I do not believe it is unethical to treat the refugees for additional conditions, especially when treatment is straightforward and does not take away vital resources from patients seeking cholera treatment. I think the decision would be questionable if treating a patient for meningitis required a significant amount of Dr. Asadour’s time, and he could no longer perform his duty to treat cholera patients. However, it seems from the information given in the case study that Dr. Asadour feels confident that he can balance caring for both cholera patients and for several patients with other serious, but treatable conditions.

Dr. Asadour acknowledges that he has emergency medical supplies to save the lives of those with non-cholera conditions. It sounds like the local hospital cannot easily access such supplies. By treating such conditions, Dr. Asadour is relieving the local hospital from expending additional time and limited precious resources. This will allow the local hospital to care for a higher number of other patients. It seems just to me that a greater number of patients overall are accessing care. Also, since these patients are also refugees, they might encounter obstacles to accessing care at the local hospital.

Dr. Asadour feels obligated to treat a patient with a serious condition who is already on his door step. However, his staff and current resources could not meet the needs of an influx of other patients. Dr. Asadour should create an informal agreement with each of these patients not to advertise the cholera station as a tent to treat all conditions. It would be unethical for the healthcare team to fail to meet the needs of the cholera patients they formally agreed to treat.

Since cholera is communicable, it would be unethical to directly and knowingly expose a non-cholera patient to a cholera patient. Yes, Dr. Asadour feels a duty to treat the patient he faces at the admissions tent. However, a line must be drawn at the point where the risks of contracting cholera outweigh the benefits of receiving treatment at the tent for another condition. Above all else, Dr. Asadour must not do any harm, so nonmaleficence is also part of the argument.

If a patient presents with a serious condition that Dr. Asadour can treat with the available medical supplies (which are not readily available at the local hospital), Dr. Asadour must first be confident that the patient will not contract cholera in the designated treatment space. This is critical – if this patient contracts cholera, he or she can spread the illness further into the community. In this case, Dr. Asadour’s beneficent act of treating the initially non-cholera patient would be highly unjustified.

I do not believe it is unethical to treat a patient who has no other options. However, due to the principle of justice, I do believe it is unethical to prioritize the health of one individual over the health of tens of others.

As long as he does not harm others in the process – by neglecting to properly treat the cholera patients who arrive at the tent – I do not believe Dr. Asadour’s attempts to provide additional care for needy, non-cholera patients will be morally questionable. This additional care, however, should be at the expense of additional clinic time from Dr. Asadour, to ensure that he is delivering the level of care that he promised to deliver to cholera patients. I write this because first and foremost, Dr. Asadour’s professional duty is to cholera patients. Then, with available time and resources, Dr. Asadour can tend to other serious conditions.

After noting further experiences and observations at the tent clinic, Dr. Asadour can advocate to the donors to either expand the pool of money for treating serious, non-cholera patients who cannot receive adequate care at the local hospital, such as meningitis patients, or to fund the clinic as a horizontal aid program, so that Dr. Asadour and his staff can meet the shifting needs of their patients more holistically.

Thomas, John, Wilfrid J. Waluchow, and Elizabeth Gedge. “Case 8.2 Ethics and Humanitarian Aid: Vertical Aid Programs.” Well and Good A Case Study Approach to Health Care Ethics. 4th ed. Ontario, Canada: Broadview, 2014. 267-68. Print.

Text Discussion

According to Terrence Ackerman, a physician’s non-interference is essential for respecting a patient’s autonomy in the post-1982 health system. However, Ackerman argues that noninterference fails to account for the transforming effects of illness. Without the adequate knowledge and skills, a patient cannot accurately assess his or her own condition. Additionally, mental health factors such as denial, depression, or fear may hinder patients from making choices that are in harmony with their life plans. For example, depression may prompt a patient to refuse treatment, which is out of character with a previous full commitment to treatment. Ackerman argues that noninterference is not the best course of action. However, the alternative creates a slippery slope in which vulnerable patients may be harmed by carelessness.

I do not think autonomy is upheld when a patient refuses life-saving treatment out of denial, depression, or fear, and the physician accepts this decision without question. In certain cases, there should be limits to how much autonomy a patient has. In my understanding, in order to help the patient maintain as much desirable autonomy and control as possible, patients should be able to, for example, choose what they would like to consume (from a list of approved food items), what they would like to do in terms of entertainment in their hospital room, which visitors they would like to have, and other such considerations.

Our society has entrusted the health of individuals in the skilled hands of physicians. However, the physician cannot always take the totality of a patient’s experiences into consideration. By engaging in a thorough conversation with the patient and family members, the physician can begin to ascertain the patient’s psychological and social situation and help them make a decision that promotes optimal autonomy.

Current Event Application

On Tuesday, March 24th, Germanwings flight 4U 9525 from Barcelona to Duesseldorf crashed in the French Alps, killing all 150 people on board. Investigators found antidepressants in the co-pilot’s apartment and discovered that co-pilot Lubitz had been treated for severe depression in the past. A Duesseldorf clinic confirmed that Lubitz visited the clinic as recently as March 10th to receive a mental health diagnosis. Torn sick notes were found in his home, which showed that the co-pilot was suffering from an illness that should have grounded him on the day of the tragedy.

Lubitz was declared “unfit to work” by a physician, but he concealed his condition both from the Lufthansa airline and his immediate professional environment.  Under the current aviation system, pilots are required to self-report if they are deemed unfit to fly by a physician. It seems to me that this self-reporting system presents a conflict of interest. What happens if a pilot is afraid of losing his work? What happens if a pilot is in denial about his condition?

With the knowledge that the patient was responsible for hundreds of lives besides his own, the physician should have reported the condition to the most relevant and important individuals at the airline. In the least, the physician could have made certain that the patient had initiated the self-reporting process. The condition was not a minor one that could be easily overlooked. I believe the physician would have protected the co-pilot’s future autonomy by intervening and reporting the condition to the airline. Potentially, all 150 innocent lives could have been spared, including the co-pilot’s.

Works Cited

Ackerman, Terrence F. “Why Doctors Intervene.” The Hastings Center Report (1982): 14-     17. JSTOR. Web. 28 Mar. 2015. <http://www.jstor.org/stable/3560762>.

“Andreas Lubitz: Torn-up Sick Note and ‘mystery Illness’ Raise More Questions about       Co-pilot.” Euronews. Web. 28 Mar. 2015.             <http://www.euronews.com/2015/03/27/andreas-lubitz-torn-up-sick-note-and-    mystery-illness-raise-more-questions-about/>.

“Doctor Had Excused Co-pilot from Work on Day of Tragic Flight 9525.”Euronews. Web. 28 Mar. 2015. <http://www.euronews.com/2015/03/28/doctor-had-excused-co-pilot-from-work-on-day-of-tragic-flight-9525/>.

“Reports: Antidepressants Found at Home of Co-pilot Andreas Lubitz.” CNN. Cable News Network. Web. 28 Mar. 2015. <http://www.cnn.com/2015/03/28/europe/france-germanwings-plane-crash-main/>.

Dilemma

A son’s mother, Carole, has been in the ICU for several weeks, is semi-conscious, and is now almost completely unaware of her surroundings. All of Carole’s attending physicians agree that her breathing muscles are irreparable and that she will suffer more cardiac arrests. Thus, since she is completely dependent on a machine in order to continue surviving and is no longer able to return to a life outside of the confining walls of the ICU, I believe her attending physicians are justified in issuing a “do not resuscitate” (DNR) order.

Analysis

Over the course of the past several weeks, her attending physicians have had sufficient time to carefully and properly assess her condition and consult with each other. The decision is not being made hastily, in an emergency room setting. Nor is the decision being made by a sole attending physician.

One opposing argument I foresee considers the religious and cultural concerns of this case. The healthcare team must be cautious of respecting the religious and cultural identity of a patient and a patient’s immediate family. But to what extent? The son argues that his mother’s soul is at stake if she passes away in a foreign land. Additionally, he will be cursed if he cannot return his mother to her homeland prior to her death. In their religious and cultural context, both of these concerns are valid. However, the son is (realistically) unable to fulfill his mother’s and his own personal wish in a timely manner, because he is “penniless and unemployed”. In this situation, the healthcare team must balance these different factors and determine what course of action is in the best interests of the patient’s health, especially since she can no longer provide her informed consent. (Apparently, she can no longer even carry out a rational conversation.)

Her health will deteriorate even more with additional cardiac arrests, while prolonging her stay in the ICU will increase her dependency on the machines. It seems that Carole’s quality of life is decreasing. Since both the son and his mother are deeply religious, I wonder whether the healthcare team could have a holistic conversation with the son, together with a trusted religious figure, about his mother’s realistic health outcomes, her suffering, and her quality of life. This approach could help the son think beyond the threat of a curse and consider an alternative decision.

Works Cited

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

Dilemma

In case 1.1, patient Marie François is refusing life-saving surgery. While analyzing this case, I focused on the physician’s major predicament – deciding whether to respect Marie’s autonomy in refusing a second surgery or complying with her children’s insistence. Each side merits valuable consideration because both parties believe they are acting in the patient’s best interest.

Reflection

This argument has multiple nuances, but I would like to center my reflection on the relationship between Marie and her medical team. It seems to me that one of the major reasons for Marie’s refusal for surgery is her mistrust of the health professionals who are providing her treatment and who are apparently disregarding her complaints. In fact, the case states, “she didn’t want the surgery because she no longer trusted the doctors providing her treatment and no one was taking her complaints seriously” (72). I think it is imperative for the healthcare team to regain Marie’s trust. The patient’s mistrust is negatively impacting her health outcomes because she has constructed a mental barrier against her physicians. I think this barrier is affecting the way the patient is processing and understanding information that is presented to her. I believe this issue of mistrust could potentially be mended and trust could be re-cultivated. If regaining her trust is not possible, the current surgeon should offer Marie (and her family) the option of working with a different medical team. I arrived at these conclusions due to the discrepancy between Marie’s willingness to receive the first operation and her refusal to consent to the second one. Marie’s children believe their mother’s expressed wishes are out of character. Specifically, her son Jacques “declared that his mother was behaving abnormally and insisted that she really did not understand the consequences of her refusal of surgery” (72). This discrepancy is possibly due to the suffering that Marie experienced following her first operation and the lack of acknowledgment and responsiveness from her healthcare team.

Comparison

According to the University of Washington’s Ethics in Medicine site, one of the elements of a fully informed consent is “assessment of patient understanding”. The following is the background information for a similar case involving patient refusal. A 55-year-old man with a 3-month history of chest pain and fainting spells needs cardiac catheterization. However, although he demonstrates understanding, he refuses the intervention. In the discussion section following the case description, the WashU bioethics resource recommends discussion and an exploration of the patient’s reasons for refusing treatment. Although a patient’s autonomy and treatment refusal should be honored, a refusal is not the end of a discussion. This patient’s refusal could be tainted with negative feelings towards the healthcare team, that should be discussed and addressed in an honest and straightforward way.

Works Cited

Ludwig, MaryJo, MD, and Wylie Burke, MD PhD. “Physician-Patient Relationship.” Ethics in Medicine. University of WashingtonSchool of Medicine, Web. 6 Feb. 2015. <http://depts.washington.edu/bioethx/topics/physpt.html>.

Thomas, John E. “Case 1.1 When Physicians and Family Disagree.” Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. Peterborough, Ontario: Broadview, 2014. 71-76. Print.

Image Sources

http://blog.himss.org/2014/05/28/from-compliance-to-engagement-reimagining-the-patient-relationship/

http://sailthesevencs.weebly.com/why-the-cs.html