How much are we supposed to care for the others? Autonomy and nonmaleficence make sense because we should respect opinions of others and not harm people, but how and where should we draw the line for the beneficence? The question rises from the base that people do not want to be involved in a situation where doing good for the others would cost them something in turn. This is the exact dilemma presented in the case study with Robert McFall and his cousin David Shimp in the Principles of Bioethics.
Robert McFall was diagnosed with aplastic anemia, needing bone marrow transplant, and he wanted his cousin David Shimp to undergo two exams to determine if he were a genetically compatible donor. However, Shimp refused after taking the first exam, which determined his tissue to be compatible to those of McFall. McFall sued his cousin for not willing to take the second exam and donate if he were to be fully compatible. The judge ruled that the law can’t force Shimp, but his refusal was morally indefensible (Principles of Bioethics). Apparently, there are generous people who are genuinely concerned about others and would donate blood even if the patient is not related to the donor as shown in the case of the Atlanta Journal Constitution blog (AJC Parenting Blog). I am not saying that Shimp should also act heroically and go through the medical procedures to donate to his cousin, but I agree with the judge’s the ruling that Shimp’s act was morally indefensible.
Beauchamp and Childress present five premises of obligatory beneficence. The first premise is met since McFall is at risk of significant damage to life. There is no doubt that he might actually die. From Shimp’s standpoint, the application of second and third premises can be questionable, though. With the chance of survival increasing from 25% to about 50% in average, Shimp’s action may not prevent McFall’s death and thereby not be considered as a necessary action he must take for McFall (Principles of Bioethics). However, fourth and fifth premises about balancing the benefits and risks for the receiver and the donor respectively may make McFall’s suing argument strong while undermining what Shimp had to present. Pondering upon these premises it can be hard to determine whether Shimp’s refusal can be viewed as morally indefensible or not.
Specifically, counterargument might bring out this point: why is the autonomy of donor not respected and why does the case seem to imply that obligatory beneficence triumphs over autonomy? Autonomy is defined as something that “encompasses self-rule that is free from both controlling interference by others and limitations that prevent meaningful choice” (Principles of Bioethics). The counterargument may state that this should not only be applied to the patients but also to everyone and especially to the donors as well who actually have control over the choice whether to donate or not. I agree; nevertheless the same standards to determine whether one is autonomous and competent must be applied to everyone as well. Therefore, Shimp’s beliefs must be evaluated for rationality.
In other words, if his beliefs are irrational, then his choice of not to go through the second exam can’t be considered as an autonomous decision and can further be seen as an immoral one. Shimp believed that 100 to 150 punctures of pelvic bone and 1 in 10,000 chance of death from anesthesia were too much of risks for his part. Is this a rational belief? In a research done by Harvard School of Public Health, there is 1 in 6,700 chance of death from car accident (Best Health Degrees). His belief is irrational because I am logically assuming that he drives around to work, to grocery stores, and to many other places risking his life while refusing to go through a procedure to save his cousin, which involves lower risks. I don’t want to say he should be forced to be the donor, but he is “morally indefensible” as the judge stated. His beliefs are irrational, and there is no valid counterargument that can say his autonomy triumphs over beneficence.
References
Beauchamp, Tom L., and James F. Childress. “Respect For Autonomy.” Principles of Biomedical Ethics. New York: Oxford UP, 2013. 101-41. Print.
Beauchamp, Tom L., and James F. Childress. “The Duty of Rescue as Obligatory Beneficence.” Principles of Biomedical Ethics. New York: Oxford UP, 2013. 206-08. Print.
Oliviero, Helena. “Georgia Girl Puts Spotlight on Life-saving Bone Marrow Transplants | AJC Parenting Blog.” AJC Parenting Blog. AJC, 3 Mar. 2015. Web. 18 Mar. 2015.
“Your Chances of Dying.” BestHealthDegrees.com. Best Health Degrees, n.d. Web. 19 Mar. 2015.
I really like the way you specify this particular case. David Shimp’s autonomy is not respected because his argument for not donating lacks rationality. Thus, by highlighting how the principle of beneficence triumphs the principle of autonomy, then it can be understood why the judge found Shimp’s acts as being “morally indefensible”.
Also, I think that Shrimp’s acts are morally indefensible because of his relationship to Robert McFall. Because David is Robert’s cousin, there is a greater expectation that he would follow the principle of beneficence as opposed to asserting his autonomy by not agreeing to a second examination. If David Shimp had no relation to Robert in any sort of way, then I would not find his act morally indefensible to same extent. While I do understand that the fact that they share some genetic markers does not explicate much information about their actual relationship, families have held important roles in healthcare because it is often assumed they have the best interest of the patient in mind. It’s important to understand the larger cultural context and social arrangements when assessing the morality of individuals such as David Shimp. Because I come from a social background where I am expected to look after the well being of my family and friends I expect the same from them as well. Thus, it is difficult for me to understand Shimp’s decision, and I am more inclined to believe that it was morally indefensible.