Bioethical Principles in Extremis

ANALYSIS
1. Bioethical principles observed or violated with specific scenario/ examples from the film
Bioethical Principles in Extremis

Extremis is a Latin phrase that literally translates to "at the point of death”. In the 2016
documentary of the same name, it focuses on the obstacles on making urgent life or death decisions
faced by the medical team and, patients in critical conditions and their families. It follows palliative care
physician Dr. Jessica Zitter, in her empathic yet emotionally tedious role assisting palliative care patients
properly make end-of-life decisions and guiding their families on how to prioritize and respect the
decisions of their loved ones. This documentary is not about using all means to save these patients’ lives
since the harsh reality is that their conditions have led them to be depend on medical technologies, such
as ventilators to sustain their lives. Instead, this documentary focuses on assisting patients’ take charge
and decide on their next course action to take, even if it means, leading them to pass and leaving their
loved ones behind. Moreover, the film showcases two different outlooks towards accepting fate are
shown – one that does not want to suffer living on a ventilator while the other who wants to keep on
pushing to survive, in the hopes of a longer life. On one hand, there is Donna with myotonic muscular
dystrophy whose only chance for survival is to undergo a tracheostomy and be connected to a life-long
ventilator. In her case, it could be seen that she has accepted her fate, thus she prioritizes her decision
to halt all barriers that will make her suffering continue. On the other hand, there is Selena, who had an
acute cardiac arrest, which has resulted towards long periods of unconsciousness. Due to this, she is
unable to legally decide for her next course of action. Thus, her family, particularly, her daughter Tama,
became her legal guardian. For them, seeing Selena’s condition was unbearable and painful, therefore
they took a more aggressive approach since they believed that Selena still had a big chance of living,
despite having. The main bioethical principles presented in this film are the following: prioritizing the
patient’s autonomy in having direct control regarding her healthcare, the importance of ensuring
informed consent from patients before undergoing critical decision-making, the emphasis on veracity
towards disclosing the criticality of their conditions and the fateful effects of taking out the medical tools
that have helped them live, and the medical team’s duty of abiding to the principle of beneficence
towards giving the appropriate medical care to these palliative care patients.
First, autonomy means that any medical decision pertaining to one’s health care should solely
come from the patient, herself. Autonomy in having direct control regarding in deciding health care
decisions is the patient’s right. It could be seen in the scenes wherein Dr. Zitter respects Donna’s
decision on not wanting to undergo a tracheotomy and when Dr. Zitter carries out Donna’s decision of
taking out the ventilator. It could be also seen in the scene wherein a doctor was having a conversation
with Donna’s husband regarding the possibility of a tracheotomy. She tells him, Is that something that
she would want for herself? Is that something that she would be open to?” This shows that doctors
prioritize the patient’s rights above all concerned parties. In the scene wherein Dr. Zitter and Tama were
conversing, Tama says “It would feel like murder to pull that life support. That’s what it would feel like
to me…I feel like maybe as a doctor, you know, being as smart, and being as knowledgeable, and being
inside medical journals, it can dwindle your optimism a little bit” while Dr. Zitter replies, “I’m just trying
to help you make a decision that’s right for your Mom.” This instance shows that Selena, the patient, is
the overall priority.
Second, it is also the right of the patient to have a clear and truthful knowledge regarding any
medical procedures that doctors will provide for him/her is a patient right therefore ensuring patient’s
informed consent before end-of-life directives are carried out is essential.
Third, upholding the principle of veracity is vital in creating critical decisions since life is at stake
here. In the film, it shows the difficult task of “breaking the heavy news” towards their patients and their
families. It could be seen in several scenes wherein Dr. Zitter had a serious conversation with Selena’s
brothers wherein she says, “Everyday, people with poor neurological prognoses are attached
permanently to machines, and unfortunately, it is very had emotionally, for us physicians when we feel
that we are taking a body and we’re keeping it alive when it’s not really the person.” For Donna’s case, it
was shown in the first scene wherein she was honest about telling Donna who wants to take out the
breathing tube will cause her to die. It was also shown wherein a doctor was explaining the deteriorating
state of Donna towards her husband and that the only way for Donna to live on is to have a
tracheostomy to help her breathe.
Fourth, practicing beneficence is a moral obligation that the healthcare should uphold in all
aspects of patient care, particularly towards patient in life and death situations. In the scene wherein a
homeless man is confined, doctors are troubled on how to properly give him medical care as they
debate whether or not he is competent to make his own medical decisions. Dr Zitter tells him, “Do you
like making medical decisions? Or do you like others to make decisions for you?” It is seen here that
despite the obstacle they face in providing him care, they also show their intent to give him the best
medical care.
2. If you were the character in the story, what will you do?
I commend Dr. Jessica Zitter’s emphatic and courageous role in dealing with critical care patients
and their families because she is entailed to a difficult role of helping patients create decisions regarding
life-and-death. Moreover, it takes a great amount of courage and empathy to help these patients in
decision-making. She states, “I started to see the unintended effect that I had never imagined — that by
prolonging the life of people who were dying, we really cause a lot of unnecessary suffering." In my
opinion, this realization of hers is monumental as she realized that her patients should not be entailed
to life-long suffering. Moreover, she also has foreseen death is the reality for her patients in critical
condition. In this sense, she has turned to a more realistic approach in helping her patients. If I was to fill
Dr. Zitter’s role, I would her follow in her footsteps. I came to realize that being part of the critical care
unit is a tough role to fill since I have to set aside my emotions and views regarding life and death. Even
if I would want to do all means for the patient to live longer, I have to accept the criticality of their
conditions and instead, help them decide which fateful route to take and respect their decisions.

Bioethical Principles in Extremis

Uploaded by

Copyright:

Available Formats

Bioethical Principles in Extremis

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Bioethical Principles in Extremis

Uploaded by

Copyright:

Available Formats

ANALYSIS

Bioethical Principles in Extremis

You might also like

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.