“The biggest thing people don’t understand is: this is not a death sentence. It’s not a suicide. It’s about rights.” – (Fox13Now)
Case Discussion:
The major moral dilemma in this case study deals with whether or not the father should receive more evasive yet more successful treatment for his severe depression even though he declined receiving Electroconvulsive Shock Therapy (ECT). The ethical issues is exacerbated when the next-of-kin, the patients’ son, has been informed of the positive as well as the negative effects of receiving ECT, however still denies the treatment for his father which could drastically improve his father’s medical condition. The psychiatrist is faced with the ethical dilemma of respect for patient autonomy versus non-maleficence. Should the psychiatrist allow the patient to revel in this very deep depression where he has attempted to commit suicide or should the psychiatrist override the wishes of the patient and administer the procedure regardless of if the patient or his next-of-kin consents? If the psychiatrist doesn’t intervene, then the father could possibly commit suicide, which goes against the ethical principle of non-maleficence; it is the duty of the psychiatrist to not harm the patient. One can argue however, is the psychiatrist really harming the patient if the patient chooses to commit suicide? The psychiatrist is also expected to respect the decisions of the patient. The patient is an adult and has made the previous decision to receive antidepressants. If the patient is able to make that choice, then he should also be able to make the choice that he does not want to undergo ECT.
My Response:
This is a very difficult dilemma to attack. However, if I was the psychiatrist in this position, I feel like I would have no other choice but to honor the decision of the patient and his son. Sometimes medical professionals can be selfish in their pursuits of solely wanting to make sure that a patient lives because no one wants a patient to die on their watch! If a patient dies, then the medical professional will feel like a failure. The psychiatrist should try his/her best to assure that the severely depressed patient causes no harm to himself and should just patiently wait the four to six weeks for the drugs to take effect.
Current Event:
The case discussion has brought up a very interesting point. What is the difference between this depressed patient and “the cancer patient who initially agrees to surgery but who now refuses chemotherapy? How can we acknowledge the right of patients to refuse potentially life-saving treatment in the one case but not in the other? (Thomas, 129-130)”. In a recent news report, a court case ruled that Cassandra C, a17-year old minor, would be forced into chemotherapy against her consent. The court said that Cassandra’s attorney failed to prove that she is mature enough to make her own medical decisions. If the girl was not a minor or successfully proved that she was mature enough to make a decision regarding her health then she would have been able to, under the law, refused chemotherapy. Cassandra’s mother approved of her daughters’ decision and exclaimed to news reporters that “The biggest thing people don’t understand is: this is not a death sentence. It’s not a suicide. It’s about rights.” This can be applied to the ECT case in that the patient, who is an adult, made a decision that should be respected by the medical staff. If cancer patients could ultimately have autonomy over their health decisions, then why can’t the depressed patient have that same autonomy?
Works Cited
Thomas, John and Waluchow, Wilfrid. Well and Good. Canada: Broadview Press, 1998. Print.
“Teen Forced into Chemo Treatments, Mother Supports Decision to Refuse.” Fox13nowcom. N.p., 07 Jan. 2015. Web. 29 Jan. 2015.
“Teen’s Forced Chemo May Continue, Connecticut Court Rules – CNN.com.” CNN. Cable News Network, n.d. Web. 29 Jan. 2015.
While it is important to respect the rights of all patients, people with depression suffer from a mood disorder where they are unable to think positively. Thus, regardless of this patient’s age, he may not have mental capacity to make these decisions. This case also raises questions about whether doctors and society as a whole have a responsibility to look after people with mental illness or to allow them to make their decisions as any other individual. The patient in this case is suffering from depression after a traumatic life event, so he may not be fully capable of thinking rationally.
The difficulty with this case is how one conceptualizes their understanding of depression. The way medical professionals view and understand cancer, is not the same as how they view depression. While a patient that has cancer is likely to be undergoing a tremendous amount of mental stress, their condition is primarily being perceived as biological as opposed to psychological which affects a doctor’s decision on whether or not to respect their autonomy. In an article published in Nature, researchers discuss and try to understand why depression has often received much less funding despite the fact that it affects over 350 million people worldwide (Ledford). Ledford explains that a large part of funding has to do with the stigma surrounding depression. By allowing patients who suffer from depression to refuse life-sustaining treatments are we further constructing this stigma by not working to address their illness? Do we want to live in a society where people with depression are left untreated and decide to commit suicide? Based on my answer to those questions, I would have to argue that the doctor should make the decision to stand by the principle of non-maleficence and treat the patient.
Work Cited:
Ledford, Heidi. “DEPRESSION WERE CANCER.” Nature 515 (2014).