Background

Although it is more than 60 years later, most people have never heard of Henrietta Lacks – whose cells have been used to save the lives of countless people. 31 year-old Henrietta was an African American woman living in the early-mid 1900’s. After being diagnosed with cervical cancer, Henrietta died in 1951 at Johns Hopkins Hospital. Due to the fact that research on such patient’s was very limited at the time, a biopsy of her tumor was taken for research purposes without ever asking her permission (Thomas, 254). What happened next changed the lives of many people – the cells reproduced and never stopped reproducing, essentially becoming “the first immortal cells ever grown in a laboratory” (Thomas, 254). These cells became famous not only in the medical field but also worldwide after being mass-produced. It is here we begin to see how the principles of ethics are being violated.

Dilemma

Within this case, the main dilemma that stands out to me revolves around the violation of Henrietta and her family’s autonomy. Henrietta and her family not only suffered considerable amounts of injustices during this time but continue to suffer through today’s time. It is noted that although Henrietta’s cells were taken without informed consent when she died in 1951, it wasn’t until 1971 that her family first became aware of the fact that her cells existed (Ethics of Informed Consent).

There were several opportunities before/during treatment that Henrietta was competent enough for physicians to ask for her consent in regards to taking her cells. What boggles me even more is the fact that her family members were also present and willing to speak their minds throughout this entire process. This is where we see the complete disregard of the ethical principle of autonomy. From an opposing viewpoint, one may argue that Henrietta’s status in society (an uneducated black woman) made it very difficult for physicians to communicate to her the details of her care. However, I would argue that a simple explanation and inquiry as to her feelings in regards to such a situation would have benefited all parties involved.

Additionally, one may present the argument that the physicians measured the principles of beneficence and non-maleficence and came to the conclusion that helping Henrietta and attempting not to harm her outweighed her autonomous rights. Although it is unclear in the reading, the physicians acquired the cells as leftovers done from a surgery intended to help Henrietta (scienceblogs). While the doctors felt as though their actions were benefiting Henrietta and the researchers felt as though they were benefiting the good of a greater number of people (mankind), it is evident that Lacks’ family did not share such sentiments. Although the outcomes proved to provide good to the greater number of people, something that falls along the lines of utilitarianism, I truly believe that the physicians failed to assess the situation properly.

Reflection

In this case, the dilemma revolves around the basic ethical principle of autonomy and its disregard. Considering Henrietta’s situation, I believe that paternalism played a role in the disregard of autonomy – as a black woman in the 1950’s Henrietta did not have the option to question her doctor’s choices even is she was presented with such an opportunity. Such a situation could be termed “benevolent deception” meaning that the physicians believe they were doing Henrietta a favor in not taking the time to explicitly state what was wrong with her and the extent of her diagnoses. I’m not saying that if such a case was presented today that the patient would 100% agree with the physicians or 100% disagree with the physicians, but at least the patient would be given the choice. While some may put more emphasis on the effects that Henrietta’s cell have had, I would put the emphasis on the lack of information and choices presented to Henrietta.

Works Cited

Ethics of Informed Consent . N.p., n.d. Web. 8 Apr. 2015. <http://rabinmartin.com/insight/ethics-of-informed-consent-and-the-legacy-of-henrietta-lacks/>.

N.p., n.d. Web. 10 Apr. 2015. <https://hawaiiesquire.files.wordpress.com/2012/05/informed-consent-consideration.jpg>.

Thomas, John and Wilfrid Waluchow. Well and Good: A Case Study Approach to Biomedical Ethics. 3rd ed. Broadview Press Ltd., n.d. Print.

Background

The transcript of public remarks made by Dax Cowart and Robert Burt presents a dialogue that unearths the morality behind physician-assisted suicide. As defined by the American Medical Association, physician-assisted suicide occurs when a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act (AMA). In the case of Donald (Dax) Cowart, the ethical issues raised by efforts to sustain his life against his wishes have made him famous. After a propane gas explosion, despite Dax’s insistence to be left for dead, he was rushed to the hospital alongside his father who died en route. Dax’s hospital treatments included immersion in chlorinated baths and having bandages stripped and replaced. Dax was left blind, without the use of his hands and with more than two-thirds of his body burned (RD p. 1). Throughout this nightmare Dax continually demanded to die by refusing consent to his treatments but his wishes were not approved.

Dilemma

As has been the trend up until this point in class, the two main issues at stake here revolve around the two ethical principles of autonomy and beneficence. The general definition for the ethical principle of beneficence rationalizes it as an “action that is done for the benefit of others,” actions that “can be taken to help prevent or remove harms” as well as actions done “simply to improve the situations of others” (UCSF). On the other hand, autonomy (respect for persons) can be defined as acknowledging a person’s right to make choices, to hold views, and to take actions based on personal values and beliefs (Bishop).

The main issue brought to light incorporates these two principles in an effort to determine whether or not Dax’s physicians had the right to go against his wishes. The dialogue proves Dax’s insistence of requesting to be let die – “I don’t want treatment” – however, Dax was put through the treatments regardless (RD p. 5). While Dax has been blessed after the accident with a life full of achievements, the debate in regards to this case questions whether or not the actions taken by the physicians were justified.

It could be argued that the action most in line with the principle of beneficence would have been for the physicians to respect Dax’s wishes and let him die. Dax’s suffering was evident to the physicians not only through his physical conditions but also through his constant emotional pleas – “the immediate issue, the urgent issue, was that my pain was not being taken care of. That was why I wanted to die (RD p. 15).” In letting Dax die, the physicians would be choosing the course of action that would be done for Dax’s benefit, help to remove and prevent harm, and also simply improve his situation by ending his suffering.

Additionally, in terms of autonomy it could be argued that Dax’s competence rules him to be completely capable of making his own life decisions.

Reflection

In this case, the dilemma revolves around the balance between the principles of beneficence and autonomy – the physicians are faced with a tough choice in confronting death. Looking back on the situation, I think it is important to consider Dax’s mental state at the time regardless of his state of mental competency. Take into account the reflection that Dax presents in the case – “I tried to take my life twice – three times if you count the time I crawled over the hospital bed rails trying to get to the window to jump out an eight-story window” (RD p. 21). A man willing to go to such extremes is clearly experiencing a great deal of pain and suffering – is it possible that he is not mentally competent and instead is so caught up in the pain and suffering felt at the moment that he cannot see a future? The doctors disagree with Dax’s grim outlook on life – their main reason for continuing with the surgeries and procedures despite his objections. Although the physicians’ decision did not respect Dax’s autonomy and did not immediately relieve Dax’s suffering, I believe they made their choice with a clear outlook on his future and therefore I stand with their decision.

Works Cited

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. Seventh ed. New York, NY: Oxford UP, 2001. Print.

“Beneficence vs. Nonmaleficence.” UCSF School of Medicine . N.p., n.d. Web. 20 Mar. 2015. <http://missinglink.ucsf.edu/lm/ethi cs/Content%20Pages/fast_fact_bene_nonmal.htm>.

Bishop, Laura. “Principles — Respect, Justice, Nonmaleficence, Beneficence.” Ethics Background. N.p., n.d. Web. 28 Jan. 2015. <http://nwabr.org/sites/default/files/Pri nciples.pdf>

“Opinion 2.211 – Physician-Assisted Suicide.” American Medical Association. N.p., n.d. Web. 16 Mar. 2015. <http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2211.page?>.

Image Webpage:

https://www.regionshospital.com/ucm/groups/public/@hp/@public/documents/webasset/dev_015033.jpg

Background

Upon reading this case I immediately thought of the institutions that were built in the early 1900’s that housed the physically and mentally disabled, of all ages, in which people would admit family members as they believed they were not fit for society. These institutions, such as Letchworth Village in upstate New York, were soon discovered to be severely mistreating the patients – including techniques of horrific experimentation (Abandoned NYC). However, as this became widely accepted as unethical and immoral in the 1950’s, experts began moving people out of institutions and into communities (History of Health Treatments). In Thomas, Waluchow & Gedge’s Well and Good, case number 6.4 presents Stephen, a seven-year-old boy with severe mental disabilities. Stephen was born prematurely and shortly after suffered extensive brain damage by meningitis that left him “profoundly mentally disabled with no control over his faculties, limbs or bodily functions” (Thomas, Waluchow & Gedge, 229). Stephen has passed through the hands of many different institutions for physically disabled children and even to a foster home.

Dilemma

The three main dilemmas I found after reading this case were:

1)   In such a situation, who gets to decide what is done with Stephen?

2)   What are the legal rights of the mentally disabled?

3)   In general, what makes it “okay” to not treat a patient?

In regards to the first question, we must turn to the principle of autonomy which acknowledges a person’s right to make choices, to hold views, and to take actions based on personal values and beliefs (Ethics Principles). In this case, Stephen lacks the cognitive capacity to make his own decision and therefore the decision should be turned over to his parents. However, the argument presented in this case is whether or not his parents should be given that right considering the fact that they are not his primary care givers and do not spend the majority of time with Stephen as the care givers in the institutions do. Some may argue that his parents hold the responsibility as they are his “next of kin” so to speak. However, in the case Justice Lloyd McKenzie claims that “the professionals who have been treating and observing Stephen since late 1982 are better qualified than [the parents] are to assess his condition and capacities because they, the parents, have hardly seen him” (Thomas, Waluchow & Gedge, 232). I agree with Justice McKenzie in putting the decision into the hands of Stephen’s caregivers.

In terms of the second question, regarding the rights of the mentally disabled, I believe the Citizens Commission on Human Rights has provided a very detailed declaration of human rights that clearly defines the rights of the mentally disabled. Some may argue that keeping Stephen alive is a waste of resources and time. However, I believe that ending Stephen’s life simply because of a disability and the immense effort necessary to keep him alive is simply inhuman. We don’t end the lives of people who are handicap because it is harder for them to perform tasks x, y, and z. Stephen was born, he is living, he is human and I believe that his rights deem it necessary to keep him alive – the declaration by the Citizens Commission states that “any patient has the right to be treated with dignity as a human being.”

The third question addresses the principle of non-maleficence described as an “obligation not to inflict harm intentionally” (Ethics principles). In this case, although the surgery would require an “extraordinary surgical intervention,” and would “constitute cruel and unusual treatment of Stephen,” the physicians have a duty to do everything in their power to treat their patients (Thomas, Waluchow & Gedge, 230). While some may believe that the pain that Stephen would suffer is grounds for making it acceptable to end his life, I believe that we must look at the case in terms of the long term rather than the short term. For Stephen, undergoing this surgery increases his chances for survival and, therefore, I believe the surgery should be performed.

Reflection

The two main dilemmas involve the principles of autonomy and non-maleficence. In terms of autonomy, Stephen lacks the cognitive capacity to make a decision for himself and therefore his parents should be responsible for making a decision. However, since Stephen’s parents do not spend much time with him, it is believed that the professionals who have been treating and observing him are better qualified to assess his condition and capacities. On the other hand, the decision as to whether or not the surgery should be performed revolves around non-maleficence. Is Stephen better off with or without the surgery? If it were up to me, I would have Stephen’s professional caregivers assess his conditions and if they agree that the surgery, despite the short-term pain, would improve his condition in the long term then I would respect their decision.

Works Cited

Abandoned NYC . N.p., n.d. Web. 17 Feb. 2015. <http://abandonednyc.com/2012/08/05/legend-tripping-in-letchworth-village/>.<http://nwabr.org/sites/default/files/Pri nciples.pdf>

Ethics Principles. N.p., n.d. Web. 18 Feb. 2015. <https://www.nwabr.org/sites/default/files/Principles.pdf>.

History of Mental Health Treatment . N.p., n.d. Web. 17 Feb. 2015. <http://www.dualdiagnosis.org/mental-health-and-addiction/history/>.

Thomas, John and Wilfrid Waluchow. Well and Good: A Case Study Approach to Biomedical Ethics. 3rd ed. Broadview Press Ltd., n.d. Print.

Background

In Thomas, Waluchow & Gedge’s Well and Good, case number 3.2 presents Simon, a widowed father of one child was brought to the hospital after being found unconscious in his bed next to an empty bottle of antidepressants. Simon’s guilt in regards to his absence during his mother’s death along with his thoughts of financial ruin led him to believe that living “in a state of perpetual depression was intolerable” and that he would “rather be dead than suffer like this for the rest of his life” (Thomas, Waluchow & Gedge, 124). Upon admission to the hospital, 36 hours later, Simon’s unkempt appearance and suicidal actions led his psychiatrist to propose electroconvulsive shock treatments (ECT).

Dilemma

Although there are several dilemmas presented within this case study, the two that stick out to me the most are those concerning the ethical principles of autonomy and non-maleficence. Autonomy, respect for persons, can be defined as acknowledging a person’s right to make choices, to hold views, and to take actions based on personal values and beliefs (Bishop). In this case, Simon refuses to consent to the proposed treatment, as he had no desire to live. After conferring further with Simon’s son, who refused to override his father’s expressed wishes, the psychiatrist was left to make a choice – to respect Simon’s wishes, and therefore his autonomy, or to violate his autonomy by applying to the review board in hopes of obtaining permission to treat Simon against his wishes.

On the other hand, non-maleficence, do no harm, can be defined as the obligation not to inflict harm intentionally (Bishop). In this case, the psychiatrist is forced to weigh the options – if Simon continued drug therapy, could it lead to further harming himself? If Simon underwent the ECT would the physical harm of the treatment itself be worse? Or maybe the ECT could cause death in a worse case scenario?

Reflection

Similar to the Integrity and Nurses’ Relationships with Colleagues and Employers case that we spoke about in class on Wednesday, the two main dilemmas in this case revolved around autonomy and non-maleficence. In terms of autonomy, Simon is entitled to refuse the ECT. However, according to a Disability Rights Brochure, “the doctor must also tell you that you are responsible for anything that happens to you because you refused the treatment” (Electroconvulsive Treatment). In medical ethics, as non-maleficence makes clear, a guiding maxim is “do no harm” (Bishop). How is the psychiatrist able to respect Simon’s autonomy while at the same time abiding by the principle of non-maleficence? Additionally, Simon’s plea to be left alone makes the psychiatrist’s decision even harder in the sense that Simon is not only refusing the ECT, but is also suggesting that he is not considering any other options to save/fix his life. Although there is no ideal solution, I believe the best way to move forward at this point would be to find another drug therapy option while keeping Simon under a close watch.

Works Cited

Bishop, Laura. “Principles — Respect, Justice, Nonmaleficence, Beneficence.” Ethics Background. N.p., n.d. Web. 28 Jan. 2015. <http://nwabr.org/sites/default/files/Pri nciples.pdf>

“Electroconvulsive Treatment (ECT).” Disability Rights California . N.p., n.d. Web. 28 Jan. 2015. <http://www.disabilityrightsca.org/pubs/539801.htm>.

Thomas, John and Wilfrid Waluchow. Well and Good: A Case Study Approach to Biomedical Ethics. 3rd ed. Broadview Press Ltd., n.d. Print.

Image Webpage:

http://www.psychiatrictimes.com/schizophrenia/possible-restriction-ect-devices-concern-grows-among-psychiatrists