Background
In Thomas, Waluchow & Gedge’s Well and Good, case number 3.2 presents Simon, a widowed father of one child was brought to the hospital after being found unconscious in his bed next to an empty bottle of antidepressants. Simon’s guilt in regards to his absence during his mother’s death along with his thoughts of financial ruin led him to believe that living “in a state of perpetual depression was intolerable” and that he would “rather be dead than suffer like this for the rest of his life” (Thomas, Waluchow & Gedge, 124). Upon admission to the hospital, 36 hours later, Simon’s unkempt appearance and suicidal actions led his psychiatrist to propose electroconvulsive shock treatments (ECT).
Dilemma
Although there are several dilemmas presented within this case study, the two that stick out to me the most are those concerning the ethical principles of autonomy and non-maleficence. Autonomy, respect for persons, can be defined as acknowledging a person’s right to make choices, to hold views, and to take actions based on personal values and beliefs (Bishop). In this case, Simon refuses to consent to the proposed treatment, as he had no desire to live. After conferring further with Simon’s son, who refused to override his father’s expressed wishes, the psychiatrist was left to make a choice – to respect Simon’s wishes, and therefore his autonomy, or to violate his autonomy by applying to the review board in hopes of obtaining permission to treat Simon against his wishes.
On the other hand, non-maleficence, do no harm, can be defined as the obligation not to inflict harm intentionally (Bishop). In this case, the psychiatrist is forced to weigh the options – if Simon continued drug therapy, could it lead to further harming himself? If Simon underwent the ECT would the physical harm of the treatment itself be worse? Or maybe the ECT could cause death in a worse case scenario?
Reflection
Similar to the Integrity and Nurses’ Relationships with Colleagues and Employers case that we spoke about in class on Wednesday, the two main dilemmas in this case revolved around autonomy and non-maleficence. In terms of autonomy, Simon is entitled to refuse the ECT. However, according to a Disability Rights Brochure, “the doctor must also tell you that you are responsible for anything that happens to you because you refused the treatment” (Electroconvulsive Treatment). In medical ethics, as non-maleficence makes clear, a guiding maxim is “do no harm” (Bishop). How is the psychiatrist able to respect Simon’s autonomy while at the same time abiding by the principle of non-maleficence? Additionally, Simon’s plea to be left alone makes the psychiatrist’s decision even harder in the sense that Simon is not only refusing the ECT, but is also suggesting that he is not considering any other options to save/fix his life. Although there is no ideal solution, I believe the best way to move forward at this point would be to find another drug therapy option while keeping Simon under a close watch.
Works Cited
Bishop, Laura. “Principles — Respect, Justice, Nonmaleficence, Beneficence.” Ethics Background. N.p., n.d. Web. 28 Jan. 2015. <http://nwabr.org/sites/default/files/Pri nciples.pdf>
“Electroconvulsive Treatment (ECT).” Disability Rights California . N.p., n.d. Web. 28 Jan. 2015. <http://www.disabilityrightsca.org/pubs/539801.htm>.
Thomas, John and Wilfrid Waluchow. Well and Good: A Case Study Approach to Biomedical Ethics. 3rd ed. Broadview Press Ltd., n.d. Print.
Image Webpage:
http://www.psychiatrictimes.com/schizophrenia/possible-restriction-ect-devices-concern-grows-among-psychiatrists
With respect to the patient’s autonomy, I think an important factor to address is this patient’s state of mind. Committing suicide is a major decision, and I believe that due to his battle with depression, he may not be reasoning clearly. If that is the case, autonomy, in my opinion, does not outweigh the importance of the non-maleficence principle. Another interesting point that you brought up is that the son is refusing to go against his father’s request. Therefore, by treating the patient with ECT, the doctor would also be going against the wishes of the closest relative. On the other hand, the son may not completely understand that his father is not reasoning clearly, and if he understood that, his views could change. Thus, I would say that the doctor should request permission to treat his patient.
I am inclined to agree with you on the idea that there is an autonomy violation in this case. Although one may argue that the patient’s capacity is diminished by his own depression, it is precisely the fact that he can explain his depression and its source and the extent of his suffering that shows he is still within his right mind in his decision-making. It is difficult perhaps to understand from the outside looking in that his rational decision is to die, but it is a decision that he is making unhindered by grief.
While the principle of autonomy is a an important ethical principle to focus on in this case, I do think it’s important to consider the possible consequences of weighing the principle of autonomy over non- maleficence . In this case, the doctor’s decision to move forward with the treatment would be going against the wishes of both the father and the son. If the doctor abides by the principle of autonomy, and the father ends up committing suicide, however, the son may feel guilty for his father’s death which can lead to depression just as his father had become depressed after feeling guilty for his absence during the time of his mother’s death. The son’s decision to go against his father’s wishes may just reflect his desire to end his father’s suffering which would cloud his own decisions on whether or not to proceed with treatment. However, there could be treatments that work to end his father’s suffering. The father expresses that he “rather be dead than suffer like this for the rest of his life”. If the doctor abides by the principle of non-maleficience and relieves his suffering, then perhaps he will want to continue to live the rest of his life. While, it is impossible to predict the future and nothing is guaranteed, it is important to take future consequences into account when weighing conflicting ethical principles against each other.