In this week’s readings, we shift from focusing on the distinction between non-maleficence and autonomy and which takes precedence to the same dilemma that presents itself when beneficence is put into the equation. Beneficence, or the principle to only practice good and prevent harm, is in my opinion more at odds with autonomous decisions than non-maleficence. This is because non-maleficence implicates not causing harm, while beneficence affirms to practice good regardless of the medical staff’s own moral and ethical opinion of the autonomous decision made by a patient.
This apparent conflict between autonomy and beneficence is highlighted in the case of Dan Cowart. Dan was seriously injured in a propane explosion that caused burns all over his body and even the death of his father. Throughout the entirety of his treatment, Dan openly and lucidly expressed his desire to not persist with treatment and no longer endure the management of condition. However, physicians continued to treatment given their expert opinion that his prognosis for a good recovery was high- and he was eventually brought to healthy standards. That said, even after recovering from his injuries, Mr. Cowart maintains that his doctors should not have continued treatment and that if put in the same position, he would still desire to be allowed to succumb to his injuries.
In this particular case, we see the moral dilemma faced by the medical staff tending to Dan’s injuries and watching over his care. On one hand, we have a competent patient who is enduring excruciating amounts of pain in order to potentially get better and voicing that this is a recovery struggle that he does not wish to push through. On the other hand, we have a team of doctors that believe his prognosis is not nearly as grim as he is making it seem and, based on their expert conclusions, choose to override Mr Cowart’s decision and continue with treatment until he recovers. In my opinion, the doctors were wrong in pursuing treatment and submitting Dan to this course of action. Although the doctors were following the principle of beneficence and choosing to prevent further harm (in this case in the form of preventing Dan’s death), it is not within the scope of their responsibility to assume that in order to maintain this principle’s integrity, they must force Mr. Cowart to endure the incredibly painful ordeal that burn recovery is known to be. The doctors are in no position to say that the pain he would go through with medical intervention was outweighed by the supposed benefits of surviving his injuries. This was ultimately Dan’s call but because letting him die when there was the potential to live weighed heavily on the shoulders and morals of the doctors, they chose to forgo adherence to Dan’s autonomous decision and follow the guidelines of beneficence instead.
Works Cited
- Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York: Oxford University Press, 2013. Print.
- Cowart, Dax, and Robert Burt. “Confronting Death Who Chooses, Who Controls?” The Hastings Center Report 28.1 (1998): 14-24. Web. 20 Mar. 2015.
The principle of “Non-Maleficence” as discussed in class needs an intention to avoid needless harm or injury that can arise through negligence, carelessness, or even unreasonable risk. Take the case of a hypothetical patient who has a small, clearly benign, tumor located in their left hemisphere of their brain around the language area. If a doctor wanted to practice non-maleficence here he would most likely take the path of keeping a close watch on the tumor for an extended period of time, and based on the tumors progression the doctor can then propose certain treatments. To immediately propose for a high risk brain surgical removal of the tumor would be an instance where the doctor causes unnecessary risk early in the onset of the tumor. In this specific case, I believe that the doctors were morally justified in their decision on continuing treatment of the patients severe burns, but only based off of the principle of non-maleficence. Considering the patient would have died without treatment, and the goal was to keep the patient alive, giving the patient life saving treatment was in no way a negligent act, and in the doctors view the pain of treatment painful as it was, was needed. To omit from treating the patient would place the doctor in the moral dilemma of intentionally causing this patient’s death.
I agree with you that it is principle of beneficence that makes this case tricky.
Seen as the principle that promotes the well-being of others, it is easy to argue that the doctors were only acting in the well being of the patient by saving life. But the problem with the decision to save his life, even when he didn’t want to be saved, is that the doctors concluded that this man’s life would be better saved than not. Is it possible that in the eyes of a patient that a life with such severe deformities is not even worth living for? It is, and that’s the problem. Doctors constantly impose their expert opinions, and this adds to their power advantage which was discussed in the reading “Why Doctors Should Intervene”. The fact of the matter is that this man was competent and met all the criteria for autonomy, but because the doctor’s decided he was being irrational about not wanting to live, they saved his life. While the doctors no doubt practiced maleficence, they weighed the principle of beneficence in accord to their own opinions instead of the patients, and it is for this reason I believe they should have let him die.
When I first read the title of this post, I assumed it would question whether saving Dax’s life was beneficent in that it preserved Dax’s life or if it was beneficent in that it assuaged the minds of the doctors caring for him. Your post did briefly comment on the weight his death would have on the doctors’ morals and shoulders, but your discussion was by and large more about the arguments that could be made according to the principles of non-maleficence and beneficence. However, I would like to pursue the idea I presented at the beginning of this comment. Does beneficence only apply to the patient, or does it reach out to his family, friends, and those involved in his care. In this case, it is clear that the doctors decided that the goods of life that Dax would have after recovering outweighed the terrible pain, and thus maleficence, he was having to endure at the hands of nurses and doctors as he healed. However, it is also possible that they were also trying to act beneficently towards Dax’s mother and towards themselves. Dax’s recovery would be a good to his mother and, as a medical success, a good to the doctors. Should such far-reaching components of beneficence be allowed morally to have an impact on healthcare decisions or should they be made purely on the balance between beneficence and non-maleficence considering the patient’s physical and mental reality alone?
Suranjana, I think you raise an interesting point by considering the other parties involved. I could see how the good of the mother and doctors would be a thought worth pondering, but only if the patient were deemed incompetent. Dax was deemed competent more than once, and even with his competence he was not entitled to his autonomy. I do not know why it would be arguable that the benefit the doctors and mother may gain should outweigh the extreme suffering Dax is enduring. I also found it shocking that Dax was not able to get an attorney to defend himself. Dax states, “the patient may have a right not to be treated, but without an advocate…it’s hard to enforce that right” (RD 22). I agree with this statement. I am concerned that without an advocate, individuals like Dax may be taken advantageous of in numerous ways. Although it may be difficult for the mother to let her son die and the doctors to stop treating a patient who does have potential to thrive as time goes on, it is what is fair to the patient. Dax is who is suffering immensely, not the mother or doctor. Yes, I agree that this must be a terrible experience for the mother who recently lost her husband, but I do not think minimizing her pain is a justifiable reason to force Dax upon excruciating suffering.
I agree with Alexandra that when it comes to beneficence, only the patient’s well-being should really be considered. Once we start considering what is best for the family, doctors, hospital staff, etc., there will be no clear place to stop. Patient care could then turn into a scale balancing what is best for everyone else and not putting enough weight on what is best for the patient. That being said, I think that the most beneficent act for Dax was to continue to treat him. Despite the fact that he was deemed competent, that doesn’t necessarily mean that the pain he was going through wasn’t clouding his judgment. In order to make patients better, doctors are usually required to put them through some sort of pain first. This doesn’t mean that pain for a short amount isn’t what is best for the patient as long as the treatments aren’t futile and are their only chance of survival. If there was only a chance that putting Dax through all this pain would keep him alive, I think we would have to reevaluate what the most beneficent action would be. However, in Dax’s case, the doctor’s were confident that the treatments would save his life and possibly restore motor functions that he was lacking initially after the accident.