Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true, but anonymized, patient care case. You vote on your decision in the case and, next week, we'll reveal how you all made the call. Bioethicist Jacob M. Appel, MD, JD, will also weigh in with an ethical framework to help you learn and prepare.
The following case is adapted from Appel's 2019 book, .
Cornelius is a 92-year-old widowed banker with terminal heart failure. He is in a hospital, on a ventilator, and drifts in and out of consciousness, but even when conscious, he appears profoundly confused. His family visits regularly, and they appear deeply devoted to him. This has been his condition since early November.
As the end of the year approaches, Cornelius's family asks for a meeting with Jill Benway, MD, the head of the cardiology unit. The family explains that they want to take Cornelius off the ventilator. In the course of the meeting, their underlying motivation becomes clear. "He's going to die anyway," says his eldest son. "If not this month, then next month. But if he dies after January first, the tax code will have changed dramatically, and half of his fortune will go to Uncle Sam rather than to his grandchildren. My father never would have wanted that." To Benway's surprise, the patient's other six children all agree that he would rather die sooner so as not to lose the tax advantage.
See the results and what an ethics expert has to say.
Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at the Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College.
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