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TRANSCRIPT

Case Study: Tonya Archer

Introduction

It is one thing to consider medical ethics in an abstract setting, but by their nature,

medical ethics involve deeply personal and emotional situations. This activity asks

you to consider a case in which the family’s wishes are in con�ict with the medical

advice they have been given. You will be asked to answer some questions at the

end of this activity.

Tonya is admitted to the hospital

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Tonya Archer is a �fteen year-old who has been admitted to Saint Anthony

Medical Center for surgery to repair an ACL injury she suffered while playing

softball. Tonya and her family have met with her surgeon and understand that

while all surgery carries risks, this is a straightforward procedure that he has

performed many times with no complications.

Post-surgical complications

The surgery goes as expected, but as Tonya is being transferred from the recovery

room to her hospital room, she went into cardiac arrest. While Tonya received

immediate medical attention, it took over seven minutes to restore cardiac

function and the loss of blood circulation resulted in brain damage. During the

attempt to resuscitate Tonya, she was intubated and placed on a ventilator. The

medical staff has determined, though, that the loss of circulation caused brain

death.

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Doctors recommend ending life support

Tonya’s doctors explain to her family that the damage Tonya sustained is

irreversible and that she suffered whole brain death, which means that there is no

neurological function, even at the most basic functions such as respiration or

cardiac function. They tell the family that the next step is to take Tonya off the

ventilator. Tonya’s parents reaction is of steadfast refusal. They tell the doctor that

they understand that Tonya has had a serious accident, but they point out that her

body is warm, her heart is beating, and that she therefore is not dead.

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Hospital administrator and medical ethicist

The doctors, hospital administrator, and the hospital’s medical ethicist tell the

family that while the ventilator and other interventions can sustain the body’s

functions, the damage done by the cardiac arrest will get worse and there is near

certain expectation that Tonya will not recover any brain function. The family is

told that there is no reasonable hope of bene�t to Tonya by continuing ventilator

and other treatment.

R � i

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Re�ection

Question 1 of 2

What are the most relevant end-of-life issues in health care ethics as they relate

to this case?

This question has not yet been answered.

The parents’ right to make end-of-life decisions for their child, the bene�t or futility

of continuing the treatment, and the appropriate use of hospital resources are all

issues that factor into this case.

Question 2 of 2

What should the hospital do? Should the hospital keep Tonya on life support as

the parents desire, or should life support be removed because all medical evidence

indicates whole brain death?

This question has not yet been answered.

Most bioethicists feel that the designation of brain death is suf�cient to justify

withdrawing life support and the law generally supports a hospital’s decision to

discontinue life support. The courts, when they have been involved, may call for

limited reasonable accommodations in order to allow for a second opinion of the

diagnosis or when religious objections have been made.

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