This case raises two issues:
- Did the mother make a morally incorrect decision by not moving to the tertiary care hospital like her family doctor recommended, which would likely improve the outcome of the daughter once she was born?
- Is it morally acceptable to withhold treatment from the baby when there’s a high chance that she won’t survive anyway, and even if she does that she will have severe mental disabilities?
In this case, the first issue can only be examined retrospectively. Many people might side with one of the residents who said that it was unfair to the baby that it had to suffer more because the mother didn’t take the doctor’s advice and go to the other hospital. While it likely would’ve been very beneficial for the mother to move to the tertiary care facility, I don’t think the mother purposefully harmed her baby. First of all, she was in a very vulnerable and uncertain state. She was unsure of when the birth would occur, and how it would go. She also suffered two other miscarriages in the past. Therefore it’s understandable that she wanted the support of her husband and her parents, which she could have by staying in the community hospital. It also appears that the her doctor failed to properly inform her about the importance of moving to the other care facility. He only mentioned it to her in a “brief conversation.” With regard to the information elements of the informed consent model, which includes “disclosure,” “recommendation,” and “understanding” (of the disclosure and recommendation of the plan), the doctor does not give adequate time to ensure that the mother fully understands the information (Beauchamp 124). If the doctor had a prolonged conversation where he discussed his concerns and the benefits of the tertiary care facility more thoroughly, then the mother would have been more likely to move to the other facility, but if she still hadn’t, then there would be more grounds to accuse her of purposeful wrongdoing.
Both the parents of the girl and the healthcare professionals are divided over the second issue. The mother wants to give the daughter every chance to live, the father is concerned about the daughter’s quality of life if she survives and the toll it will take on their marriage, the resident doesn’t think that living a severely cognitively impaired life would be worth it and describes how much it will cost the family to treat her later in life, and the pediatrician does not want to suspend treatment since she is not braindead, and is hopeful about the fact that the girl has a chance of surviving with little or no cognitive impairment. The father and resident seem to be most concerned with the resources, time, and money it will take to care for the girl. The pediatrician is clearly framing the possible outcomes by mentioning her chances of survival and life without disability, and hardly acknowledges the possibility of death or a severe mental disability. The mother is clearly emotionally attached to the daughter, especially since all of her other children died. While there is a degree of bias in everyone’s decision, I don’t think that suspending treatment is the right course of action, especially considering that the daughter might not die, and her condition would be even worse if she lived.
Citation:
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2013. Print.
Hi Jack!
I recognize both of the issues of the case you pointed out; however I am unsure why the first issue is overly relevant in terms of moral principles. While I do agree with your point that there should have been more of a conversation or push on behalf of the family doctor for the mother to go to the tertiary care facility, whether or not the mother went should not change her decision on whether or not she should withhold the treatment from her baby. The child may have had better chances of survival had the mother gone to the tertiary care facility in the first place, but there is nothing that the physicians or family can do about that after the fact. I think the main moral issue with this case is whether the parents and/or the physician should withhold the potentially life-saving treatment from the baby due to the low chances of survival and “normal” life or if withholding treatment is medically unethical.
It does make the situation more difficult to assess considering all parties involved have different opinions. However, I agree with your decision that ultimately withholding the treatment should not be an option. As we discussed in class today, I believe that the process should be taken one step at a time rather than viewed as a whole from the beginning. The father in the case argues that “if she survives, and is handicapped, my wife will have to stop working, and I don’t know how we’ll manage without her salary” (Thomas, Waluchow, Gedge 187). Although this may be true, this is not the only possible scenario. The physician states that the child is not “inevitably going to die in the near future” and has a “50 per cent chance of suffering severe cognitive disabilities” which means that there is also a 50 percent chance that the child is either normal or only has mild disabilities in which the family would be able to care for the child (187). With a 50 percent chance of a relatively “normal” quality of life, I believe it would be morally unethical on the grounds of nonmaleficence to withhold treatment.
Also, even if the child is born with severe mental disabilities, there are other options besides the parents drowning in the financial burden of her hospital bills or the round-the-clock care the child would require. Foster care is always a viable option as well as an inpatient facility for disabled children such as Sunny Hill described in Case 6.4 (229). I do not think it is ethical to decide not to treat the child on the grounds that 5 years from now it may cause issues with the marriage or not be financially affordable. There are always other options and with each step of the process more options become available. I think that cases such as these must be taken one step at a time in order to prevent biases and “worst case scenario” thinking to cloud judgment. There is still a 25 percent chance that the baby recovers and leads a normal life, a rate that I believe is too high to justify withholding treatment.
Citation:
Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well And Good: A Case Study Approach to Health Care Ethics. N.p.: Broadview, 2014. Print
Hi Jack!
I like how you explicitly state the moral issues addressed in the case. However, I do not agree that the mother’s decision to not move to the tertiary care hospital is a morally incorrect decision. If anything, I think that the physician made the mistake by not explaining clearly the benefits of going to the tertiary hospital and the consequences of not changing hospitals. Also, as I mentioned in class, I think the discussion of whether or not the mother was in the wrong for not going to the tertiary hospital is entirely subjective based on whether or not the individual making the argument thinks of an unborn baby as an individual with rights. If the unborn baby does not have rights and is not considered an individual, then the mother is the patient and the physician is required to do what is in her best interest, which is to stay at the local hospital. On the other hand, if the unborn baby is seen as an individual with rights, then both the mother and baby are viewed as patients and the physician must decide what is in the best interest of both patients.
To address, your question as to whether or not treatment should be withheld from the patient, I believe that the situation should be completed on a step-by-step basis. In class it was discussed how at each increasing level, more options are available. As a result, saving the baby should be seen as the first step and each step afterwards will have more possibilities allowing the parents to choose which option best suites their needs in addition to their baby’s. While many only think of foster care as a possibility when a family is unable to care for their child, there are plenty of other options. For example, the New York Times wrote a piece on how there are alternatives to foster care. A new idea that is beginning to gain traction is the proposal “to help youths return to their original families wherever it is possible to do so safely by providing their parents, or in some cases other relatives, with an extensive array of in-home support services” (Bornstein). This idea would benefit the patients in question in many situations such as the case of baby girl Q. The father’s main concern is a lack of resources and ability to care for the baby. This concern can be resolved with extensive in-home support services that will benefit the baby’s well-being and keep the family from needing to put the baby in foster care.
Morgan Brandewie
Works Cited:
Bornstein, David. “A Families-First Approach to Foster Care.” The New York Times. The New York Times, 21 Feb. 2011. Web. 20 Feb. 2017.
Hi everyone,
I had similar reactions to you all when first reading this case. Although I understand the significance of the mother’s choice of staying in the local hospital to give birth as important to subsequent events, I don’t believe that it should be of focus in the case at all if the concern is whether or not to treat the baby. A woman in labor would obviously like to be as comfortable as possible. In retrospect, she should have been better persuaded to travel to the other hospital to give birth, but she didn’t. Her hospital decision should not influence choices to sustain the child’s life, even if it did decrease her baby’s chances.
A second aspect of the case I found influential was the disagreement particularly between the mother and father on the direction of treatment for the baby. The mother absolutely preferred that life-sustaining treatment be given whereas the father questioned the morality of attempting to save the baby. If both parents had agreed on a course of action, this dilemma may have been simplified (if even possible given the other circumstances). If the parents cannot agree on a decision, maybe there should be a third party such as an unbiased legal expert or judge contributing to the decision. To not respect the wishes of a parent creates an entirely new set of ethical questions surrounding consent. I too believe that the baby should be given the best possible chance for life. There are still reasonable odds in favor of this, and withholding treatment on the grounds of a potential problem years later is not enough cause to do so.
Thanks!
Elisabeth Crusey
Hi Jack,
Thank you for such an interesting post. As a nursing major, I took Human Growth and Development last semester and found myself relating this case to the ethical issues in the neonatal intensive care unit. Perhaps the most contentious is the withdrawal of life‐sustaining treatment from infants who may otherwise survive. As you discussed in your analysis of this case, one of the most important factors influencing this decision is the prediction that the infant will be severely intellectually disabled.
Uncertainty is common in newborn intensive care. Prognostic uncertainty arises from a number of factors, including plasticity of the developing brain, individual resilience, the influence of the environment and treatment, and limitations in clinical assessment and prognostic tests. There is further uncertainty about future experiences, particularly of individuals with significant cognitive impairment. For example, even if we knew the exact degree of future impairment we would remain unsure of how much pain or pleasure the child would experience (Wilkinson).
I’d like to note that future low levels of well-being do not, however, make individual less worthy of moral consideration. Rather, the moral status of an individual determines how we should take future well-being into account and whether it is obligatory to preserve her life. The moral status of an adult would remain unchanged following a prediction that the adult’s future contains only a very slight positive balance of well-being or even net negative well-being (though this would potentially have major implications for her treatment). Similarly (in this case), a newborn’s moral status is not altered by predicted future impairment (Wilkinson).
Works Cited
Wilkinson, Dominic J. “A Life Worth Giving? The Threshold for Permissible Withdrawal of Life Support From Disabled Newborn Infants.” The American Journal of Bioethics. National Center for Biotechnology Information, U.S. National Library of Medicine. Feb 2011; 11(2): 20-32. Web. 24 Feb. 2017.
I agree. I personally don’t think that any sort of judgement can be made that implies that the baby’s life is not worth living, regardless of the level of disability it faces.
The other options for taking care of the baby are definitely worth looking at. I don’t think that foster care or something comparable should be the immediate choice, but it is important to note that it exists as a way of relieving the parents.