In following the first course of action, the critical care team respects the autonomy in which Philip’s parents have as a surrogate decision maker. By respecting the autonomy of Philip’s parents they are appealing to their values and outlook on life. Despite Philip’s suffering and poor outlook, the pursuit to continue aggressive life-sustaining treatment would give Mr. and Mrs. Mutesi comfort in knowing that they tried everything possible to give Philip a fighting chance. By pursuing this course of action, the critical care team is diverting valuable resources such as medical equipment, personnel and time in order to sustain Philip in his current state. From an egalitarian and utilitarian standpoint this course of action goes against the appeal of justice suggesting that equals should be treated equally. From a utilitarian perspective, the resources used in maintaining Philip’s status could alternatively be used to treat someone with a greater outcome.In pursuing the second course of action, the critical care team will go against the decision of Mr. and Mrs. Mutesi and refuse to use aggressive life-sustaining measures on Philip in order to pursue palliative care. This course of action appeals to the duty of beneficence of the healthcare provider. The aggressive life-sustaining support that Philip is currently receiving is causing him much pain and agony and not resulting in a better health outcome. By transitioning Philip to palliative care, the critical care team is providing comfort for Philip in his last days of life. This course of action also results in less demand on resources of the critical care team allowing them to allocate treatment of other patients in a more effective manner. However, this course of action also goes against the autonomy of Philip’s parents and their decision to pursue aggressive life-sustaining care.
In this particular situation, I agree with the critical care team’s decision to refuse the use of aggressive life-sustaining measures on Philip and instead pursue palliative care. In this case it is made very clear that Philip’s chance of surviving 2 years is low and that he is only expected to survive for the next 10-12 months. The case also made Philip’s suffering and pain very apparent. With Philip’s level of pain and poor prognosis, palliative care is the best approach for relieving his suffering. The case description also stated that Philip’s parents accepted Dr. Smith’s DNR order at first, albeit reluctantly, which suggests that they are concerned with Philip’s suffering and understanding of his poor outcome. Mr. Mutesi appears to be less realistic about Philip’s prognosis than Mrs. Mutesi, perhaps suggesting that he has yet to come to terms with situation and that his emotions may be clouding his judgement. I would suggest the critical care team first try to get Philip’s parents to come to terms with the reality of the situation with the aid of a chaplain in order for them to not have their judgement clouded by difficult emotions. If the parents still wished to continue aggressive life-sustaining support for Philip I believe it would be appropriate to refuse further measures and instead pursue palliative care. I believe this would be the best course of action because it provides comfort for the patient and allows resources to be allocated in more beneficial way for society as a whole. These reasons both support the appeals of beneficence and justice. The main drawback and weakness of this course of action is the fact that the critical care team would go against the autonomy of Philip’s parents. However, I believe that the benefit to Philip and society as a whole outweigh the wishes of Mr. and Mrs. Mutesi to continue futile treatment and aggressive life-sustaining support.