In this blog post, I intend to bring the more specific principle of justice into the discussion of W&G Case 6.3 “Tracy and Robert Latimer: ‘It Was Right to Kill My Daughter.’”  When reflecting on this specific case, it is hard to ignore the blatant moral problems in Mr. Latimer’s intentional actions.  However, the mention of the “Capabilities Theories” (Beauchamp and Childress 259-60) raise aspects relevant to the case surrounding Tracy’s quality of life that could support and undermine her father’s decision to kill her, as well as the court’s responsibility in ruling about such actions.

The quality of a person’s life is “contingent on what they are able to achieve, and a life well lived is one in which individuals sustain and exercise a group of core capabilities” (Beauchamp and Childress 259).  In Tracy’s case, she inherently cannot fulfill the ten core capabilities listed, most applicably “affiliation” and “control over one’s environment.” Tracy has no control over her environment or ability to participate in decisions over her future, and assumingly has a more difficult time than others developing bonds and acting independently.  For these main reasons, her capabilities do not match those of a typical person’s.  In reference to the principle of justice as laid forth by Beauchamp and Childress, “[…] we, as a society, ensure that the world does not interfere with individual’s development of their core capabilities […]” (260).  Tracy is vulnerable and subject to the decisions others make on her behalf. Acting justly it is the responsibility of society (not just Mr. Latimer) to protect Tracy’s best interests. If those are along the lines of PAS, it is necessary that correct procedures are followed and honored.  Mr. Latimer could argue that Tracy’s disabilities qualify her for living in a “reduced state” and not fulfilling the capability of life, Tracy possesses many other capabilities. To possess and express these, however, may indicate different things.

The Stanford Encyclopedia of Philosophy makes a distinction between “functionings and capabilities”, or the “opportunity versus the ability” to do something.  In terms of core capabilities, should there be a distinction between having the opportunity to partake in emotions, love, political opinions and discussions, and being physically and mentally able to do so?  Tracy, as a human being, certainly had the opportunity to fulfill the core capabilities outlined for social justice, but physically and mentally could not. An important distinction must be considered on a case-by-case basis to provide adequate justice.  To create a just world and society, we must think and act in accordance with what is best and considered just individually and not always necessarily what is better for the common good. Was there, or could there have been, a duty of justice to the public and good in Tracy’s case?  It is a mistake to generalize justice to one specific concept and attempt to encompass all cases, and it is important to realize that, like almost all principles in bioethics, justice is relative.

Sources

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York:  Oxford UP, 2009, 2013. Print.

Robeyns, Ingrid. “The Capability Approach.” Stanford Encyclopedia of Philosophy. Stanford University, 14 Apr. 2011. Web. 31 Mar. 2017.

Thomas, John, Wilfrid J. Waluchow, and Elisabeth Gedge. “Case 6.3: Tracy and Robert Latimer: ‘It Was Right to Kill My Daughter’.” Well and Good: A Case Study Approach to Health Care Ethics. Peterborough, Ontario: Broadview, 2014. 222-28. Print.

Image Credit

http://www.quotesvalley.com/quotes/possibility/

The concept of paternalism in biomedical ethics gives authority of people’s bodies and autonomy to qualified persons, and could lead to a serious abuse of power if used as reasoning for simply controlling patients or their families’ choices for a host of reasons.  As controversial and as it is, paternalism is needed in cases where it is truly in the patient’s best interests to forgo their wishes, but there will always be a gray area in determining what those interests are.

Intervention in suicide attempts are, necessarily, considered paternalistic.  In “Confronting Death: Who Chooses, Who Controls?”, Dax Cowart asserts that “The right to control your own body is a right you’re born with, not something that you have to ask anyone else for […].”  This commonly upheld idea of autonomy is the precise reason the principle of paternalism exists – to essentially ignore a person’s autonomy if the reason for doing so benefits the person in question. Paternalism regarding cases of suicide, however, involve the act of suicide as a moral right and the state of the person attempting it.  Psychiatrists often consider a suicide attempt as a sign of a mentally incompetent person, but in doing so they are singling out the act of suicide as justification for revoking a person’s autonomy. If suicide is a “human right”, how is it different than any other action a person does to change his or her life for the better or worse?  A way to approach this dilemma is the relativity of suicide to other tasks, momentarily ignoring the social stigma surrounding it. People with suicidal thoughts should of course be given options, assistance, and concern, but doctors do not necessarily have inherent authority to intervene in a suicide attempt when not asked or given consent (this source explains various philosophical principles of thought on this topic).

Since the aforementioned texts define suicide along the lines of a human right, should society approach physician-assisted suicide any differently? To some, it is considered acceptable to assist in somebody’s suicide based on the argument that it is more humane if the person will accept no other alternative. To do this, though, would be to classify suicide as an acceptable, maybe even untouchable, act under the terms of autonomy and a person’s right to his or her own body.

From these conclusions, there is an evident correlation between intervention in suicide and physician-assisted suicide. If intervening in a suicide attempt on terms of beneficence, even if a person is mentally competent, is considered morally acceptable, then physician-assisted suicide is ethically justifiable under similar criteria of beneficence. There must be much more discussion surrounding the relation of suicide intervention and physician-assisted suicide, as each of those topics pertains to restricting autonomy and the ever-growing presence of paternalism in society.

Sources:

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2009, 2013. Print.

Cowart, Dax, and Robert Burt. “Confronting Death: Who Chooses, Who Controls?” The Hastings Center 28.1 (1998): 14-24. JSTOR. Web. 12 Mar. 2017. <http://www.jstor.org.proxy.library.emory.edu/stable/3527969>.

Kelly, Chris, and Eric Dale. “Ethical Perspectives on Suicide and Suicide Prevention.” Advances in Psychiatric Treatment. The Royal College of Psychiatrists, 01 May 2011. Web. 12 Mar. 2017. <http://apt.rcpsych.org/content/17/3/214>.

Image Credit:

http://sociologylegacy.pbworks.com/w/page/75297230/Paternalistic

This brief blog post is unrelated to this week’s readings and the immediate ethical issues we discussed in class, but I thought it would be interesting to hear some feedback on this topic. While reading the Well & Good Case 6.3 “Tracy and Robert Latimer” and wrapping my mind around the pertinent ethical issues in the case, I couldn’t help but think about the sentence Mr. Latimer received for killing Tracy – a few years in prison and then parole – and the precedent it would set for future generations and trials. I understand that this specific case is filled with questions surrounding the principles of nonmaleficence, killing versus letting die, and the Mr. Latimer’s general intentions, but how does it look if this is his sentence for admitting to taking a human life?  I feel as if the court must be conscious of this and provide some explanation or exception to prevent murderers from receiving lesser sentences on the basis of their personal, “untouchable” morals and beliefs.  The Stanford Encyclopedia of Philosophy states that present generations “are obliged not to violate the rights of future generations.”  Does Mr. Latimer’s short sentence compromise the security or rights of future victims or the accused in the legal system? Do we have a right to protect future people under this concept of “intergenerational justice”? I’d love to hear your thoughts.

Thanks!

Elisabeth Crusey

Sources:

Meyer, Lukas. “Intergenerational Justice.” Stanford Encyclopedia of Philosophy. Stanford University, 03 Apr. 2003. Web. 27 Feb. 2017. <https://plato.stanford.edu/entries/justice-intergenerational/#Bib>.

Image Credit:

http://www.policyinnovations.org/ideas/policy_library/data/01667

Dr. Anita Ho’s article, “Relational autonomy or undue pressure? Family’s role in medical decision-making,” urges physicians and healthcare professionals to promote understanding and support between patients and their families regarding serious medical decisions.  Some see a family’s influence as a violation of a competent individual’s ability to make an autonomous choice about their health, and some see it as irresponsible on behalf of the doctor to allow a family to do so.  I would argue, however, that a family’s presence and influence in a patient’s decision is an important if not critical aspect of their own autonomy and that it should not be viewed always as a detrimental aspect to the decision-process, but a helpful one.

In her article, Dr. Ho states “Contemporary medicine has inadvertently reduced many patients with full histories and relational identities to diseased body parts and medical jargons” (Ho 130) to introduce the impact that advancing medical care has on a patient’s experience.  While advances in technology and more complex procedures are fantastic and life-saving, at times a patient feels small and helpless in the process.  If doctors neglect to fully explain situations and terms to patients, there is a risk of manipulation or detachment of the patient from the issue at hand.  The presence of a family’s questions and opinions in cases like these, as Ho mentions, can reduce confusion and allow the patient a sense of security.  A physician must certainly balance a family’s opinions as well as those of the patient on a case-by-case basis.

A family can sometimes aid in advising what professionals believe is medically best for the patient, but can also provide a patient assurance in what medical professionals perceive as the medically wrong decision.  In the W&G Case 3.2 concerning Simon and the administration of electroconvulsive shock therapy, Simon’s son was present and supported his father’s decision to not undergo the treatment.  There are other aspects of autonomy and consent present in this case, but in the familial sense, Simon’s son was present, listened to medical advice, and supported Simon’s decision.  The support Simon’s son offered did not necessarily sway Simon’s decision but still provided influence in it.

In an article by Dr. Laura Sedig published by the AMA Journal of Ethics, it is argued that “Focusing on the strict definition of autonomy and failing to recognize an individual as part of a family leads to an incomplete understanding of decision making for informed consent” (AMA Journal of Ethics).  Neglecting to involve a family in a serious medical decision does just that – creates a platform of misunderstanding and a risk of uninformed consent on behalf of the patient.  A holistic approach to medicine does not just include the physiological or mental components of a case, but the entire picture.  The impact of a patient’s relationships and understanding are paramount in ensuring the best medical decision is made.  Families’ opinions truly can influence a patient to the point where they completely change their mind about what they want.   A concept of autonomy is that “beliefs and choices shift over time,” (Beauchamp and Childress 113), so is ignoring a family’s ability to do this a risk to a patient’s own autonomy?

Works Cited

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York:  Oxford UP, 2009, 2013. Print.

Ho, Anita. “Relational Autonomy Or Undue Pressure? Family’S Role In Medical Decision-Making.” Scandinavian Journal Of Caring Sciences 22.1 (2008): 128-135. Psychology and Behavioral Sciences Collection. Web. 12 Feb. 2017.

Sedig, Laura, MD. “What’s the Role of Autonomy in Patient- and Family-Centered Care When Patients and Family Members Don’t Agree?, Jan 16 – AMA Journal of Ethics (formerly Virtual Mentor).” AMA Journal of Ethics. American Medical Association, 2016. Web. 12 Feb. 2017. <http://journalofethics.ama-assn.org/2016/01/ecas2-1601.html>.

Thomas, John, Wilfrid J. Waluchow, and Elisabeth Gedge. “Case 3.2: Non-Consensual  Electroconvulsive Shock Therapy.” Well and Good: A Case Study Approach to Health Care Ethics. Peterborough, Ontario: Broadview, 2014. 124-31. Print.

Image Credit

Peter C. Vey/The New Yorker Collection/The Cartoon Bank

(from: http://blogs.hospitalmedicine.org/Blog/the-return-of-the-death-panel/)

Dilemma

Simon is a financially-unstable, 53-year-old widowed male with one son. Simon was found unconscious in his home in close proximity to an empty bottle of Elavil, a prescribed and controlled antidepressant medication.  After being stabilized in a hospital’s ICU, Simon was moved to the Psychiatry Unit for further treatment.  Upon observation in the unit, Simon exhibited symptoms indicating severe mental depression; he was disheveled, upset, disconnected from activities, complained of inhibited brain function, suffered insomnia, and exhibited and mentioned suicidal intent.  A psychiatrist advised a two-week period containing six electroconvulsive shock treatments (ECT) as a more effective alternative to the previous drug regimen used in treating Simon’s depression.  Simon refused the ECT based on the risks involved and his lack of will to live.  Simon’s son concurred with his father’s decision and Simon was declared mentally competent despite his depression.  Should the psychiatrist appeal to proceed with the electroconvulsive shock treatments or should Simon’s decisions be honored even if they aren’t medically in his best interests (Thomas, et al. 124-125)?

Discussion

ECT is not an uncommon medical procedure, but its use is contested to this day (please learn more about the University of Michigan Health System’s ECT Program). As with any serious medical decision, there are significant risks involving ECT.  Its side effects can include short-term and long-term memory loss, confusion, muscle aches, nausea, and other medical complications concerning anesthesia (Mayo Clinic).  Besides the concern over these side effects, Simon was declared mentally competent, and therefore able to make decisions regarding his health although he expressed suicidal intent. Per the “three-condition” theory of autonomy (Beauchamp and Childress 104), Simon was (1) intentionally aware of the side effects of ECT and the risks of the procedure, (2) he understood the severity of his situation despite his mental illness and there was no lapse in communication between the patient and doctor, and (3) the only influence or control in Simon’s case was his mental state.  These reasons do not provide justification to override his autonomy altogether.

As large as the medical risks of refusing ECT might be, Simon’s competency and valid autonomy must be honored.  Simon’s degree of competency may not equal that of somebody with less severe depression than he, but he has been declared within responsible realms to decide on a course of his own treatment.  Furthermore, his son wished to proceed with whatever his father chose.  The son’s concurrence with his father may lead doctors to believe that the son is confident that his father made his personal choice appropriately and in accordance with reason, although it was not medically advised.  The psychiatrist on the case presented possible courses of treatment, advised ECT as the best possible option to treat Simon’s depression, and should not appeal to proceed with the treatment against Simon’s wishes because Simon’s autonomy took priority in the case when he was declared competent.  Should Simon’s degree of competency be truly questioned, should his situation worsen or pose an immediate (not potential) harm to others, or should another option of treatment be found, then the psychiatrist is obligated to re-evaluate the situation with new factors. But for now, Simon’s decisions and autonomy should be regarded with credibility.

Works Cited

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York:  Oxford UP, 2009, 2013. Print.

Mayo Clinic Staff. “Electroconvulsive Therapy (ECT) Risks.” Electroconvulsive Therapy (ECT).   Mayo Clinic, 19 Sept. 2015. Web. 20 Jan. 2017. <http://www.mayoclinic.org/tests-      procedures/electroconvulsive-therapy/basics/risks/prc-20014161>.

Thomas, John, Wilfrid J. Waluchow, and Elisabeth Gedge. “Case 3.2: Non-Consensual      Electroconvulsive Shock Therapy.” Well and Good: A Case Study Approach to Health           Care Ethics. Peterborough, Ontario: Broadview, 2014. 124-31. Print.

University of Michigan. “University of Michigan Department of Psychiatry.” Electroconvulsive Therapy. University of Michigan, 2016. Web. 20 Jan. 2017.                             <http://www.psych.med.umich.edu/ect/>.