Applying Dijfe1'tmt Approaches to Ethical Problems
An 18-ycar-old diagnosed 2 years ago with an inoperable brain tumor is admitted to the ICU with refractory seizures. He is intubated and placed on high doses of sedatives to prevent further seizures. An MRI done on the second day after admission shows that his tumor has progressed despite intrathecal chemotherapy. His parents arc both involved and supportive but are divorced and schedule their visits to avoid each other. Seventy-two hours after admission to the ICU, the parents are asked to participate in a family conference in accordance with unit policy. The oncologist, the intcnsivist, the ICU nurse, and the social worker all attend the meeting with both parents. The oncologist describes the prognosis as poor, and the intensivist explains the measures being taken to support him in his critical state, and the option of changing the goals of care and focusing on his comfort. Both parents seem to appreciate the severity of illness and the mother requests to take her son home because "that's where he'd want to be."The father, who is a respiratory therapist, becomes angry, stating "you don't get it, do you? He has to be here in the ICU He's too sick to move, even though I know you want to take him away from me. "The mother stands up and tearfully declares "you always want to make it about us, but this is about him!" and exits the conference room. The father then tells the team that he understands that removing his son from the ventilator is the right course of action, but he's not sure his ex-wife is capable of making that decision, and "whatever happens, I want to be with my son as much as I can." In a separate conversation with the patient's mother, she tells the team "we can stop the machines, if I can just take him home."
The members of the healthcare team all witness the same situation, but they interpret it through different ethical frameworks and arrive at different conclusions as to how to proceed.
How would a principle-baaed approach apply to this situation?
What is the correct action to take if this case ill examined &om a care-bued perspective?