Background:

In “Access to Health Care,” Brody and Engelhard analyze several different models of healthcare that exist in the world such as the British National Health Service. Even in a developed country like the United States, people are not always able to receive the medical care that they require. For example, the CDC estimates that, in 2013, 5.9% of people in the United States did not receive the care that they needed as a result of high costs.

Dilemma:

At the end of their discussion, Brody and Engelhard present several cases that involve people struggling to obtain medical care. In Case A, Brody and Engelhard describe a patient, Mr. A, who has been diagnosed with an inguinal hernia. Since Mr. A has been disqualified from receiving surgery at the county hospital due to his income, he and his wife cannot afford the procedure. The dilemma in this scenario includes the doctor suggesting that Mr. A wait for a better job or save up money as opposed to operating on Mr. A despite the financial issues.

Discussion:

One aspect of this situation to consider is whether the doctor is violating the principle of nonmaleficence by suggesting that Mr. A postpone the surgery. Nonmaleficence revolves around not inflicting harm or evil (Beauchamp and Childress, 151). As per the Mayo Clinic, without treatment, the hernia will most likely cause the patient pain, and it may also lead to intestinal damage. Therefore, by not performing the surgery, the physician is directly inflicting harm since Mr. A will suffer until he is operated on.  Ultimately, the physician is violating the nonmaleficence principle by refusing to do the surgery, so he should operate on Mr. A despite the financial complications.

Another point to discuss is that the symptoms from the hernia may also lower Mr. A’s chances of receiving a better job or saving up more money as the physician had recommended.  If that turns out to be true, then Mr. A will never be able to afford the procedure, and the hernia may only get worse. This suffering that Mr. A will have to endure only due to financial reasons relates to justice. Beauchamp and Childress present the definition of distributive justice: “The term distributive justice refers to fair, equitable, and appropriate distribution of benefits and burdens determined by norms that structure the terms of social cooperation” (250). If one assesses the situation from the justice perspective, then the doctor should make the decision to perform the procedure.

It is important to clarify that I certainly do not believe that Mr. A should be operated on for free by the surgeon. Resources are clearly used in order to treat Mr. A, and he should be held responsible for paying for the procedure. However, a payment plan could be designed to ensure that Mr. A instead pays over a longer period of time. For instance, the case mentioned that the family had two cars, so one car could be sold to finance the payment plan. There can be multiple approaches towards creating a payment plan that Mr. A and his wife would be comfortable with. Furthermore, after the procedure, Mr. A’s health is likely to improve, so he may also be able to obtain a better job more effectively. Ultimately, the doctor should operate on Mr. A despite the financial issues, which can be resolved over a longer period of time after the procedure.

References:

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2009. Print.

Brody and T. Engelhard, “Access to Health Care,” Bioethics: Readings and Cases

CDC. “Access to Health Care.” Centers for Disease Control and Prevention. N.p., 20 Jan. 2015. Web. 03 Apr. 2015. http://www.cdc.gov/nchs/fastats/access-to-health-care.htm

Mayo Clinic Staff. “Inguinal Hernia.” N.p., n.d. Web. 03 Apr. 2015. <http://www.mayoclinic.org/diseases-conditions/inguinal-hernia/basics/complications/con-20021456>.

Source for image: http://www.wohlsenconstruction.com/assets/uploads/projects/Phoneixville_Hospital_-_Operating_Room.jpg

Background:

In Case 6.2, “Sue Rodriguez: Please Help Me to Die,” the patient, Sue, is suffering from amyotrophic lateral sclerosis (ALS), which is also known as Lou Gehrig’s Disease. As per the ALS association, this disorder involves the progressive degeneration of motor neurons, which affects cells in the spinal cord as well as the brain. This degeneration results in diminished muscle movement, and the muscles atrophy. Symptoms include muscle weakness in the arms, legs, swallowing, etc. The average life expectancy for patients with ALS is two to five years after diagnosis although it varies from person to person. After being diagnosed with ALS, Sue has asked for a medical professional to help her with committing suicide before the disease takes her life.

Dilemma:

In Sue’s situation, one moral dilemma that is especially important to consider is, after the court ruled that doctors helping Sue were legally justified to do so, whether a physician should or should not assist her in committing suicide. While the physician knows that he or she is legally permitted to aid Sue with ending her life, the question involves whether the doctor is morally justified to participate. This issue revolves around the principle of nonmaleficence.

Discussion:

The first objective should be to determine whether the physician is violating the principle of nonmaleficence. Beauchamp and Childress present the obligation of nonmaleficence: “One ought not to inflict evil or harm” (151). By participating in a procedure that directly leads to the patient’s death, the physicians are clearly inflicting harm. The next topic to address is whether this violation of nonmaleficence is justified. Sue would be requesting this assistance when she believes it is the right moment for her: “The dilemma she faced was that “by the time she no longer [was] able to enjoy life, she [would] be physically unable to terminate her life without assistance.” In light of this, Rodriguez petitioned the courts for an order “which [would] allow a medical practitioner to set up technological means by which she might, by her own hand, at the time of her choosing, end her life”” (Thomas et al., 214). Overall, Sue’s decision would be entirely autonomous, and the physician would only be helping her achieve her goal. In addition, unlike the case with Tracy Latimer in which Tracy did not explicitly express her wishes to die, Sue has clearly declared that she would be ending her life. Furthermore, the alternative to respecting Sue’s wishes would most likely only slightly prolong her life, and consequently, her extensive suffering after which she will inevitably pass away. One could argue that by causing Sue to suffer with the symptoms instead of allowing her to take life, the doctor is also inflicting harm. Therefore, this situation, for a doctor, does not involve a decision where one option leads to inflicting harm whereas the other results in the physician not causing harm. Ultimately, the violation of the nonmaleficence principle is justified, in this case, despite directly leading to the patient’s death, and the physician should assist Sue with ending her life on her own terms.

References:

ALSA. “What Is ALS?” The ALS Association. N.p., n.d. Web. 10 Mar. 2015.

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

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

Image Link: http://www.visembryo.com/images/ALSneuronMuscle.gif

Background:

            The CDC FastStats sheet states that, in 2013, there were roughly 30,000 deaths and 10.7 deaths per 100,000 people in the population from motor vehicle traffic accidents. In the case, “When to Give Bad News,” the victim of a serious car accident, Amira, is being treated for various severe injuries such as a collapsed lung and kidney damage. Meanwhile, her partner, Casey, passes away at the same hospital. As Amira is preparing for surgery that may or may not save her life, she asks about Casey as well as her daughter who was successfully treated at a different hospital.

Dilemma:

One dilemma that is important to discuss is whether the nurses should tell Amira about the passing of her partner before her surgery as she drifts in and out of consciousness. Amira does ask about the well-being of her child and Casey when she is conscious. Therefore, it can be argued that it is unethical to either lie about her partner being alive or to not respond to the question at all. This course of action would count as a violation of her autonomy regarding the decision of whether she wants to hear the truth. In addition, the medical staff could theoretically deliver the news after Amira recovers from the procedure, but as the case states, there is a possibility that Amira may not survive the surgery, so they may not have the chance to tell her later, which would lead Amira to pass away without knowing about Casey’s death.

However, there are also several reasons for not providing Amira with this information. For example, the case mentions that Amira’s condition is very serious, “Her physical status is unstable, and the nurses and their colleagues fear that any further stress might seriously impair her capacity to survive the surgery and post-operative care in a coma” (Moorhouse and Khan, 233). The medical team appears to believe that Amira may not be able to make a full recovery if she endures more stress. Learning about the death about her loved one would certainly count as the addition of a significant amount of stress.  The medical staff would, thus, be violating the nonmaleficence principle by endangering the health of their patient with this stressful news about the death of her partner.Therefore, the medical staff definitely must consider her medical well-being as they decide when to deliver the bad news.

Conclusion:

While it could be seen as unethical, assuming she dies during the surgery, to let Amira pass away without knowing about Casey’s death, I would argue it is even more unethical to increase Amira’s chances of not surviving the procedure by delivering this news as she is about to be operated on. Autonomy is a very important principle to uphold, but in this case, it would harm Amira, so nonmaleficence should outweigh autonomy. Ultimately, as medical professionals, it is the staff’s job to do all they can to save Amira’s life, and in this difficult situation, I suggest lying about Casey or withholding that information entirely and then hoping that Amira survives the procedure so that they can tell Amira the truth after she recovers.

References:

CDC. “Accidents or Unintentional Injuries.” Centers for Disease Control and Prevention. N.p., 06 Feb. 2015. Web. 13 Feb. 2015.

Moorhouse, A. and P. Khan “Case 3: Emergency and Trauma Nurses: When to Give Bad News” Concepts and Cases in Nursing Ethics. 232-242.

Source for the image: http://www.injurylawyers.com/wp-content/uploads/2014/11/2-car-crash-1-300×225.jpg

The case, “Research Involving Alzheimer Patients,” revolves around the enrollment of elderly people with middle stages of Alzheimer’s disease as subjects for a research project that assesses the effectiveness of a new drug at treating Alzheimer’s. For patients to be added to the study, the investigators required consent from the patients themselves, consent from their closest relatives, and approval from the medical staff at St. Mary’s (Thomas, 129). If some patients were labeled as “legally incompetent,” only consent from the relatives was necessary. One dilemma related to this situation involves whether the medical staff should or should not object to the recruitment of their patients for this study.

The medical staff could argue that it is necessary to object to the recruitment process to protect the patients from being exploited. According to the National Institute of Aging, Alzheimer’s includes various symptoms that range from memory loss and confusion to the inability to perform daily tasks such as getting dressed. As they progress, these issues can lead to institutionalization and to the patients believing that they are helpless and are a burden to society. It may be true that the participants are, thus, consenting primarily because of this feeling that they are no longer able to contribute to society, so they think that by enlisting, they will be considered “valuable.” The medical staff may become concerned about the patients being exploited as research subjects due to this attitude.  Moreover, in scenarios where patients are “legally incompetent” and the relative provides the consent, the medical staff could choose to object if they are doubtful of the relative’s judgment.

There are also multiple reasons for the medical staff to not object to the researchers recruiting subjects from their facility. One reason would include them potentially intruding on the patients’ autonomy. In their book, Beauchamp and Childress define respect for autonomy as an important principle that involves respecting and supporting autonomous decisions (13). In this scenario, if the patients give their consent to participate in the study, the staff would be ignoring their autonomy by objecting. Furthermore, if a patient is ruled “legally incompetent,” but the closest relative provides consent, an objection by the staff could also be controversial. In addition, all the Research Ethics Boards endorsed this project (Thomas, 130). Additionally, it is important to consider the fact that the patients’ participation could result in treatment of their Alzheimer’s if the results from the study demonstrate the efficacy of the drug. This potential discovery would also lead to the treatment of many other individuals who have this disease. Without the involvement of these patients, Dr. Selleck argued that there might not be a sufficient sample size. Assuming this is true, the objection from the medical staff would prevent the researchers from investigating a potentially life-changing drug for all Alzheimer’s patients including those from St. Mary’s.  Ultimately, I believe that the disadvantages of an objection significantly outweigh the benefits, so Ann Wilson and her staff should not have objected to the recruitment process.

Worked Cited:

“Alzheimer’s Disease Fact Sheet.” National Institute on Aging. NIH, n.d. Web. 23 Jan. 2015.

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2009. Print.

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