Case Study on Euthanasia and Ethical Dilemmas in Healthcare

Case Study on Euthanasia and Ethical Dilemmas in Healthcare

Case Study:

You are the Chief Medical Officer (CMO) of a reputed government hospital. A 72-year-old terminally ill patient, Mr. Rajesh Sharma, has been suffering from an advanced stage of motor neuron disease (MND) for the past five years. His condition has deteriorated to the extent that he is in constant pain, completely dependent on life-support machines, and unable to communicate except through minimal eye movement.

His family, including his son and daughter, have approached the hospital with a request for passive euthanasia, citing unbearable suffering and the futility of continued medical intervention. They argue that prolonging his life is merely extending his suffering and financial burden. The hospital’s ethics committee is divided on the issue.

India recognizes passive euthanasia under the Supreme Court’s ruling in the Common Cause v. Union of India (2018) case, which allows withdrawal of life support under strict conditions. However, Mr. Sharma’s case lacks a living will, and his immediate family is making the decision on his behalf. Some doctors argue that withdrawing life support amounts to playing God, while others believe that forcing a patient to suffer indefinitely violates human dignity.

As the CMO, you must decide on the appropriate course of action while considering ethical, legal, and medical implications.

Questions:

1. What are the ethical dilemmas involved in this case? Discuss using ethical theories such as utilitarianism, deontology, and virtue ethics.
2. Should euthanasia be considered a fundamental right, or does it contradict the principle of the sanctity of life? Justify your stance.
3. As the Chief Medical Officer, what steps will you take to ensure a morally and legally sound decision in this case?
4. Discuss the role of the patient’s autonomy in end-of-life decisions. How should the absence of a living will affect the decision?
5. Suggest a policy framework that balances compassion, medical ethics, and legal safeguards for euthanasia in India.
6. How can hospitals and governments improve end-of-life care to reduce ethical conflicts around euthanasia?

Suggested Solutions:

1. Ethical Dilemmas Involved

• Utilitarianism: Supports euthanasia if it reduces suffering and maximizes overall well-being for the patient and family.
• Deontology: Opposes euthanasia as it violates the moral duty to preserve life.
• Virtue Ethics: Emphasizes compassion and dignity in decision-making rather than strict rules.

2. Euthanasia as a Right vs. Sanctity of Life

• Pro-Euthanasia Argument: Right to die with dignity, reduces suffering, aligns with autonomy.
• Against Euthanasia Argument: Life is sacred, doctors’ role is to heal, not end life, potential misuse.

3. Steps as a Chief Medical Officer

• Convene a multi-disciplinary ethics committee for deliberation.
• Seek judicial permission if legal ambiguities persist.
• Ensure patient’s suffering is not artificially prolonged against ethical considerations.
• Discuss palliative care options with the family.

4. Role of Autonomy and Living Will

• Patient autonomy: Should be central to decision-making.
• Absence of Living Will: Raises concerns about substituted judgment—whether the family’s decision truly reflects the patient’s wishes.

5. Policy Framework for Euthanasia in India

• Mandatory Living Wills for all patients.
• Strict legal oversight to prevent misuse.
• Guidelines for physicians on ethical euthanasia decision-making.

6. Improving End-of-Life Care

• Expand palliative care and pain management.
• Educate families on advanced healthcare directives.
• Strengthen hospice facilities to reduce dependency on euthanasia.