Minimally Conscious State
Codes are being called, signaling distress. Voices are raised, accusations tossed like daggers at each other, claiming the moral high ground. The patient's children are fighting, forgetting what is best for the patient in their need to assert their power. The patient is immobilized. She continues to slip between a minimally conscious state, a state in which the patient is aware of herself and the surrounding environment, and a persistent vegetative state, PVS, a chronic condition that preserves blood pressure, respiration, and cardiac function, but not cognitive function. I pore over the case looking for answers, legal documents, and recommendations.
Unfortunately, when a parent is incapacitated the Do Not Resuscitate order, DNR, an advance directive or living may fall to the wayside -that is why there are measures in place to ensure the wishes of the patient are followed. The family, especially the person with durable power of attorney and those in charge of judicial matters, provide checks and balances to each other safeguarding written, legal instructions. Those who have written directives trust others to bear the burden of upholding the decree.
My obligation as an ethicist is to weigh evidence despite warring factions. I am limited though by my role to simply give a recommendation to those who are disputing. What if the patient could be revived? What if all it took was to remove from the body the affliction causing the minimally conscious state? The directives, in this case, ask for an assessment to be made, decrees used as guidelines and, in case the patient is impaired, the request for removal of anything which is malignant.
my recommendation to abide by the directives. Why? To explain my reasoning, the above patient’s case can be thought of in terms of thee United States Constitution. As evidenced by the Amendments, the Constitution is a living document which remains flexible, yet is also susceptible to warring factions. Congress, which once could unite over protecting the integrity of the Constitution, now tears it asunder in an effort by the opposing parties to obtain the moral high ground. The Executive Branch has over-reached, insinuating itself into other areas, slowly strangling their ability to function while failing to execute the directives put forth faithfully. By approving the American Health Care Act and removing the Fair and Safe Workplaces Act, both Congress and the Executive Branch have failed in their duty to safeguard the public. What of the Judicial Branch? They have fulfilled their requirement to interpret the law, yet faces censure.
Currently, society is in a minimally conscious state. Society is aware of executive and congressional orders which harm the seven principles of the Constitution, which include popular sovereignty, republicanism, separation of powers, checks and balances, limited government, individual rights, and federalism. The health of a nation can be restored if we displace those who are malignant by adhering to directives written in beneficence. Failure to act on the directives in the Constitution and the Amendments would resign the Constitution to a state where the organs are functioning, but cognitive function is lacking.