Beauchamp and Childress summarize moral arguments for the need for the United States to adopt a national health care policy and recognize health care as a right. Proponents of national health care argue that a “decent minimum” should be provided to give individuals basic medical care they need to prevent and treat illnesses. The benefits of this would provide collective social protection for the country and give individuals a fair opportunity for health outcomes. A national health policy has yet to be adopted in the US, though, with opponents arguing that healthcare should be something people need to work for and purchase themselves instead of relying on the government to provide it for them. This is an example of a libertarian argument that emphasizes the need for individual choice and autonomy. In the case of developing a national health policy, it contrasts with the utilitarian approach that strives to offer the most benefit to the most people with the cost-sharing approach of a single-payer socialized medicine system. With such a system, people are not left out from receiving care because they cannot individually pay. These contrasting views make it very difficult for health policy in the US to change.

Possible middle ground to contrasting viewpoints could be to offer free medical care to children. It provides the two benefits of national health care that Beauchamp and Childress give: collective social protection and fair opportunity. Children’s health care majorly involves vaccination protection and treatment from illness. This provides collective social protection because it helps to eliminate communicable diseases from the population, a serious public health concern. It also benefits others by preventing them from catching children’s viral illnesses that may otherwise go untreated. Children are a vulnerable population that easily spread illnesses through their close contact with other children and staff members in schools. Investing in children’s health not only protects individual children, but also the rest of the population.

Free health care for children provides them with a fair opportunity in life. Unlike adults, children have no control of their life circumstances. Providing them with life-saving vaccines and minimum care as children allows them to face less disadvantages as an adult. Both of the benefits of free health care for children follow the moral principle of beneficence and nonmaleficence because it aims to help those in need and prevent harm from occurring. The same moral principles could be applied to free health care for all people, though, so this is not where the distinction of free care for children comes through.

Free health care for children is uniquely interesting because it has less of a violation of autonomy. Libertarians argue for the need for people to be responsible for themselves and make their own choices, but few would extend this argument to children. Children are unique in that they often have no choices and if they do they are under the constraint of their parents. They also have not made poor choices affecting their health outcomes such as smoking and excessive drinking. Some would argue that being unable to afford healthcare is a result of individuals’ poor decisions and that it is their individual responsibility to provide themselves with adequate care, not the government’s. No logical person would argue, however, that it is a child’s responsibility to provide his own medical care. Providing free medical care to children provides them with a fair opportunity at medical outcomes, irrespective of their parents’ decisions. An extreme libertarian approach could argue further that children should not be entitled to free care because they are individual parents’ responsibility, not the responsibility of the government. However, not providing children with free care has serious consequences to disease prevention and opportunity fairness. Government provided care for children fulfills moral obligations of beneficence and nonmaleficence with limited threat to individual autonomy.

Moral issues arise when patient autonomy conflicts with family interests. This generally occurs when the patient’s decision conflicts with what the family thinks is best. Conflicts can also occurs when the patient’s decision may not be in the best interest of his or her family, even though the family may not vocalize their disagreement. Patient autonomy grants patients’ the right to make their own medical decisions after having all information made available to them. In some cases, though, patients do not make decisions that doctors would deem most logical. Sometimes these decisions do not just affect the health of the patient, but also the well being of the patient’s family. Difficult cases like these force ethicists to question when it is appropriate and necessary for doctors to intervene.
Nadya Suleman started a media forest fire when she gave birth to octuplets in 2009. Her babies were born via IVF technology at the service of her doctor, Michael Kamrava. Controversy arose when the media publicized that Ms. Suleman was unmarried, had six other children, and was receiving welfare assistance. Many critics turned to Ms. Suleman who made a choice to have more children. Others, however, questioned her doctor for agreeing to Ms. Suleman’s request by providing IVF services. This case brought up the question of whether Ms. Suleman’s patient autonomy should have been more important than the interests of her family and own health.

When considering patient autonomy, it first is necessary to highlight that Ms. Suleman was a fully competent patient. She had received IVF treatment and had children before, so she was aware of the risk of multiple births pregnancy and the responsibilities of raising a child. A proponent of her patient autonomy could argue that Ms. Suleman’s own decision to have a child through IVF should be the only thing that matters in her doctor providing IVF services. While many criticize Dr. Kamrava’s decision to treat Ms. Suleman when she was a single mom and had six children, this criticism could be critiqued as very moralistic. As a doctor, his role is to provide his patients with medical services without judging their personal decisions and let that intervene with treatment. One could also argue that not providing Ms. Suleman with IVF treatments is a form of eugenics, because it claims that she should not have more children. Because she cannot get pregnant without IVF treatments, a eugenics argument could be used to claim that Dr. Kamrava refusing to treat Ms. Suleman is a form of him deciding she cannot have more children because of her socio-economic or marital status.
The interests of Ms. Suleman’s family and health arguably could be considered a higher priority than her patient autonomy. While it may have been Ms. Suleman’s choice to receive IVF treatments, critics argue that this was a bad choice and that Dr. Kamrava should have intervened by refusing to treat her. The nonmaleficence principle dominates this argument. Ms. Suleman had six embryos implanted in her, which far exceeds the recommended amount for IVF treatment. This arguably had the potential to cause great harm to her health and the health of the embryos because of the risks of multiple fetus pregnancies.
Another argument supports the idea that her having more children brings potential harm to the children she already has, as well as the new babies who will be born. The interests of the children were arguably compromised through this because now their parental attention and financial resources available to them are depleted more with eight new children. Ms. Suleman’s parents were also involved in the care of their grandchildren and disagreed with the availability of IVF treatments to their daughter, because of the harm caused to the family. One also could consider the financial harm and burden on the state, because Ms. Suleman cannot fully support herself and was relying on government assistance. All these arguments highlight potential harm that could be caused not to the patient, but to others as a result of both Ms. Suleman’s decision and Dr. Kamrava’s compliance.
In the case of Nadya Suleman, I think that the interests of her own health and family should were more important than the moral need for patient autonomy. Dr. Kamrava acted in a way that was medically and morally irresponsible. Ms. Suleman’s own health was compromised by implanting so many embryos and the harm to her family proves to be an issue financially. Ultimately, professionals agreed that Dr. Kamrava acted negligently and he lost both his California medical license and membership to the American Society for Reproductive Medicine. As a doctor, Dr. Kamrava should have stepped in and considered the moral consequences of his decisions, not just Ms. Suleman’s choice as his patient.

Beauchamp and Childress outline the difference between killing and letting die. Both require moral discussion because they bring up moral dilemmas of nonmalefence, and in some cases, autonomy. Killing involves one imposing some sort of intervention on the patient that ends his life, such as providing euthanasia. Letting die means that a medical intervention is not used and the patient therefore will die, such as disconnecting a patient from a breathing machine when he does not have functioning lungs. There are some cases when killing or letting die are always wrong, and other cases where the moral lines are less clear. Beauchamp and Childress describe how the action alone is not the moral dilemma, “rightness and wrongness depend on the merit of the justification underlying the action, not on whether it is an instance of killing or of letting die”(p. 176). Killing and letting die are instead unique acts that are incredibly dependent on a specific situation when trying to morally justify them.
Many laws surrounding killing and letting die are very restrictive because of this. Laws do not govern specifics situations, but all situations. Because killing and letting die could occur in situations that would make the acts morally wrong, laws are overly cautious and restrictive of this. One of the most controversially debated issues today is the state-by-state legality of late-term abortions after twenty weeks of pregnancy. This relates to the issues of killing and letting die because many of the women who seek late-term abortions are pregnant with fetuses with severe medical issues.
Fetuses always are complicated to discuss because there is disagreement about whether or not they should be morally considered in the same way as living humans. Conversations surrounding abortion, however, consider the fetus much more after twenty weeks of pregnancy because the fetus is viable outside the womb and therefor could become a person. Many states have outlawed abortion after twenty weeks because of this, thinking it is comparable to infanticide. One of the biggest arguments against this, though, is that it can be very harmful to both women and fetuses with health complications to not allow abortion.
With advanced obstetric technology today, health complications in utero can be detected most of the time. Some of these complications like severe spina bifida, heart problems, and brain tissue damage are known by doctors to cause a baby to die shortly after birth. Nonmaleficence is used to justify abortion in this case because it eliminates the pain the newborn baby will face shortly before death. It also eliminates the emotional pain and trauma parents go through by carrying a fatal fetus to term and then watching it die shortly after birth.
In these cases, abortion proponents argue that killing the fetus by aborting the pregnancy causes the least amount of harm for both the parents and the fetus. Often times the fetus can feel pain in utero and in almost every single case will feel pain after it is born. Opponents of abortion argue that killing a fetus is always wrong and that the fetus dying naturally in utero or after birth is the best approach. Letting die could also apply to babies born with health complications. Many parents who find out about the health complications before the child’s birth choose not to intervene when the child is born. They often feel that surgeries and medical interventions will only cause the child pain for a small chance of recovery. Opponents of abortion often support this approach because it avoids killing the fetus, but also minimizes additional pain the baby could feel.

Citation: Beauchamp, Tom L., and James F. Childress. “Nonmaleficence.” Principles of Biomedical Ethics. 7th ed. New York, NY: Oxford UP, 2013. 174-78. Print.

Case 1.1 handles the moral dilemma of who should decide whether or not Mrs. Francois should have the second surgery. Both the doctor and the patient’s family are in disagreement with the patient about her choice not to have the surgery. The family feels very strongly about Mrs. Francois having the surgery, whereas the doctor does not have the same emotional involvement, but feels that the surgery is the best medical decision for Mrs. Francois. This case deals with the moral issue of autonomy. As the patient on whom a medical intervention is being made, Mrs. Francois is legally granted full authority to decide whether or not to have the surgery. This case, however, questions many aspects of her decision.
As a precursor to an autonomous decision, the patient needs to be fully informed. The responsibility of this lies in Mrs. Francois’ doctor. As her doctor, he needs to adequately explain the surgery, as well as its potential risks and benefits. The case study does not provide details of what the surgeon said. The surgeon should take his responsibility a step further by also explaining other potential options to Mrs. Francois and their outcomes. He needs to not let his bias as a surgeon sway her towards surgery if there is another method available to her.
The doctor, however, still needs to make a recommendation. Medical recommendations inherently can be biased with doctors recommending prescriptions they commonly use, surgical methods they are used to, and methods of treatment they are most familiar with. This if not inherently bad, though, if their recommendations are most helpful to patients. It becomes as issue when financial biases are attached to their recommendations, which is why there are laws in place that require doctors to disclose medical practices in which they have a financial interest. In this case study, it would be incredibly wrong for Mrs. Francois’s doctor to recommend surgery if there was a better alternative, simply because he would earn more money from her insurance company from performing surgery. Recommendations are necessary because patients are in a vulnerable position because they do not have the same medical expertise as doctors. They need to rely on doctors to help them make decisions that are best for their health, which is why doctors need to give them a recommendation based on solely medical grounds.
After doctors make recommendations, they need to make sure patients understand the information they have disclosed and their recommendations. This element becomes much more ambiguous and difficult for a doctor to fulfill. In the case of Mrs. Francois, the doctor had difficulty knowing if Mrs. Francois fully understood the information given to her. While the doctor could be sure he told her everything he needed to tell and made a nonbiased recommendation, it was hard for him to be sure she fully understood everything. This was called into question because resisting the life-saving surgery seemed irrational and against her early behavior when she consented to the first surgery.
The overall issue in this case was whether or not Mrs. Francois was competent to make the decision. Because of all of the medical issues she has recently dealt with, her family argued that she was not competent, but the doctor felt she was because she could communicate in an intelligent manner. As the patient, the decision should ultimately be hers and the doctor needs to act in accordance with that. Because of the circumstances of Mrs. Francois’ health and her family’s disapproval, a third party should be brought in to judge her competence. The surgeon should receive a second opinion from a psychiatrist to judge whether or not Mrs. Francois is medically competent.
If the psychiatrist deems that Mrs. Francois is competent, then her decision to not have surgery should be honored. While the surgeon may be legally threatened by the son, this is not a reason for him to operate and he should stand by his decision to respect Mrs. Francois’ choice. If the psychiatrist feels Mrs. Francois is not competent, then the surgeon should honor the family’s wishes and perform the surgery. This could potentially save Mrs. Francois’ life and the surgery should not be forgone because she is temporarily mentally ill. In this situation, taking away Mrs. Francois’ autonomy to choose is the best choice because it can bring her the best outcome and reflect what she would have chosen if she was mentally competent.