In this case (Case 2.2) in “Well and Good” the issue concerning social determinants is reviewed. IT specifically looks at a woman named Martha, who has suspicion over a growth in her mouth she suspects is oral cancer. However, Martha and her partner are both unemployed and care for three children. So, when her doctors recommend a series of tests and regimens for her to follow she consciously declined treatment since she was not able to pay. This case brings about issues concerning public policy and healthcare.

One of the questions that arose for me: was the length at which universal healthcare should stretch to? In the case, it mentions how in Canada only 50% of low-income citizens. Many people believe that dental care is a luxury form of healthcare. Even in the US, many plans do not cover many dental procedures, as they are not deemed necessary. Under the Affordable Care Act, there is an extreme lack of dental coverage and to get any kind of dental one must get outside care/coverage. However, at what point to we deem medical care as necessary or superfluous. In the case of Martha, her symptoms were seen as a sign of a possible severe illness or it could have been simply a direct result of prior poor oral hygiene. But, with poor coverage for issues such as dental/oral concerns many people are subject to live in conditions that severely lower their quality of life. At what point do we quantify beneficence and try to establish a way to maximize profit from healthcare.  Although most people will agree that things like heart conditions and kidney failure are more important to treat for people, is it fair to subject people to live with tooth decay or serious oral issues.

The interesting thing, that ties into the idea of social determinants, is that poor people are the ones that fail to get coverage. It’s not like the coverage for these issues are not an option, they are just not a viable option. I know that universal healthcare programs cannot cover everything for everyone, but where do we draw the line for what is a ‘health privilege’ . How can we protect the underprivileged from being stripped from basic health needs? Since we are able to determine some health measure to be “extra,” what stops other basic needs to be put into that category. I feel that with determinants like this opens a slippery slope to removing more coverage from the poor while only supporting people that have the means to pay for the luxury of healthcare.

In the beginning of this article, the topic of autonomy was dissected. He directly reasons against Beauchamp and Childress’ definition of autonomy. Ackerman describes the two conditions in which a person is fully autonomous, when: 1)”behavior is governed by plans of actions that have been deliberated through deliberation or reflection” and 2) the behavior “intentionally and voluntarily” stems from a person’s life plans.  And with these qualifications of an autonomous person, Ackerman thus argues that illness causes the affected person to not achieve these requirements. He posits that illness, both physical mental, causes a person to make biased decisions that do not reflect full autonomy.

However, I feel that this argument contains many flaws. One being that the question of autonomy is very prevalent for those who suffer from illness.In an example, a man ‘irresponsibly’ chooses to not have life-saving neurosurgery because of the “cosmetic affects” and “possibility of neurological damage.” The critique is that the illness caused irrational thought-processes to occur and the person makes a decision that they would have made without the illness.  I further contest that argument as another one of his reasonings to why illness dissolves autonomy, is that it makes a person decide that they hadn’t otherwise. He gives the example of the woman with continuous diagnoses of cancer refusing treatment after her last diagnosis. The claim was that “it was unlike her” to refuse treatment as she has not refused before. It was due to her depression that make this “new” decision for her, according to Ackerman. However, you can only judge who a person is by their reality, and their reality is being ill. To say that the woman would not have refused treatment if she were not depressed is too speculative to remove her status as an autonomous being. As a person potentially undergoing treatment, she has the right to decide if she should go through another round. Specifically this woman has suffered many bout of cancer, and has had treatment help her but only for her to become sick again. And due to her complications this time, her willingness may be decreasing . Not directly due to her newly-developed depression. Also you can’t judge a person’s choice simply on what she has agreed to before. In that case, what is the point of asking consent for treatment for a chronically ill-person?

To say that people who are suffering from something do not posses autonomy is also problematic, as this would lead to doctors or individuals close to the “ill person” to have more say in treatment (or lack thereof) for the individual. Ackerman continues to pose that noninterference is the not the best mode of action for doctors, and should not be acted on. He says that because an ill person lacks autonomy, the doctor must have a role in decision making. Because of the doctor’s expertise, his/her opinion should definitely be taken to account. However, they should only have a firm role in decision of treatment, if the person’s autonomy and abilities are greatly diminished or existent. As long a person’s decision to undergo treatment or not does not harm another, their choices should be respected. As blurring the lines of medical consent and status of autonomy can cause a slippery slope in how people and their illnesses are approached by medical professionals. This can cause exploitation and harm to those vulnerable populations that may not have the ability to directly/properly contest a doctor’s opinion/recommendation.

References:

Ackerman, Terrence F. “Why Doctors Should Intervene.” The Hastings Center Report 12.4 (1982): 14-17.

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York, NY: Oxford UP, 2001.

Paterick, Timothy J., Geoff V. Carson, Marjorie C. Allen, and Timothy E. Paterick. “Medical Informed Consent: General Considerations for Physicians.” Mayo Clinic Proceedings 83.3 (2008): 313-19.

In the case 6.3, a young girl with severe cerebral palsy, Tracy, is killed by her father, Robert, due to her perpetual suffering from her condition. When arrested and charged with second-degree murder, Mr. Latimer argued that he committed the act to put his daughter out of her constant misery. However, the courts did not initially agree with Mr. Latimer and sentenced him to life in prison. Later on, after appeals and reevaluation of the case, Robert Latimer was seen to not have committed a heinous crime, rather, an unconventional way of caring for his child. Thus is sentencing was reduced. The strongest backlash came from groups supporting the rights of disabled persons, as they argued that Tracy’s rights were not being respected. In that the issue arises: were Tracy’s rights infringed upon although she has no official way to provide consent and was enduring pain for most of her life?

Although Mr. Latimer committed the act with good intent, I believe that he was wrong in killing Tracy due to lack of ethical justification. First off, Mr. Latimer took it upon himself to end his daughter’s life without any formal consent from her or medical professional support. Even though Tracy was not able to give her consent due to her cerebral palsy. In this, Mr. Latimer in essence committed a non-voluntary euthanasia, which is illegal. Also, not only did he lack the direct consent of Tracy, but also her mother as well as her doctors. Since Tracy is minor, her mother is also an autonomous figure for her and needs to provide her consent on major decisions made for Tracy. Also, there is no impending medical need for Tracy to lose her life. None of her doctors proposed a mercy killing as a way to end Tracy’s suffering. Rather, they stuck to the moral codes of ethics and practiced non-malfeasance by recommending surgeries that could help her daily life. According to the text, Tracy’s pain was perpetual however not necessarily constant. Although she experienced suffering in the past and will most likely face it in the future, she death was not warranted due to her consistently conscious state. Her life was not directly at risk at the time of her death.  As Beauchamp distinguishes, there is a difference between “allowing to die” and killing. While allowing to die in this case were to be if Tracy experienced a sever compilation in her condition that threatened her life. If her parents placed a DNR on her, then Tracy would be dying by natural causes consistent with her parents being her autonomous figures.

Another issues brought about in this case is risking the “slippery-slope” where we must define a justified killing if the patient is not consenting. If the patient is able to consent, than euthanasia or “mercy killings” can be a more dignified way for people with terminal, painful conditions to pass. However, the issue arises when the patient is not consenting, albeit the patient is a child or is cognitively unavailable. Who is it then that can make these decisions? Must a medical professional also consent for the procedure?  And where is the line drawn to distinguish if euthanasia or mercy killings are even  justified for each situation?

Of all those questions, I feel that the one that would provide the greatest slippery-slope is the last. Theoretically, we could grant consent to the patient’s next of kin, spouse, or caretaker. However, how can we make sure that the assisted deaths would be done with pure intent? Although a person may be facing imminent death while also painfully suffering, how do we know the consenting person in the situation isn’t doing it for greedy purposes that would diminish the purity of ending the patient’s suffering? This would be the hardest to criteria to gauge since everything can seem circumstantial and coincidental.  For example, a successful woman who is battling brain cancer who had slipped into a coma after months of excruciating pain. If her son was the one granted to be the consensual being as well as happens to be the sole heir to her fortunes, how can it be determined if he is trying to put his mother out of her misery or simply trying to cash in his inheritance early?

References:

“BBC – Ethics – Euthanasia: Voluntary and Involuntary Euthanasia.” BBC News. BBC, n.d. Web.

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2013. 176-79. Print.

Kishore, Lalit. “Mercy Killing: Pros and Cons.” Merinews. N.p., n.d. Web.

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well and Good: A Case Study Approach to Health Care Ethics. Peterborough, Ontario: Broadview, 2014. Print.

In this case, a woman “G” is pregnant with a child but is also battling an addiction to glue-sniffing. Because of her addiction, she was remanded to a treatment facility against her will by Child and Family Services due to her addiction causing physical and mental disabilities to her children born from prior pregnancies. However, Manitoba Court of Appeals overrules the decision of the lower court. G is allowed out of the facility and gives birth to a healthy baby. It was also noted that she has control over her addiction ad is expecting another child.

The issue that arises here is if G should have been sent to the treatment facility against her will due to the potential harm to the fetus due to her addiction. I personally believed that G, being a competent adult, should not have been put into the facility due to her addiction. Unless she was arrested for a crime and her sentence was to be served at the treatment facility, it was unlawful to commit her to the facility. The reason behind this is that the “harm” is hypothetical at this point. Sending G to the treatment facility, although preventative, was against her rights as an able-bodied and mind woman. As the book notes, this case opens the door for a “slippery slope” effect where the line of rights for an unborn child and rights for the living-woman is blurred. (p. 203) The book also points out, what would be the case for women that smoke or drink during pregnancies? Although those actions are not illegal they also prove to cause potential problems for a fetus. Would those actions also constitute a woman’s involuntary admission to a treatment facility? Since that is not the case, it should not be the case for G as well.

Another issue that comes about in this case, is whose rights is to be protected in this situation. Although protecting fetus is important, it must be considered that the fetus is not a living person, in the sense that it is existing in the world without biologically depending on its mother. Because of this, can we assume that it should have the same rights as its mother? I think not. G is the only living person in this case and therefore her rights should be the ones enforced. The state is supposed to enforce the rights of its inhabitants, and prior to giving birth G is the only one who is a citizen in this case. Treating her fetus as a living child, whose rights are to be enforced would be an over-reach. In Canada, abortion is legal at all stages of pregnancies, and there are no legal obstacles in getting an abortion. But if the life of G’s fetus is recognized and her addiction is seen as endangerment, why is abortion not considered a homicide or even a manslaughter? The stipulated definition of life should be carried out throughout all legal situations.