http://a57.foxnews.com/global.fncstatic.com/static/managed/img/Health/0/0/Henrietta%20Lacks_AP_Aug%207%202013.jpg

Henrietta Lacks was a woman age of thirty, living in the 1950’s as an African American woman. She was diagnosed with cervical cancer and died within a year of the diagnosis unfortunately. Before she passed away, physician in charge taking care of Henrietta took her tissue sample without her consent (The Immoral Life of Henrietta Lacks). It was discovered that cells from Henrietta (referred to as HeLa cells) continuously divided without dying, an optimal cell line that scientists were looking for. Previously, researchers had tried to keep the cancer cells alive to advance on with their research projects, but they were unsuccessful. The ethical issue kicks in here, the physician taking the cells without Henrietta or her family’s permission and not even providing them with any monetary compensation for the contribution of the cells.

Before determining whether the doctor’s decision to take the cells from Henrietta without her consent was just or not, I would like to take a look at the issue of autonomy. Whether it was before or during the chemotherapy treatment, she was competent to not only speak for herself but also consider medical treatment decisions. In addition, her family members were present right beside her to give inputs. Therefore, the physician obviously violated the patient’s autonomy when HeLa cells were extracted from Henrietta’s tissue. One defending view might present beneficence that would ultimately result in helping of others as the research in cancer advances. However, this view can’t justify the violation of autonomy that the physician didn’t tell the truth, respect the privacy, and obtain consent to Henrietta and her family (Principles of Bioethics).

Considering justice side of the issue, I want to ask a few questions. What happened to the societal strive to raise the issue of the need to protect subjects from exploitation when research offers no benefit to the patient (Principles of Bioethics)? Was it because Henrietta was an African American woman? Because she had a low social status? Would the physician have informed and gotten the consent had the patient been White? Regarding Henrietta’s race and economic status, it can be inferred that the physician’s action displayed disparities in providing fair opportunity. Beauchamp and Childress’s view on the material justice states that there should be maximum of liberty and property resulting from the exercise of liberty rights and participation in fair free-market exchanges (Principles of Bioethics). Strictly speaking, cells for research purposes should be bought for unless the patient voluntarily donates her cells. Cells are goods that have monetary values, having potential to contribute to great discoveries in the field of medicine. However, Henrietta and her family received nothing in return, not even a thank-you.

One other apparent issue here is the undue profit. I understand that she didn’t participate in a research project as a volunteer to receive monetary compensation but with her cells that would change the future of the research field, her family should have given a financial reward. This injustice of distributing too little, or in this case none, of a payment brings the argument back to implicit disparity possibly due to her race and economic stance in getting cells without Henrietta’s permission that violated her autonomy. In conclusion, Henrietta was the patient who was unjustifiably exploited in terms of autonomy and justice by the medical system of the era in 1950’s, although her cells still strive today contributing tremendously in the field of research.

References:

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

Skloot, Rebecca. The Immortal Life of Henrietta Lacks. New York: Crown, 2010. Print.

How much are we supposed to care for the others? Autonomy and nonmaleficence make sense because we should respect opinions of others and not harm people, but how and where should we draw the line for the beneficence? The question rises from the base that people do not want to be involved in a situation where doing good for the others would cost them something in turn. This is the exact dilemma presented in the case study with Robert McFall and his cousin David Shimp in the Principles of Bioethics.

Robert McFall was diagnosed with aplastic anemia, needing bone marrow transplant, and he wanted his cousin David Shimp to undergo two exams to determine if he were a genetically compatible donor. However, Shimp refused after taking the first exam, which determined his tissue to be compatible to those of McFall. McFall sued his cousin for not willing to take the second exam and donate if he were to be fully compatible. The judge ruled that the law can’t force Shimp, but his refusal was morally indefensible (Principles of Bioethics). Apparently, there are generous people who are genuinely concerned about others and would donate blood even if the patient is not related to the donor as shown in the case of the Atlanta Journal Constitution blog (AJC Parenting Blog). I am not saying that Shimp should also act heroically and go through the medical procedures to donate to his cousin, but I agree with the judge’s the ruling that Shimp’s act was morally indefensible.

Beauchamp and Childress present five premises of obligatory beneficence. The first premise is met since McFall is at risk of significant damage to life. There is no doubt that he might actually die. From Shimp’s standpoint, the application of second and third premises can be questionable, though. With the chance of survival increasing from 25% to about 50% in average, Shimp’s action may not prevent McFall’s death and thereby not be considered as a necessary action he must take for McFall (Principles of Bioethics). However, fourth and fifth premises about balancing the benefits and risks for the receiver and the donor respectively may make McFall’s suing argument strong while undermining what Shimp had to present. Pondering upon these premises it can be hard to determine whether Shimp’s refusal can be viewed as morally indefensible or not.

Specifically, counterargument might bring out this point: why is the autonomy of donor not respected and why does the case seem to imply that obligatory beneficence triumphs over autonomy? Autonomy is defined as something that “encompasses self-rule that is free from both controlling interference by others and limitations that prevent meaningful choice” (Principles of Bioethics). The counterargument may state that this should not only be applied to the patients but also to everyone and especially to the donors as well who actually have control over the choice whether to donate or not. I agree; nevertheless the same standards to determine whether one is autonomous and competent must be applied to everyone as well. Therefore, Shimp’s beliefs must be evaluated for rationality.

In other words, if his beliefs are irrational, then his choice of not to go through the second exam can’t be considered as an autonomous decision and can further be seen as an immoral one. Shimp believed that 100 to 150 punctures of pelvic bone and 1 in 10,000 chance of death from anesthesia were too much of risks for his part. Is this a rational belief? In a research done by Harvard School of Public Health, there is 1 in 6,700 chance of death from car accident (Best Health Degrees). His belief is irrational because I am logically assuming that he drives around to work, to grocery stores, and to many other places risking his life while refusing to go through a procedure to save his cousin, which involves lower risks. I don’t want to say he should be forced to be the donor, but he is “morally indefensible” as the judge stated. His beliefs are irrational, and there is no valid counterargument that can say his autonomy triumphs over beneficence.

References

Beauchamp, Tom L., and James F. Childress. “Respect For Autonomy.” Principles of Biomedical Ethics. New York: Oxford UP, 2013. 101-41. Print.

Beauchamp, Tom L., and James F. Childress. “The Duty of Rescue as Obligatory Beneficence.” Principles of Biomedical Ethics. New York: Oxford UP, 2013. 206-08. Print.

Oliviero, Helena. “Georgia Girl Puts Spotlight on Life-saving Bone Marrow Transplants | AJC Parenting Blog.” AJC Parenting Blog. AJC, 3 Mar. 2015. Web. 18 Mar. 2015.

“Your Chances of Dying.” BestHealthDegrees.com. Best Health Degrees, n.d. Web. 19 Mar. 2015.

How big of a role should our family play in our lives? Obviously, family members are significant others who have and will influence us in every aspect of our lives. However, when it comes down to making medical decisions, I believe that family members’ opinions should be carefully and critically evaluated. When patient’s autonomous decision clashes with those of family members, doctors should be able to follow the decision of the patients while respectfully letting go of what family members have to say and have decided.

Consider Mr. M who reversed his decision regarding resuscitation and other life-extending measures after talking with his wife (1). Mr. M is totally autonomous. He was fully conscious and was aware of what he was going to encounter; in other words, he was competent because he had the abilities to comprehend, process information, and reason about consequences of his actions, which we can somewhat assume from what is told from the short scenario (2). Therefore, there is no reason for considering his family member’s opinion at all. It may sound harsh, but here is my question: can we say it is moral for a person to defer his autonomy to another person when he is competent? This is completely different scenario from one giving informed consent to doctors to perform a surgery. In the latter case, there are voluntary, understanding, and authorizing actions that rise from one’s autonomy, while in the former case one is completely giving up his or her autonomy. Family members are very important involved in decision-making, but the final say should go to the patient who is competent.

http://statusmind.com/images/2013/04/FamilyFacebookStatusMindPictures-8573.jpg

One general belief of relationship between family members is that they aren’t based on temporary contracts but on empathy and beneficence family members have towards one another (1). This argument can be used to defend the view that family members have a say when making a medical-related decision. There is nothing wrong with this statement itself, but the interpretation of the meanings of empathy and beneficence may become problematic. For instance, one Jehovah’s Witness family member in the Well and Good would not support blood transfusion thinking that it will ruin one’s soul and ultimately turn into dust after death instead of being saved to enjoy the eternal life with God. However, there is the patient who is not as devout of a believer pleading to doctors to save her life (3). There are many issues to consider, but I would like to briefly focus on one of them here whether we can consider the family member’s point of view as beneficence.

The Jehovah’s Witness family member who doesn’t support blood transfusion holds irrational belief that prevents him from grasping true belief, which would allow him to have a reasonable argument to deny the surgery with blood transfusion if he had one. Doctors should be hesitant to respect his choice for his daughter because his opinion isn’t reasoned from a true belief and thereby is not rational (4). True belief comes from understanding the contextual information and applying those information to set one’s goal. The father believes that he is doing what is the best for his daughter by not giving blood transfusion and saving her soul, but since it’s based upon a false, irrational belief, it is a false beneficence that would actually harm and kill his daughter. I think it is important to realize that empathy and beneficence are what give family members a say to what the patient goes through in the hospital setting; nevertheless, it is also crucial to consider where the beliefs of the family members are coming from.

Generally, family members seek the best option for the patient, but doctors should still respect patient’s autonomy over the family’s input in patient’s decision because the values the family members hold may not necessarily correlate with what patients hold. Better yet, doctors need to be careful and put more weight on patients’ autonomy; family members’ views might not always be based off of a true belief, as it wasn’t in the Jehovah’s Witness case.

References:

1. Ho, Anita. “Relational Autonomy or Undue Pressure? Family’s Role in Medical Decision-making.” Nordic College of Caring Science (2008): 128-35. Print.
2. Beauchamp, Tom L., and James F. Childress. “Respect for Autonomy.” Principles of Biomedical Ethics. New York: Oxford UP, 2013. 117-40. Print.
3. Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. “Case 3.5 Religious Conflict over a Life-Saving Blood Transfusion.” Well and Good: A Case Study Approach to Health Care Ethics. N.p.: n.p., n.d. 142-50. Print.
4. Savulescu, J., and R. W. Momeyer. “Should Informed Consent Be Based on Rational Beliefs?” Journal of Medical Ethics 23.5 (1997): 282-88. Web.

http://www.brainviews.com/abFiles/ImgPet.htm

Simon who is a widowed father of age 53 came to the hospital with mentally unstable mind. He had a severe depression to the point of attempting suicide and wasn’t willing to receive the proposed treatment (1). The dilemma is whether physicians should take Simon’s refusal as a respect for his autonomy and not give the proposed treatment of electroconvulsive shock therapy or value beneficence more and give the treatment despite Simon’s will. Specifying a little bit more, we need to focus on and explore if Simon is competent enough to be considered as autonomous and decide the matter for himself.

In Scotland, the government has introduced an interesting bill to be considered supporting physicians to assist their patients with committing suicide should they desire (2). It has complicated issues and questions involved, such as what are patients’ and physicians’ roles, is it moral to help patients to commit suicide, what is physicians’ job ultimately in helping patients, how do we redefine “helping”, how do we balance between patients’ autonomies and physicians’ need to be beneficent, etc. Applying it to Simon’s case, if we value his autonomy, he not only won’t be treated with the electroconvulsive shock therapy but also will most likely to commit suicide. As a result, doctors may be passively “assisting” Simon to commit suicide. Before we go further and look deeper into whether it is morally better for the doctors to value autonomy over beneficence, it is important to specify what constitutes autonomy and if doctors should respect Simon for his autonomy, if he has any.

According to Beauchamp and Childress, there are three components to autonomy: intentionality, understanding, and noncontrol (3). Simon has intentionality; he doesn’t want the treatment. In addition, although there are influences and resistances exerted by the physicians, Simon remains firm and “noncontrolled”. His autonomy is questionable when we consider his understanding of the situation, though. He doesn’t seem to understand his own situation nor the benefits and possible consequences of the electroconvulsive shock therapy due to the severe depression he has. This ties into assessing one’s competence. Appelbaum and Grisso presented the standards of incompetence including inability to understand one’s situation and its consequences (4). Simon may be able to express his own intentions, but whether physicians should respect his autonomy is debatable because of his current mental condition that hinders his understanding of the circumstances. I say doctors should go ahead and give him the treatment.

Now, the consequences of valuing beneficence over autonomy may be costly. Simon may suffer from permanent memory loss and possibly death in the worst case scenario, not to mention the fact that the treatment only temporarily relieves the severe depression. However, I believe physicians should consider the best solution for the patients always, and in this case, it is treating him with the electroconvulsive shock therapy. They should respect patients’ autonomy, but not when a patient is about to commit suicide because of depression or when the patient himself doesn’t really know much about his own state of mind incapable of making a reasonable decision. In fact, the consequence of valuing autonomy over beneficence is much worse, Simon with his severe depression that doesn’t seem to improve with the current medication, which might lead to his suicide. To give or not to give the treatment is the dilemma. Neither way can satisfy every party involved. Therefore, I believe physicians should make the best choice for the patient who doesn’t meet the criteria of autonomy by giving the treatment to prevent Simon from committing suicide.

References:

1. Waluchow, Wilfrid J., and Elisabeth Gedge. “3.2 Non-Consensual Electroconvulsive Shock Therapy.” Well and Good. a Case Study Approach to Health Care Ethics. By John E. 1926- Thomas. Peterborough, Ontario: Broadview, 2014. 124-31. Print.

2. Russell, Paul. “Pro-assisted Suicide Lobby Making Nonsense.” LifeSiteNews. Life Site, 28 Jan. 2015. Web. 29 Jan. 2015. <https://www.lifesitenews.com/opinion/pro-assisted-suicide-lobby-making-nonsense>.

3. Beauchamp, Tom L., and James F. Childress. “Respect for Autonomy.” Principles of Biomedical Ethics. New York, NY: Oxford UP, 2001. 101-40. Print.

4. Paul S. Appelbaum and Thomas Grisso, “Assessing Patients’ Capacities to Consent to Treatment,” New England Journal of Medicine 319 (December 22, 1988)