I agree with the authors of this paper (Buchanan) that health care is a universal right that we have as humans. It’s more than just an act of beneficence to provide health care to those who need it but an issue of justice. It is hard to enforce an act of beneficence. I don’t believe you can force anybody to perform or provide financially an act of beneficence if they don’t want to, so it’s important to understand that life-sustaining health care is not simply an act of beneficence, but an issue of justice. As humans, there’s no question that we hold a certain moral status that should be respected by fellow humans. Therefore, I believe that we are morally obligated to take care of those in need by providing necessary, life-sustaining or life-saving health care. Besides it being the fair and morally correct thing to do in regards to justice, it is also what is best for not only the individual receiving the health care, but also society as a whole. By providing preventative health care such as immunizations, we are protecting whole communities from the spread of disease. Also, by keeping individuals healthy, we are keeping our communities healthy, which means its people will better be able to provide for the society’s needs.

The only issue I run across with saying that health care is a universal right is when people abuse this right. Whether we want to acknowledge it or not, there will be people who will take their right to health care for granted and not take care of their bodies like they should. There is definitely a limit to the health care resources we have, and if we are constantly providing health care to people who do the harm to their own bodies, then we are wasting it. There are other people who need support in obtaining health care who will never get it if we waste all of our resources on those who exploit the right. Therefore, I believe that even though health care is a universal right, there needs to be a system set up to ensure that the right isn’t being abused. However, I am a little stuck on what this should look like practically. It seems easy when you’re talking about people who smoke or abuse drugs or alcohol, but what about those people who put their health in jeopardy for their livelihood or to perform another beneficent service to humankind such as military or servicemen and women? Should their health care be restricted in the same fashion as drug addicts’ health care because they both knowingly put their health at risk? It hardly seems fair to put the two in the same boat, so this is when I struggle with saying that everyone has the same right to health care. However, you also don’t want to give special health care rights to certain individuals because then I don’t think it can really be considered a universal right if others receive more of the right or better quality of treatment. Therefore, I think we need to be careful making qualifications that certain people have more of a right to health care than others, but we also need to make sure the right to health care is not being abused, if we want to have enough resources to be able to provide to everyone.

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York: Oxford University Press, 2013. Print.

Buchanan, Allen, “The Right to a Decent Minimum of Health Care” Philosophy and Public Affairs 13 (1): 68-78 (1984).

This week, I read a case entitled “Confronting Death: Who Chooses, Who Controls?,” which contained dialogue between Dax Cowart and Dr. Robert Burt. Dax was injured in a terrible gas tank explosion that left him blind and without the use of his hands. His father was also killed during the accident. Throughout the seven years that he was treated in an acute burn ward, he continually requested that treatment be stopped because of the extreme pain that he was going through, and he attempted suicide three times. Despite being declared competent by his psychiatrist, the doctors ignored his requests and continued treatments until the skin grafts were done, and he was able to walk again. Once again, this case brings up the recurring issue of autonomy versus benevolence. The dilemma is whether or not the patient’s power of autonomy should outweigh what the doctor believes is best for the patient. Should the patient be able to refuse life-saving treatment against doctor recommendation if he is deemed competent? Another question is whether or not the most benevolent act was actually to continue to treat the patient or let him die.

I believe that the doctor’s made the morally correct decision in treating Dax despite his competence and request to have treatment discontinued. Even though psychiatrists declared Dax competent, it doesn’t mean that emotionally he was in the right state to make life or death decisions. He lost his dad in the same accident and was in an incredible amount of pain while he was refusing treatments. It is possible that despite his competence, his judgment was still clouded enough for him not to see that treatment was the best thing for him. Along with the doctors, his family also wanted treatments continued despite his requests.

Usually when we see these cases of autonomy versus benevolence, the patient is refusing treatment and willing to die because he or she is terminal and simply speeding up the process of a quickly approaching, inevitable death. In this case, I don’t necessarily believe the most benevolent act would be to keep the patient alive. If they are in an incredible amount of pain and the treatments are futile, then I think refusing these treatments could be what is best for them. However, in Dax’s case, he is initially refusing treatments because of the pain and possible quality of life (which he later admits was not a factor in his current happiness), but the treatments were going to save his life. And isn’t that the doctor’s duty? To save lives? Of course we want to know that our doctor’s care about our opinions and aren’t being paternalistic, but I would much rather know that my doctor is doing everything in his or her power to save my life than being passive and just waiting for me to tell them what to do. Along with doing what is best for the patient, I would go as far to say that it is a doctor’s moral obligation to save lives when they can be saved. And while it is true that doctors can’t know exactly how much pain their patient is going through, I think it is safe to say that they understand pain more than a normal person. They’ve seen enough pain in their patients to know roughly what can be handled and what cannot. It’s not like they’re completely lacking in understanding of what it means to be in pain. Therefore, I don’t believe Dax’s doctors were acting purely paternalistically when they ignored Dax’s requests and continued to treat him. I believe they were doing what was best for their patient and fulfilling their moral duty by saving his life.

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.

In Case 6.4 Stephen Dawson: Should Severely Mentally Challenged Patients Be Treated in Well and Good, we are introduced to a seven-year old boy named Stephen with severe mental and physical handicaps in need of a simple but life-sustaining surgery. Stephen’s parents made the decision (since Stephen was a child, mentally handicapped, and non-verbal) that he should not receive the surgery and be “allowed to die with dignity rather than continue to endure a life of suffering” (Well and Good).  The main questions that this case presented to me was regarding who gets to make life and death decisions for the mentally handicapped, how much should the quality of life of the mentally handicapped affect their treatment options, and should treatment ever be ceased if we don’t know the will of the patient?

For me, the answer to the first question is fairly clear: the person with the most knowledge of the disabled person’s quality of life and day-to-day activities should be allowed to make the health decisions. This does not necessarily deem the parents or family members the most adequate to make decisions for the patient. I will have to agree with the authors of Well and Good and the courts deciding on Stephen’s case that in this situation, the parents aren’t the most fit to make decisions regarding treatment. Stephen had not been living with his parents the past couple of years, and workers at Sunny Hill argued that he had been understimulated and had a higher potential for mental capacity than what had shown and what his parents claimed he had.

The next two questions from the case are related and ask when, if ever, is it morally acceptable to cease life sustaining treatment of a disabled person, if you can’t know his or her will regarding the decision? For me, this wasn’t a question of whether or not disabled people have the right to the same life sustaining treatment that mentally competent people have because that answer is obviously yes. However, the question arises of how far you should go to sustain the life of a mentally disabled person with a very low quality of life when you cannot know their will. This is a question of non-maleficence, and whether or not a low quality of life does more harm to a person than death. If the person were mentally competent, we would simply allow them to make the decision on their own about whether their quality of life is worse than death. However, with Stephen being a child and mentally disabled, we cannot know anything definite about how he feels or how his quality of life is. We can only make assumptions about what we see. If Stephen had a chance of getting better, I believe this case would be much easier to decide. However, it is apparent that performing this surgery, despite its low risks, would simply be extending a life of low quality where he would continue to worsen until he died.

Despite all of these facts, I believe the judge was right to allow the State to make the decision to provide Stephen with the treatment. While to us it may seem like Stephen has nothing to live for, he could be a perfectly happy little boy. The problem with deciding that Stephen shouldn’t have the surgery is that we would be deciding for somebody else, who can’t tell us otherwise, that his life is no longer worth living. According to the President of the National Federation of the Blind, “when doubt exists at any time about whether to treat, a presumption always should be in favor of treatment” (“Medical Treatment of Disabled Infants”). This statement was made originally regarding disabled infants, but I believe the same logic should be applied to any young disabled child. They are not only too young to understand what is going on, but also don’t have the mentally capacity to tell us how they feel about their situation. The California Institute of Justice also released a set of amendments regarding the “legal rights of persons with disabilities, which also has a section on disabled infants that I believe applies to Stephen’s case. It says that “the[se] amendments attempt to ensure that decisions about medical treatment for handicapped infants are not made on the basis of subjective opinions concerning the future ‘quality of life’ of a person with a disability” (“Legal Rights of Persons with Disabilities, 65). The California Institute of Justice is making the same point I am making, that we cannot make life or death decisions for a mentally disabled person simply on what we think their quality of life is. We cannot know it for sure, and what if we are wrong and kill a little boy who was disabled but otherwise happy? In the end, I believe it would do more harm to the patient to guess about what he perceives his quality of life to be and allow him to die, than to continue to treat and allow him to live the rest of his life.

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 5th ed. New York, N.Y.: Oxford UP, 2001. Print.

Lockyear, Bill. “Legal Rights of Persons with Disabilities.” State of California Department of Justice. 1 Apr. 2006. Web. 21 Feb. 2015.

“Medical Treatment Of Disabled Infants.” National Federation of the Blind. 1 Mar. 1985. Web. 21 Feb. 2015.

Thomas, John E., and Wilfrid J. Waluchow. Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. Toronto: Broadview, 2014. Print.

The dilemma presented in Case 5.4 in Well and Good called “Protecting an Unborn Child” is whether or not a mother’s right to self-determination is more important than her unborn child’s rights and health. Should she be forced into rehab for her drug addiction for the health of her fetus? This question comes down to an issue of autonomy vs. non-maleficence. In one respect, the mother’s choice to continue her drug-abusive ways should be respected because it is her body and her right to control it. On the other hand, the decisions she makes during her pregnancy will mostly likely (due to the experiences of her previous pregnancies) affect the child in a negative fashion in the long run. According to Beauchamp and Childress, both are important moral principles that must be considered in the final decision. There have been many cases in which these two important moral principles fall into conflict.

One example of a similar situation is Case 3.5 in Well and Good called “Religious Conflict over a Life-Saving Blood Transfusion,” which we discussed in class. This case involves a Jehovah’s Witness father who wants to refuse a life-saving blood transfusion for his daughter in order to save her immortal soul from hell while possibly condemning her to a physical death. In this case, we also discovered a conflict between autonomy and non-maleficence, where respecting the decisions of the father (and possibly even the daughter) on behalf of his child had the possibility of harming her physically. In this case, we discussed a “standard” used by courts in which doing no harm to the patient outranks the parents’ choices on the care of their child. It is the doctor’s obligation to do everything he can to help the patient, even if it means not respecting decisions of the parents that are potentially harmful to the patient.

Another conflict of moral principles in the case of the unborn child is autonomy and justice. The mother’s right to self-determination directly violates the unborn child’s rights (if he or she has any) to a healthy life in the future. While it is true that an unborn child technically does not have the same legal rights granted to human beings, the decisions being made about the unborn child’s health will affect him or her for the rest of his life when he or she is born. Therefore, is it right to deny rights to an unborn child when the consequences won’t be evident until he or she is born and has rights of their own?

By choosing to carry the pregnancy to term, she is choosing a life for her child. Assuming she wants that child’s life to be easy and free of complication, her decisions to continue in her drug-abusive ways are almost guaranteeing a hard life for her child with respect to her past pregnancies. With that decision, I believe “G” is morally obligated to protect the well being of her child even before he or she is born since these decisions will affect her child only after they are born. However, I would have to agree with the courts that legally, you can’t force the mother to end legal actions that may or may not harm a fetus with no legal rights. In a perfect world, I would love to see women choosing to be mothers by making the decision to carry their pregnancy to term make decisions to not do drugs, smoke, drink, and do other activities with specific, known negative effects on a fetus. If a mother’s moral obligation is to care for her child, then why should that begin just once the child is born?

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 5th ed. New York, N.Y.: Oxford UP, 2001. Print.

Thomas, John E., and Wilfrid J. Waluchow. Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. Toronto: Broadview, 2014. Print.