Case
Uploaded by
fredpaulportugalezaCase
Uploaded by
fredpaulportugalezaThe Case of Maria
Maria was an 82-year-old woman. She had been seriously incapacitated by arthritis for
over two years, and was also virtually blind following recent unsuccessful cataract and
glaucoma treatment. Maria was being cared for by her family in the family home. Although
Maria’s family found this quite difficult, they were coping reasonably well.
However, Maria’s condition deteriorated drastically when she suffered a severe
cerebral vascular accident (or stroke) and was admitted into hospital. The result of the stroke
was that Maria was left in what her physicians called a ‘semi-coma’. The doctors at the
hospital immediately began to provide Maria with artificial nutrition and hydration by means
of a naso-gastric tube, but they told the family that they felt that no other treatment was
appropriate as Maria was very unlikely to recover.
Maria’s family visited her regularly at the hospital, but they found these visits very
upsetting. Maria found it extremely difficult to speak and was clearly very distressed. Whilst
recognizing the severity of Maria’s condition, her relatives, who cared for her a great deal,
and the staff at the hospital were careful not to discuss this in her presence. Despite this, it
was clear from the start that Maria herself found her situation intolerable and, during the first
6 weeks of her hospitalisation, repeatedly expressed her wish to be allowed to die. She did
this through the use of signs and hard-fought words, even though this was itself extremely
difficult and distressing for her. As she became increasingly frustrated, Maria also made
several repeated attempts to remove her feeding tube.
Clearly, this was also very upsetting for Maria’s children, who were spending quite a
lot of time with her at this stage. They knew that their mother had a lifelong aversion to
hospitals and medicine, and they felt also a duty to respect her clearly expressed wish to die.
After having discussed this among themselves, Maria’s children together decided to approach
her physician about the possibility of withdrawing treatment and allowing her to die, as she
wished.
At their meeting with the physician, however, he made it very clear to the family in no
uncertain terms that he would not consider acceding to such a request. He said that he felt that
this would go against his responsibilities as a doctor to his patient. He also argued that
Maria’s requests to be allowed to die should not be taken at face value as Maria had a recent
history of mild depression. Maria’s family were unhappy with this decision and with the
doctor’s reasoning, but felt that they had no choice other than to accept it.
After a further week, however, Maria’s condition had deteriorated to such an extent
that she was now in a full and irreversible coma and, after further discussion with the family,
the physician agreed to withdraw nutrition but continued to refuse absolutely to withdraw the
supply of hydration.
Maria survived for another 2 weeks without respiratory or other complications, but
then died rather suddenly when she suffered a second stroke.
After the death of his mother, Maria’s son complained bitterly to the physician about
the way his mother had been dealt with. He argued that, had the physician agreed with the
family’s request for the withdrawal of all kinds of treatment when this was originally
requested, his mother would have died sooner and would have suffered a great deal less than
she did. He argued that, when it is clear that a patient is going to die, the doctor’s duty is to
alleviate their suffering, and that this means that it can sometimes be wrong to keep a patient
alive for as long as possible and at all costs.
Source: Parker, Michael, and Donna Dickenson. The Cambridge medical ethics workbook: Case studies, commentaries and
activities. Cambridge University Press, 2001.
