title: Do you have a right to decide? Or do we have a right to acquiesce?
abstract: Clinicians make decisions about patient management on a daily basis and are required to act in a way that is both legally and ethically correct. To act legally requires compliance with a set of rules which reflect the values and interests of society. Ethical decisions are based on what we believe as a group to be morally right. Morals are, however, unique to the individual. Balancing the legal, ethical and moral dimensions of clinical decisions has the potential, therefore, to generate conflict for the individual practitioner. In this paper we report a case study of a patient with a high cervical spine injury resulting in quadriplegia, without prospect of a ventilator independent life. The patient, who was assessed as having capacity to make decisions, subsequently elected to have treatment withdrawn. In this case, withdrawal of treatment constituted removal of mechanical ventilation which ultimately resulted in death. The patient also requested for his organs to be donated after he was deceased. This case study, to our knowledge, is the first report of donation after cardiac death following a high cervical spinal injury in a cognitively intact patient. As such, this case study allows us to discuss the moral, ethical and legal implications of donation after cardiac death following withdrawal of medical treatment.
authors.affiliation: Gold Coast University Hospital, Australia. Electronic address: gregory.comadira@health.qld.gov.au.
authors.forename: Gregory
authors.initials: G
authors.lastname: Comadira
authors.affiliation: Gold Coast University Hospital, Australia.
authors.forename: Lucy
authors.initials: L
authors.lastname: Hervey
authors.affiliation: Gold Coast University Hospital, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Winearls
authors.affiliation: Gold Coast University Hospital, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Young-Jamieson
authors.affiliation: NHMRC Centre for Research Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University and Gold Coast University Hospital, Australia.
authors.forename: Andrea
authors.initials: A
authors.lastname: Marshall
mesh_terms: D003657:Decision Making; D004992:Ethics, Medical; D006801:Humans; D008297:Male; D008875:Middle Aged; D011782:Quadriplegia / Q000209:etiology* / Q000503:physiopathology; D012121:Respiration, Artificial; D013124:Spinal Injuries / Q000150:complications* / Q000503:physiopathology; D009927:Tissue and Organ Procurement; D016312:Treatment Refusal / Q000941:ethics*
keywords: Capacity; Donation after cardiac death; Ethics; Intensive care; Organ donation; Right to refuse