FEU Public Intellectual Lecture Series | Dr. Maria Fidelis Manalo | Part 2

Summary

In this enlightening discussion, Dr. Manalo delves into the complexities of end-of-life care, emphasizing the importance of respecting a patient's autonomy and dignity. He outlines the ethical principles of beneficence, non-maleficence, autonomy, and justice in bioethics, guiding medical professionals in making difficult decisions. The conversation touches on the challenges of 'pulling the plug', the role of advanced directives, and the significance of a patient's informed consent. Dr. Manalo also addresses the emotional and ethical dilemmas faced by doctors, advocating for a compassionate and patient-centered approach in palliative care.

Takeaways

• 😷 The term 'pulling the plug' refers to the decision to discontinue life support, which is a complex and sensitive issue for families and medical professionals.
• 🏥 In cases of acute conditions like pneumonia alongside terminal illnesses, the use of mechanical ventilation might be temporary, with the aim of weaning the patient off the ventilator once the acute condition is treated.
• 🔄 The transition from intubation to a tracheostomy is made when a patient is unable to breathe without mechanical ventilation, allowing for more natural communication and eating.
• 📜 Advanced directives are crucial in end-of-life care, allowing patients to specify their preferences for care, including whether to continue life support in the event of terminal illness.
• 💔 The decision to cease life support should be made with the understanding that it allows for a more natural death rather than euthanasia, which is illegal and unethical in most contexts.
• 🤔 Ethical dilemmas in medicine often require balancing the principles of beneficence, non-maleficence, autonomy, and justice, ensuring that care is provided with respect for the patient's rights and dignity.
• 👨‍⚕️ Doctors play a vital role in guiding families through end-of-life decisions, providing information, and supporting the patient's autonomy while also considering the emotional impact on loved ones.
• 📝 Documentation is essential in medical ethics, particularly in cases where life support is to be withdrawn, to ensure that the patient's wishes are respected and to protect medical professionals from legal repercussions.
• 🙏 Spiritual and emotional support is an integral part of end-of-life care, with medical professionals often working alongside spiritual leaders to provide comfort and guidance to patients and their families.
• 🧠 The importance of human life and dignity is a central theme in medical ethics, with decisions made in the context of the sanctity of life and the responsibility to care for it, even in the face of terminal illness.

Q & A

What does 'pulling the plug' refer to in the context of medical care?

In the context of medical care, 'pulling the plug' refers to the decision to discontinue life-sustaining treatments, such as mechanical ventilation, allowing a terminally ill patient to die naturally.

Why might a patient be intubated and placed on mechanical ventilation?

A patient might be intubated and placed on mechanical ventilation if they are having difficulty breathing on their own, such as in cases of acute pneumonia or other respiratory failures.

What is the difference between 'weaning' and 'pulling the plug' in medical terms?

Weaning refers to the process of gradually reducing a patient's dependence on mechanical ventilation to allow natural breathing, while 'pulling the plug' is the act of discontinuing mechanical ventilation when it is determined that the patient cannot be cured and is terminally ill.

What is a tracheostomy and why is it performed?

A tracheostomy is a surgical procedure that creates an opening in the trachea to insert a tube for long-term mechanical ventilation. It is performed when a patient is expected to need mechanical ventilation for an extended period and cannot breathe without it.

What are Advanced Directives in the context of end-of-life care?

Advanced Directives are legal documents in which a person specifies their preferences for end-of-life care, including life-sustaining treatments, in case they become unable to communicate their wishes.

Why is it important for doctors to discuss end-of-life preferences with patients?

Discussing end-of-life preferences with patients is important to respect their autonomy and ensure that medical decisions align with their values and wishes, providing a more dignified and peaceful end-of-life experience.

What are the four ethical principles of bioethics mentioned in the script?

The four ethical principles of bioethics mentioned in the script are beneficence, non-maleficence, autonomy, and justice.

How does the principle of autonomy apply to end-of-life decisions?

The principle of autonomy in end-of-life decisions means that the patient has the right to self-determination, including the choice to accept or refuse medical treatments, based on their informed consent and personal values.

What is the ethical dilemma faced when a patient's family disagrees with their end-of-life preferences?

The ethical dilemma arises when the patient's family disagrees with their end-of-life preferences, as healthcare providers must balance respecting the patient's autonomy with the emotional and cultural considerations of the family.

Why is it important for medical professionals to document end-of-life care decisions?

Documenting end-of-life care decisions is important to ensure clarity, avoid misunderstandings, and provide legal protection for healthcare providers when acting in accordance with the patient's wishes.

What advice does Dr. Manalo give to medical students regarding ethical dilemmas in bioethics?

Dr. Manalo advises medical students to understand and reflect on the principles of bioethics, seek guidance and consultation when in doubt, and always consider the patient's best interest while respecting their autonomy and dignity.