RCSIsmj ethics challenge winner 2010: Can doctors say ‘enough’?

The RCSIsmj Ethics Challenge for 2010 presented a case of a woman with longstanding medical issues that ultimately resulted in her staying in the surgical ICU for four months, dependent on ventilator support, haemodialysis and total parenteral nutrition. Though her physicians felt that she had no hope of surviving outside of the hospital, the patient’s daughter continued to push for aggressive treatment. The aim of this article is to discuss the ethical issues highlighted by the case and to provide a course of action for the patient that suitably addresses these issues. Where appropriate, counter-arguments are introduced to highlight the complexity of this case. Though the case occurs in New York, we have approached it largely from the perspective of healthcare in Ireland. However, the issues in the article are indeed universal and are worthy of discussion for medical professionals everywhere. When does life support begin to prolong death and suffering? How can a physician determine the limits of his duty of care? Should allocation of limited resources be considered by the physician when he is making his decision to withdraw life-sustaining treatment?