Consider the following case then answer the questions at the end:
Inflicting Agony to Save a Life
[Taken from: Sara T. Fry and Robert M. Veatch. Case Studies in Nursing Ethics, 2nd Edition. Boston: Jones and Bartlett
Publishers, 2000. P. 128-129.]
Sally Morganthau was an experienced nurse in the care and treatment of patients suffering from body burns. She was newly
assigned as the primary nurse for James Tobias, a 32-year-old man who had been on the burn unit of Parsons County Hospital for
four weeks. He had suffered 60 percent body burns (40 percent first- and second-degree, and 20 percent third degree) after
being trapped in a house fire.
It was clear to the staff that Mr. Tobias would survive his injuries, but his treatment process would be a long and painful
one. He would be hospitalized for months and would face a number of operations. He would probably lose his eyesight and have
limited mobility due to extensive muscle damage in the lower extremities. Of greater concern to the staff was Mr. Tobias’
mental distress from his tankings and dressing changes. He often screamed with agony as the staff worked on his dressings. He
demanded that they stop, but the team, used to the screams of its patients, continued their efforts, day after day. Because of
the excellent record of this particular burn team, patients for whom survival would have been unprecedented only a few years
ago pulled through.
One day after his daily tanking and dressing changes had been completed and he had returned to his room, Mr. Tobias asked for
Ms. Morganthau. He insisted that no further treatment be performed. He made it clear that he understood that this would mean
his possibilities of surviving his injuries would decrease and that if he did survive, his contractures would be worse and his
problems even more severe. Yet he insisted that the agony was too much for him, and he did not want any further treatment.
Ms. Morganthau spoke with her nursing colleagues and discovered that Mr. Tobias had been demanding that they stop the
treatments for over a week. A psychiatric consult had confirmed that Mr. Tobias was mentally lucid and understood the
significance of his decision. Dr. Albertson, the chief of the unit, was well aware of Mr. Tobias’ feelings. He had seen
patients like Mr. Tobias before. Some who had considered refusing further treatment thanked Dr. Albertson and the staff years
later for going on. Dr. Albertson knew that Mr. Tobias’ life was on the line. He was not going to lose a patient he knew he
could save.
1. Based on the means/ends version of the categorical imperative, what should the hospital staff do?
2. Does Mr. Tobias meet the three elements of consent (competence, understanding, and voluntariness)?
In order to answer these questions, you will need to explain the theory or concept and demonstrate how, in your view, this
case does or does not meet the criteria.
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