Beauchamp and Childress propose a two-tiered system of health care. The first tier covers basic and catastrophic health needs. The second tier, includes better services such as luxury hospital rooms and cosmetic surgeries at your own personal expense. They claim that this system “guarantees basic health care for all on a premise of equal access while allowing unequal additional purchases by individual initiative, thereby mixing private and public forms of distribution” (273). This system is too general. There are several ways to treat a medical issue and at times many diagnostic tests are needed to find out what the exact medical issue is and how to treat it. So what would be included under basic services? Also does not address the historical injustices and prejudices of the medical system. Minority populations have been targeted for unethical medical research and blocked from necessary medical care. A just health care system has to take into account these injustices and prevent them from happening again. The system must also attempt to right the wrong that occurred and repair the damages that were done. For example, the blood of Henrietta Lacks was studied in the lab. Her cancerous cells helped create lifesaving vaccines, but she was never given proper treatment for her illness. Some of her cells are still used today in research. Until recently, there was no compensation for the use of her cells. Immediate members of her family did not even have access to health care due to a lack of insurance, yet Lacks cells brought millions of dollars into the health care industry. Recently, the government gave her family full free health coverage to attempt to right the wrong that was committed. Using Lack’s cells without her permission violated her privacy and autonomy. The health care system has to account for the historical medical injustices that occurred. There are systems and ideologies that reinforce institutional racism, especially in the health care system. A fair system has to actively attempt to deconstruct these systems and ideologies. Therefore, the health care system cannot be general. We have to address very specific aspects of what is right and wrong. We also have to stop acting like we live in a perfect world and recognize the wrongs that have been done in our society and address them. A decent minimum must account for the barriers that people have to overcome in order to have health care. We also have to recognize that access to health care does not automatically translate to the use of the health care system. People, especially vulnerable and minority populations, are very skeptical of the medical system because of the historical injustices. Therefore, I believe that the health care system should give more benefits and help to vulnerable and minority populations because they are extremely disadvantaged. The only way to close the disparity gap and begin to build fairness is to disproportionately target vulnerable and minority populations for social and health benefits. This is very similar to the egalitarian view of justice.

References:

Principles of Biomedical Ethics: “The right to a Decent Minimum of Health Care”272-279.

Ackerman argues that respecting a patient’s autonomy does not mean a doctor should not interfere on a patient’s decision. He argues that it is a doctor’s duty to interfere and give the patient control over his/her body again. I agree with Ackerman that respecting autonomy does not require noninterference, but I do not agree with his construction of illness or the aspect of control.  He argues that illness interposes the body between us and reality (15). This means that a sick body is lies somewhere between the human experience and reality.  I do not agree with this statement for several reasons. First, it makes humans and reality mutually exclusive. This is a problem because both humans and reality a very much intertwined. Human’s perception of the world around them creates reality. Therefore, one cannot exist without the other.

Second, this view asserts that the ill body creates the separation between humans and reality. In order for this to be true, the body has to be separate from the human. A human body is what makes a person a person because the body is the foundation of all human experiences. Through our bodies, we interact with and get to know the world around us. We create reality through our bodies, thus you cannot separate humans from their bodies. Issues arise when you separate a human from his body because he is no longer considered human. For example, a fetus is not considered a person until it has human bodily features and functions.

Third, this view states that illness is not a part of reality. Every human at some point in time will experience some form of illness. This may be the flu, a cold, cancer, or a broken limb. The human body is susceptible to illness and that is a huge part of our reality. Illness is common in the sense that everyone at some point will get sick, but it is uncommon because people should not get sick often. When a person is frequently ill and that illness hinders him from having other experiences that is when illness becomes a problem. But in most cases of illness people are still very much connected to reality. Illness changes reality, but it does not void it. We have to realize that illness is very much a part of realty and the human experience. I find it very interesting that Western society has made the process of aging an illness. As we get older, our bodies naturally begin to degrade and become more susceptible to disease. That is supposed to happen, yet our society has made aging a disease. There a treatments for wrinkles, sagging body parts, and dysfunctional body parts.

Maybe, illness is not the issue. Maybe the issue is how we conceptualize illness. I believe Ackerman wrongly assumes that we have control over our bodies. He believes that it is the doctor’s job to give us control over our bodies again, but I believe that illness reminds us that we never had control. I do not agree with Ackerman’s justifications for a doctor interfering, but I do agree with his conclusion. Doctors should interfere and help patients, but I do believe that the principle of autonomy is strong enough to support this conclusion, or at least not in the way that Ackerman specifies it.

References

Ackerman, Terrance “Why Doctors Should Intervene” The Hastings Center Report 12 (4): 14-17 (1982).

I find Beauchamps and Childress’s explanation of killing vs. letting die inadequate. I believe that they overlook a foundational question and that they contradict themselves. The authors argue that “in ordinary language, killing is a causal action that brings about death, whereas letting die is an intentional avoidance of causal intervention so that disease, system failure, or injury causes death” (175).  Death is the obvious result of both of these explanations, but Beauchamps and Childress barely address death in the explanations they give. I would define killing as the taking life and letting die as the allowance of death. While my definition is very simple, I believe it focuses on the foundation of the distinguishment: death.

I believe the core question is “when is death acceptable in a medical setting”? One flaw that the authors have is the lack of specification. They justify their explanations with non-medical examples that apply conceptually, but not in practice. For example, they support the claim that killing “does not entail a wrongful act or crime, or even an intentional action” with the case of one driver killing another in an automobile accident (175). Conceptually, this example could apply in a medical setting because a doctor and a driver could kill a person. I believe it does not apply in practice to a medical setting because a doctor has more responsibility to a patient than a driver has to a fellow driver or pedestrian. A doctor has an obligation to try and improve the life of his/her patient, while a driver has an obligation not to interfere with others drivers. I do not believe that the responsibility that a driver has can be compared to that of a doctor because a doctor has an obligation to improve the other but a driver has an obligation not to interfere. Therefore, I believe that the driving example is inadequate to support the claim that killing “does not entail a wrongful act or crime, or even an intentional action” (175).

Furthermore, Beauchamps and Childress go on to contradict the claim that killing “does not entail a wrongful act or crime, or even an intentional action” (175) by stating that “killing has traditionally been conceptually and morally connected to unacceptable acts (176). By definition an act that is unacceptable is wrong; therefore, killing has to be wrong if it is unacceptable. Now, it is possible for something to be wrong, but acceptable. For example, some doctors over treat patients and that is wrong, but it is acceptable.  The authors try to justify their contradictory claim by giving examples of cases that do not apply to the foundation of the issue. They list a series of circumstances in which killing is justified. I believe that this does not apply when making the distinguishment between killing and letting die because you cannot use exceptions to create the rule. At the foundation, killing will always be wrong because it is unacceptable. There is a difference between justification and acceptability. Things that are accepted are the norm and apply in majority of circumstances; but there are some circumstances in which things can be justified in order to be accepted, but they are not the norm. I believe that the authors support their arguments in this section based upon the exceptions and not the norms. You cannot build a strong argument based off of exceptions. Thus, I find their distinguishment between letting die and killing to be inadequate.

Blog 1: When Physician’s and Family Disagree

Dilemma: In the case of Mrs. François there is a dilemma to operate or not to operate. If the doctor operates, it seems that the patient’s autonomy is violated because she has clearly expressed that she does not want to have surgery. On the other hand, the doctor has an obligation to do what is best for the patient, and if he does not operate Mrs. François will die. I believe the doctor can operate without violating the principle of autonomy. First, we have to determine what the patient’s choice is because she has made more than one decision. Mrs. François has made the following 2 conflicting choices: to have surgery in order to live, and to not have surgery and die. Which choice accurately represents the patient?

Personal Opinion: I will argue that the doctor should operate on the patient, and that this action does not violate the patient’s autonomy.  I believe the doctor should operate based upon the principle of autonomy, under the following specification: respect choices that accurately represent the desires of the patient. Mrs. François initial choice to have surgery on her ovaries shows that she values her own life and wants to live. I think that the side effects of the hysterectomy and bilateral oophorectomy have created a fear in the patient that undermines her competence. She rightfully has a fear of having another operation because the first operation got her into her current situation. The doctors have tried to explain to Mrs. François that her situation is life-threatening and she needs surgery in order to live; but I think Mrs. François is not competent enough to understand due to her fear. I believe that Mrs. François does not want to have surgery because she does not want to die. She wants to live. She feels better and is most likely afraid to go under the knife again due to the outcomes of her previous surgery. Therefore, she does not agree to have another surgery because she feels fine, and probably does not trust the doctors to have her best interest in mind.  The case states that, “respect for the autonomy of individuals does not require respecting their expressed wishes if these can be shown to be seriously out of character and irrational” (66). Assuming that Mrs. François wants to live, then her choice to not have surgery is out of character. Also, the son has expressed that his mother is not acting like herself, and that she does not fully understand the consequences of her choice. Therefore, I believe that the doctor ought to operate with the consent of the son because Mrs. François is acting out of character. The patient’s decision is made out of fear rather than her true desires.

Comparison: This case is very similar to Mr. Z case. Mr. Z was severely depressed to the point of suicide, but refused electroshock therapy. His son also refused to consent to him having the treatment. In class, we questioned when we should respect one’s autonomy. We concluded that we should respect autonomy when it does not harm the individual. In both of these cases, the principle of autonomy and non-benevolence overlap. Through specification and balancing, it is possible for these principles to intertwine and produce the best outcome.

References

Thomas, John E., and Wilfrid J. Waluchow. “Case 1:1 When Physicians and Family Disagree”. Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. Toronto: Broadview, 2014. Print.

Thomas, John E., and Wilfrid J. Waluchow. “Case 6:1 Non-Consensual Electro-Convulsive Shock Therapy”. Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. Toronto: Broadview, 2014. Print.