PhilosophyCase studyEnd of life care

Should we withhold life support? The Mr. Martinez case

A DNR order and a respiratory failure caused by a staff error — two facts that pull the obvious answer apart, and the brief removes the surrogate who might have resolved it.

Aug 8, 2026Updated Aug 10, 2026

Editorial process

Last reviewed · August 8, 2026

Written by

Aaron Bishop

MA, Education

assignment interpretation and research-methods coaching across disciplines

Reviewed by

Dr. Nathan Cole

PhD, Rhetoric & Composition

Argumentation and thesis development

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Interpret the task
Assignment instructions
Deliverables
Proposed outline
Research plan
Reference shortlist
Final review

Two facts that pull the obvious answer apart

The case is constructed so the obvious answer is wrong, and seeing why is most of the assessment. Mr Martinez has a valid DNR order, so the reflex reading is that nothing should be done. But a DNR order refuses cardiopulmonary resuscitation; it is not a refusal of all treatment, and it says nothing about transfer to intensive care, ventilation, or oxygen titration. Read the case again and the second decisive fact appears: his respiratory failure was *caused by his oxygen being inadvertently turned up*. This is not the natural progression of his disease. It is an iatrogenic harm, and treating a harm the institution caused is a different question from prolonging a dying process the patient declined. State both facts in the opening paragraph, because everything the assessment asks for afterwards is easier to argue once the reader knows the question is not simply whether to honour a DNR.

Those two observations should structure the paper, because the brief's first required element is *the patient's directives*. Say precisely what the directive covers and what it does not. A DNR is a scope-limited refusal made in anticipation of a particular event; extending it into a general instruction to withhold care is a substitution of the clinician's judgement for the patient's, which is the failure of respect for autonomy dressed up as compliance with it. The stronger reading is that Mr and Mrs Martinez refused resuscitation from an expected cardiopulmonary arrest, and that a reversible complication of a treatment error was not the circumstance either of them had in mind. Say what the paper would conclude on the opposite reading too, since showing that you considered the broad interpretation and rejected it for a reason is stronger than never having noticed it.

*The patient's quality of life* is the element that most often goes wrong, because students answer it about the patient rather than about the judgement. Quality of life is the patient's own assessment, not the clinician's estimate of what a life with advanced COPD is worth, and the evidence here is that he was being treated actively and *seemed to be doing better* — a man expected to recover from this admission. Where his own view is unavailable, the paper should say so and explain what standard applies instead: substituted judgement where prior wishes are known, and best interests only where they are not. Getting that hierarchy the right way round is a demonstrable competency. Say explicitly which standard you are applying and on what evidence, because the assessment's competency wording is about demonstrating sound ethical thinking rather than about reaching a particular result.

The brief adds a constraint that changes everything and is easy to miss: *assume that doctors cannot contact Mrs Martinez and must make this choice on their own*. That removes the surrogate, so the paper cannot resolve the case by deferring to family. What survives is the prior directive as evidence of values, the clinical facts, and the ethical principles. It also raises the emergency question — whether treatment may proceed under presumed consent while the surrogate is unreachable — which is a real doctrine and worth naming. Note the brief still asks for *the family's stated preferences*: those exist, in the joint DNR request, and should be reported as evidence even though the family cannot be consulted now. Note also that the constraint is artificial and says so, which means the paper can acknowledge that contacting her would ordinarily be the first step while still answering the question as posed.

The last required element names the trap explicitly: *any conflicts of interest that might arise because of the patient's respiratory failure*. The failure was caused by a staff error. An institution facing potential liability has an interest in how the event is characterised and in what happens next, and a decision to withhold escalation could be — or could later appear to be — influenced by that interest rather than by the patient's. Name it directly, say why it must not enter the clinical decision, and say what disclosure is owed. Then apply the four principles by name to reach a conclusion in two to three pages, with autonomy, non-maleficence, beneficence and justice each doing identifiable work. Two to three pages is short for six required elements, so allocate roughly a paragraph each and resist retelling the case, which the marker has already read.

Required element	The reading that fails	The reading the case supports
Patient's directives	DNR means withhold everything	A DNR refuses CPR; it is scope-limited
Cause of the deterioration	COPD progression	Iatrogenic: the oxygen was turned up in error
Quality of life	The clinician's estimate of a COPD life	The patient's own view; he was improving
Family's preferences	Unavailable, so ignored	The joint DNR request is stated evidence
The surrogate	Defer to Mrs Martinez	The brief removes her; decide without
Moral issues	Killing versus letting die, in the abstract	Whether this death is caused or permitted
Conflicts of interest	Not addressed	Institutional liability for the error
Ethical principles	Named in a list	Each applied to a specific fact of the case

Likely learning objectives

Inferred from the brief — check these against your own rubric.

01
Read a directive for its actual scope rather than its general implication.
02
Distinguish disease progression from iatrogenic harm in an ethical analysis.
03
Apply substituted judgement and best interests in the correct order.
04
Identify an institutional conflict of interest and say what follows from it.

Assignment instructionsQuoted verbatim

Read the full question

Review every instruction before using the planning guidance that follows.

Write a 2-3 page paper that examines the moral and ethical issues involved in making a decision regarding limiting life support. End-of-Life Issues With our framework of ethical theories and principles in hand, we begin our look at some of the critical ethical issues in our contemporary world, starting with end-of-life issues. This assessment covers ethical questions related to end-of-life care. Passive euthanasia is the removal or refusal of life-sustaining treatment. Examples of passive euthanasia include removal of a feeding tube or a ventilator, or forgoing a life-prolonging surgery. Passive euthanasia is legal in all 50 states, and the principle of autonomy gives informed patients the right to refuse any and all treatments. Patients who are unable to make such decisions in the moment (because they are unconscious, for example) might have made their intentions clear beforehand with an advance directive or similar document. Things become more complicated, however, when a patient who is unable to make treatment choices has not made his or her wishes clear, either formally in a written document, or informally in conversations with family members or friends. Another problem concerns cases in which there is disagreement about whether the treatment is sustaining the life of a person in the full sense or merely as a body that, because of severe and irreversible brain trauma, is no longer truly a living person. Active euthanasia, or assisted suicide, introduces further difficult moral questions. A patient who has a terminal illness and who has refused treatments that would merely prolong a potentially very painful and debilitating death might want the process of dying to be hastened and made less painful. The patient might want to take his or her own life before the disease reaches its horrible final stages. Should patients be legally allowed to have help in this endeavor? If suicide itself is not morally wrong, at least in cases like these, is it wrong for another person to directly help bring about the patient’s death? Is it wrong for doctors, a role we naturally associate with healing and the promotion of life, to use their medical expertise to deliberately end a patient’s life if the patient wants this? Demonstration of Proficiency By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria: Competency 1: Articulate ethical issues in health care. Articulate the moral issues associated with limiting life support. Competency 2: Apply sound ethical thinking related to a health care issue. Demonstrate sound ethical thinking and relevant ethical principles when considering limiting life support. Explain important considerations that arise when contemplating limiting life support. Competency 5: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others and is consistent with health care professionals. Exhibit proficiency in clear and effective academic writing skills. Assessment 3 Instructions: Should We Withhold Life Support Preparation Case Study: Mr. Martinez. Mr. Martinez was a seventy-five-year-old chronic obstructive pulmonary disease patient. He was in the hospital because of an upper respiratory tract infection. He and his wife had requested that CPR not be performed should he require it. A DNR order was written in the charts. In his room on the third floor, he was being maintained with antibiotics, fluids, and oxygen and seemed to be doing better. However, Mr. Martinez’s oxygen was inadvertently turned up, and this caused him to go into respiratory failure. When found by the therapist, he was in terrible distress and lay gasping in his bed. This media piece provides the context for this assessment; make sure you have reviewed the case study thoroughly. Additionally, it may be useful to think through the following issues as they relate to Mr. Martinez’s case: Should Mr. Martinez be transferred to intensive care, where his respiratory failure can be treated by a ventilator, and by CPR if necessary, and his oxygen level can be monitored? What are the key ethical issues or models at play in this case study? What are the key end-of-life issues at play in this case study? How can an understanding of models and best-practice help to guide health care practitioners to make ethical and legal decisions? Instructions In a 2–3 page analysis of the case study, address the following: The patient’s directives. The patient’s quality of life. The family’s stated preferences. The moral issues associated with limiting life support. The ethical principles most relevant to reaching an ethically sound decision. Assessment 3 Instructions: Should We Withhold Life Support Important considerations such as implications, justifications, and any conflicts of interest that might arise because of the patient’s respiratory failure. When writing your assessment submission assume that doctors cannot contact Mrs. Martinez and must make this choice on their own. To help you reach an objective, ethically sound decision, draw upon concepts and arguments from the suggested resources or your independent research. Support your response with clear, concise, and correct examples, weaving and citing the readings and media throughout your answer. Submission Requirements Written communication: Written communication is free of errors that detract from the overall message. APA formatting: Resources and citations are formatted according to current APA style and formatting guidelines. Length: 2–3 typed, double-spaced pages.

What the Mr. Martinez case analysis must contain

01
A 2-3 page analysis of the case.
02
The patient's directives, and what they cover.
03
The patient's quality of life, assessed on the right standard.
04
The family's stated preferences as evidence.
05
The moral issues associated with limiting life support.
06
The ethical principles most relevant, applied to the facts.
07
Implications, justifications and conflicts of interest.
08
A conclusion reached without contacting the surrogate.

From the directive's scope to a justified decision

The directives, read for scope

State what the DNR refuses and what it leaves open.

What caused the crisis

Identify the respiratory failure as iatrogenic rather than disease progression.

Quality of life and the standard of decision

Apply the patient's own view, then substituted judgement, then best interests.

Deciding without the surrogate

Work the case under the brief's own constraint.

Conflicts of interest

Name the institutional interest created by the error, and its consequences.

Principles and decision

Apply the four principles to the facts and reach a justified conclusion.

Reading DNR scope before reading euthanasia ethics

Recommended databases

Journal of Medical Ethics and American Journal of Bioethics
NCBI Bookshelf
PubMed Central
The assessment's suggested resources

Search sequence

1.
Read a reference on the scope and limits of DNR orders first, because the whole analysis turns on what the directive does and does not cover.
2.
Search the ethics literature on withholding versus withdrawing treatment, which is the moral-issues element and has a substantial and genuinely contested literature.
3.
Look up decision-making standards when a surrogate is unavailable, since the brief's constraint removes the ordinary route and the emergency doctrine has to be named accurately.
4.
Find guidance on disclosure after harm, which is what turns the conflict-of-interest element from an observation into an obligation.

Directives, refusal of care and withdrawal ethics

These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.

Nothing here is cleared for citation until you have read it.

01
Withholding and withdrawing life support in critical care settings: ethical issues concerning consent
Journal of Medical Ethics · 2007
Directly on the brief's central element, and specifically on consent — which is what the case removes when it takes Mrs Martinez out of reach. Use it to argue what may be done, and on what authority, when the surrogate cannot be consulted.
02
Advance Directives
StatPearls, NCBI Bookshelf · 2023
The reference that establishes what a DNR order actually is and what it covers, which is the foundation of the paper's first and most consequential move. It also sets out the decision-making hierarchy the quality-of-life element depends on.
03
Refusal of Care
StatPearls, NCBI Bookshelf · 2023
Clarifies the conditions under which a refusal is valid and how far it extends, which is what lets you argue that a refusal made in anticipation of one event does not govern a different one. Central to the scope argument.
04
Withdrawal Aversion and the Equivalence Test
The American Journal of Bioethics · 2019
The best available source for the moral-issues element, because it examines the intuition that withholding and withdrawing differ morally and tests it. Citing it lets you engage the killing-versus-letting-die question with an argument rather than with a definition.
05
Limitation of life sustaining therapy in disorders of consciousness: ethics and practice
Brain · 2024
Current work on how limitation decisions are actually justified in practice, including the role of prognostic uncertainty. Useful for the implications section, where the paper has to say what follows from deciding under incomplete information.

Before the life support case analysis is submitted

Common mistakes

Treating the DNR as a refusal of all treatment.
Missing that the respiratory failure was caused by a staff error.
Answering the quality-of-life element with a clinician's estimate.
Resolving the case by deferring to Mrs Martinez, whom the brief removes.
Ignoring the family's stated preferences because they cannot be consulted.
Discussing active versus passive euthanasia in the abstract, unattached to the case.
Naming the four principles without applying any to a specific fact.
Omitting the conflict of interest, which the brief asks for explicitly.
Failing to say what disclosure is owed after an iatrogenic event.
Reaching no conclusion, or a conclusion with no stated justification.
Exceeding three pages on the background before analysing anything.

Submission checklist

The DNR's scope is stated precisely.
The iatrogenic cause of the deterioration is identified.
Quality of life is assessed from the patient's standpoint.
The joint DNR request is used as evidence of values.
The analysis proceeds without contacting the surrogate.
Substituted judgement and best interests are correctly ordered.
Each of the four principles is tied to a fact in the case.
The institutional conflict of interest is named.
What disclosure is owed is addressed.
A decision is reached and justified.
The paper stays within 2-3 pages.

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