Case Study: Tonya Archer
Introduction
It is one thing to consider medical ethics in an abstract setting, but by their nature, medical ethics involve deeply personal and emotional situations. This activity asks you to consider a case in which the family’s wishes are in conflict with the medical advice they have been given. You will be asked to answer some questions at the end of this activity.
Tonya is admitted to the hospital
Tonya Archer is a fifteen year-old who has been admitted to Saint Anthony Medical Center for surgery to repair an ACL injury she suffered while playing softball. Tonya and her family have met with her surgeon and understand that while all surgery carries risks, this is a straightforward procedure that he has performed many times with no complications.
Post-surgical complications
The surgery goes as expected, but as Tonya is being transferred from the recovery room to her hospital room, she went into cardiac arrest. While Tonya received immediate medical attention, it took over seven minutes to restore cardiac function and the loss of blood circulation resulted in brain damage. During the attempt to resuscitate Tonya, she was intubated and placed on a ventilator. The medical staff has determined, though, that the loss of circulation caused brain death.
Doctors recommend ending life support
Tonya’s doctors explain to her family that the damage Tonya sustained is irreversible and that she suffered whole brain death, which means that there is no neurological function, even at the most basic functions such as respiration or cardiac function. They tell the family that the next step is to take Tonya off the ventilator. Tonya’s parents reaction is of steadfast refusal. They tell the doctor that they understand that Tonya has had a serious accident, but they point out that her body is warm, her heart is beating, and that she therefore is not dead.
Hospital administrator and medical ethicist
The doctors, hospital administrator, and the hospital’s medical ethicist tell the family that while the ventilator and other interventions can sustain the body’s functions, the damage done by the cardiac arrest will get worse and there is near certain expectation that Tonya will not recover any brain function. The family is told that there is no reasonable hope of benefit to Tonya by continuing ventilator and other treatment.
Reflection
What are the most relevant end-of-life issues in health care ethics as they relate to this case?
The parents’ right to make end-of-life decisions for their child, the benefit or futility of continuing the treatment, and the appropriate use of hospital resources are all issues that factor into this case.
What should the hospital do? Should the hospital keep Tonya on life support as the parents desire, or should life support be removed because all medical evidence indicates whole brain death?
Most bioethicists feel that the designation of brain death is sufficient to justify withdrawing life support and the law generally supports a hospital’s decision to discontinue life support. The courts, when they have been involved, may call for limited reasonable accommodations in order to allow for a second opinion of the diagnosis or when religious objections have been made.
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