Background

CASE 1.1: “When Physicians & Family Disagree”

In Case 1.1, “When Physicians and Family Disagree”, Mrs. Francois, a 63 year-old French Canadian women, is readmitted to the hospital shortly after being released. Six days after undergoing a hysterectomy and bilateral oophorectomy, Mrs Francois reported having a severe abdominal pain, and her blood pressure began to drop.  After examining Mrs. Francois, the doctor concluded that she had generalized peritonitis and that she would need an operation or she would probably die. However, despite the doctor’s straightforward explanation and her what was perceived as her stable mental condition, Mrs. Francois refused. Her family was distressed by her decision to refuse the surgery, and the son even threatened the physician to act or he would hold the physician responsible for his mother’s death. The case raises questions about autonomy and implied consent for patients who refuse treatment.

CASE 2: “Family Struggles With Father’s Wish To Die”

I came across this story on NPR, and I thought it would be particularly interesting to discuss and compare this case to the one that was in the Well and Good book. In Case 2, 66 year-old man named Robert Schwimmer was diagnosed with pancreatic cancer in 2013.  Now, after being in hospice care, he has expressed that he does not want to prolong his life and would like to accelerate his death if he finds himself in excruciating pain.  In this case, the son is willing to help his father, but he admits it would be difficult for him to do so for both legal and spiritual reasons.  Legally, it would difficult to implement Robert Schwimmer’s decision because physician assisted suicide is not legal in Illinois. Spiritually, the son expresses that he feels uncomfortable playing any role in his father’s death. Despite these reservations, the children are willing to respect to the father’s wishes.

Analysis

Both of these cases are quite similar in that both cases the legal course of action does not necessarily dictate the morally correct course of action. In Case 1, the physician is faced with both legal conflicts as well as moral conflicts.  If the doctors abides by the law that requires consent from the patient before medical intervention, then he violates principle of minimizing harm and fails to commit to his professional obligations despite following the principle of autonomy. If he fails to act, however, and is legally charged with “criminal neglect” by not performing the surgery, and he may also be in violation of principles of minimizing harm because the patient would have died. The legal implications of the doctor’s possible decisions do not reveal what the ethical course of action would be in this situation. In Case 2, Robert Schwimmer does not want to prolong his life if his qualify of life declines.  However, the laws that are in effect in his state challenge his autonomy to make those choices.

By comparing these cases, it is possible to gain insight on how to approach situations where the patient is refusing life-sustaining treatment.  After reading Case 2, I would argue that the physician ought to perform the surgery in Case 1.1.   While the physician does has a moral obligation to respect a patient’s autonomy, the principle of autonomy​y can be specified in this case.  Mrs. Francois is entitled to her autonomy as long as she is fully competent to make these autonomous decisions.  While Mrs. François was visibly competent and appeared stable in eyes of the physician, the son asserted that “his mother was behaving abnormally” (Thomas & Waluchow 62) and that “she didn’t understand the consequences of her refusal of the surgery” (Thomas & Waluchow 62). The conflicting perception in Mrs. François competency and mental suggests that her autonomy may not be used to support her decision to refuse treatment.  In Principles of Biomedical Ethics, Tom L. Beauchamp and James F. Childress discuss the concept of “sliding-scale strategy”.  Writers that support sliding strategy argue that “as the risks of a medical intervention increase for patients, so should the level of ability required for a judgment of competence to elect or refuse the intervention” (Beauchamp & Childress 119) . The sliding strategy allow one to consider all the risk of intervention, or in this case, lack of intervention,  and use that set the expected level of competency to make that decision. In this case, Mrs. Francois’s risk for not having surgery is death. Thus, if her competency is not fully understood or clear than the doctor has more reasons to perform the surgery.

Interestingly, while I do feel that the physician ought to perform the surgery for Mrs. François, I would argue that Robert Schwimmer should be allowed to accelerate his death if, and only if, he is in excruciating pain or his quality of life declines. The primary difference between this case and Mrs Francois’ is the concept of harm,pain, and competency. In Mrs. François case, she is currently having “abdominal pain”, yet is refusing treatment that would save her life. Thus, by neglecting to treat her, the physician is not minimizing her harm, but rather allowing it to continue.  If her autonomy is questionable on the basis of her competency, then there is more of reason to follow the principle of minimizing harm and performing the surgery than following the principle of autonomy. However, in Robert’s case, he is refusing life-sustaining treatment if he is a state of pain or decreased quality of life.  Robert was only interested in accelerating his death under a specific set of conditions. Although the details of Robert’s competency are not completely clear, his wishes and reasoning do seem to reflect rational. His family also does not point to any abnormalities in behavior which is not the case with Mrs. François. In Robert’s case, if the physician refuses to intervene and remove the life sustaining treatment, he is not minimizing harm nor is really respecting the choices of him and his family.   If Mrs François was to have the operation, she would most likely have a more promising future and quality of life than Robert, who is likely to become progressively worse in his health over time.  Whereas the physician is deciding between life and death for Mrs. Francois in Case 1.2, the physician is Case 2 is coping with the question of sustaining Robert’s life.  The different conditions in these cases require different moral actions on the part of the physician despite seeming somewhat contradictory.

Work Cited:

Thomas, John E., and Wilfrid J. Waluchow. “When Physicians and Family Disagree.”Well and Good: A Case Study Approach to Biomedical Ethics. 3rd ed. Peterborough, Ont.: Broadview, 1998. 71-76. Print.

NPR STAFF. “Family Struggles With Father’s Wish To Die.”. National Public Radio (NPR). 1 Feb. 2015. Web. 4 Feb. 2015

Beauchamp, Tom L., and James F. Childress. “The Meaning and Justification of Informed Consent.” Principles of Biomedical Ethics. Seventh ed. New York: Oxford UP, 2013. 120-25. Print.