Case
Beauchamp and Childress describe a hypothetical case about woman with Alzheimer’s. She is described as being an extremely happy person. In the beginning stages of her disease, Margo had made a living will. In this living will she stated that she did not want life-sustaining treatment if she were to develop another life-threatening illness. Now, Margo has developed pneumonia. The health care team is now deciding whether or not to administer the antibiotics (Beauchamp and Childress 229).
Ethical Dilemma
The health care team and surrogate decision maker are faced with a dilemma between respecting ones autonomy or acting beneficently. Should they not administer an antibiotic, which respects her advance directive, and will likely result in her death, or should they ignore it and give her the antibiotic, which will probably save her life.
Discussion
In this case, I believe the health care team and surrogate decision maker ought to administer the antibiotics. The health care team would be acting under the principle of beneficence and would be able to save this woman’s life. They would be acting under the best interest standard. According to Beauchamp and Childress “the best interest standard can in some circumstances validly override advanced directives executed by formerly autonomous patients” (Beauchamp and Childress 228). In this case Margo made her advanced directive just as she had been informed of a devastating illness. At this point she may have assumed the worst possible outcomes of the course of her illness. With that assumption in mind, she may have not wanted to be kept alive in order to just suffer more from the notoriously devastating Alzheimer’s. According to the doctor, Margo was one of the happiest people she has ever known. This shows that Margo may have overestimated the severity of her Alzheimer’s. It is unclear that if Margo knew she would have a more mild case would she still have decided to forgo life-sustaining treatment in the case of acquiring an additional illness. It may be unfair to keep a now incompetent person bound to a prior decision, which could have been not adequately informed. This raises issues of advanced directives. One problem with an advanced directive is that it may not be sufficiently explicit (Beauchamp and Childress 189). In this case Margo is not clear about which types of measures she does not want to have taken. She may not want to spend her time in a hospital being kept alive by a ventilator or feeding tubes, but she may not oppose minor interventions. In this specific circumstance she has contracted pneumonia. This illness is life-threatening but it also can be cured with a relatively noninvasive treatment: antibiotics. Margo has also not shown any deep personal views against antibiotics. Giving her antibiotics is acting out of beneficence because it will ultimately save her life. This decision could be considered as an act of hard paternalism because it is acting against Margo’s autonomous preferences but it can be considered justified hard paternalism. It is justified because her pneumonia has put her at risk of significant, preventable harm (being death) and giving her antibiotics would most likely prevent death. This brings one to have to consider the treatment with antibiotics. It is not a futile treatment because it will produce a physiological effect, they are likely to be effective, and are more beneficial than burdensome (Beauchamp and Childress 169). “Actions that prevent major harms… while only trivially disrespecting autonomy have a plausible paternalistic rationale” (Beauchamp and Childress 221). The prevention of harm, giving Margo antibiotics, clearly outweighs the risk of death because they are relatively noninvasive and have a high probability of being effective. In this case the medical team ought to act beneficently because this act only slightly infringes on Margo’s autonomy and will provide a great benefit.
References
Beauchamp, Tom L., James F. Childress. Principles of Biomedical
Ethics. 7th ed. N.p.: Oxford University Press, 2012. Print.
http://www.vanderbilthealth.com/main/11283
I am not so sure if it is unfair to bind a person to her prior decision that she made when she was competent, because theoretically, it is ethical and a way of respecting the patient’s autonomy. However, I agree that this is one of the justifiable paternalism cases. Beauchamp and Childress stated that “As benefits for a person increase and that person’s autonomy interests decrease, the justification of paternalistic action becomes more plausible” (Principles of Bioethics). The patient’s autonomy decreases apparently due to the override of beneficence over the autonomy. Then, the main question we need to ask here is: what are the benefits of injecting antibiotics to the patient? One obvious point you mentioned, which I agree with, is the avoidance of death. Death is a harm, and there is no doubt. After death occurs, there is nothing physicians can do that is good for the patient. Furthermore, even though physicians or anyone can’t determine this patient’s value of life, everyone would agree that being happy adds positive value to her life. If the physicians were to let the patient die, they are taking away the potential of a good life. As an advocate of the idea of sanctity of life, I don’t think the fact that this patient is incompetent now makes her life any lower quality than it was before, and when she recovers, she will live as happily as she was before. Therefore, she should be saved by the antibiotics.
Reference:
Beauchamp, Tom L., James F. Childress. Principles of Biomedical
Ethics. 7th ed. N.p.: Oxford University Press, 2012. Print.
Hey, Rebecca. Thank you for your post, for I enjoyed reflecting on semantics. For example, Margo’s living will states that she does not want “life-sustaining treatment”. However, as both you and the text mention, the aforementioned wish, and advanced directives in general, lacks specificity. According to the common definition of “life-sustaining treatment”, such treatment would include processes that prolong the life of an individual for whom death is imminent. In Margo’s case, however, she suffers from pneumonia, a curable disease. Therefore, Margo does not experience inevitable death, and the antibiotics would not prolong her suffering. In fact, the medications would prevent her from suffering. Thus, the physicians should not debate over the need for justifying administering antibiotics, because they are not overriding her autonomous desire. They ought to administer the medications to Margo. Furthermore, if one chooses to argue the classification of antibiotics as a “life-sustaining treatment”, then the physicians ought to administer the medications anyway based on the principles of beneficence.