consensus on futility did not exist.  Perhaps caregivers could have held their own conference on the care of MW.

Next, the case narrative does indicate a problematic breakdown of communication regarding MW’s pain management; here, one may have understood MW’s treatment as abuse.  The Baby Doe Rules require health care providers to administer life-sustaining treatment unless one of three conditions are met: the newborn (1) will inevitably die despite treatment, (2) will remain in a permanent coma, and (3) will receive treatment that is “virtually futile” and “inhumane” (Veatch, et al., 46).  In this case, MW’s health professionals were administering a significant dose of fentanyl for sedation and analgesia.  Although MW seemed to have “little hemodynamic response to painful stimulation,” the case report indicates, “further assessment of his degree of comfort was impossible given his requirement for neuromuscular blockage.”  In other words, caregivers were uncertain about how much pain MW was experiencing.

MW’s parents did not want to be responsible for ending MW’s life by “pulling the plug,” nor did they want his health providers to be responsible.  They therefore insisted that everything possible be done to sustain his life.  However, his parents continued to trust that MW’s caregivers were managing his pain sufficiently; they “did not believe that their child was suffering from all of the invasive therapy.”  The question here is to what extent does the caregiver’s ignorance of MW’s pain cast doubt on whether his parents were indeed making an informed decision regarding the continuation of his aggressive treatment.

In this case, it seems that MW’s struggle for survival consumed his entire vital energy; indeed he ultimately succumbed to his medical deterioration and died.  MW’s health care providers should have communicated more effectively with his parents about their uncertainty regarding his pain management.  Provided these perspectives, it seems that the treatment provided to be disproportionate.  Thus, one could have considered the aggressive treatments to be morally optional as they were morally extraordinary (cf. Directive 57; USCCB).  In MW’s case, foregoing or withdrawing the treatment would have allowed MW to die due to his underlying pathologies.  A subsequent ethics consultation would have helped MW’s parents and health care professionals understand that this withdrawal of treatment was not a form of intentional killing and therefore the caregivers and parents were likely making the best choice in the face of uncertain circumstances without causing further harm or suffering for MW.  That is, it is morally and ethically acceptable to forego or withdraw such treatment.  In such cases, caregivers should emphasize that they will always care for patients even though life-sustaining treatment will be foregone or withdrawn.

References:

Walter, James J.  “The Meaning and Validity of Quality of Life Judgments in Contemporary Roman Catholic Medical Ethics.” In Quality of Life: The New Medical Dilemma.  Eds. James J. Walter and Thomas A. Shannon.  Mahwah, NJ: Paulist Press, 1990. 78-88.

United States Conference of Catholic Bishops (USCCB).  Ethical and Religious Directives for Catholic Health Care Services.  4^th edition.  Washington, DC: USCCB, 2001.