Contrary to popular belief, the United States has had universal healthcare with automatic enrollment and a penalty for opting out for decades: Medicare. Upon the 65th birthday of any United States citizen or legal resident, the person in question is pulled into the Medicare system of health benefits, open enrollment plans, and medication payment initiatives. With this history of implementing broad, social standards for the betterment of society as a whole, it makes sense to try to extend this same system to the greater masses.

With respect to the justice of doing so, one must approach this from a public health standpoint. If the majority of people are gaining good quality, inexpensive, and accessible treatment for their general health concerns, the majority of people will then use this benefit and better the overall health of the country. This will consequently add to the work capacity of the nation, overall happiness, and quality of life of the general population.

The issue, however, arises in the United States in particular, when any policy seems to impede on social liberties normally tied to autonomy. With the implementation of a marketplace healthcare “shopping” system,  the choices available for coverage seem to be limited. However, I believe that it is a positive trade-off given that the quality and cost are being adjusted to better suit the consumer. There is still an aspect of choice involved with partaking in the marketplace system and the general population maintains or gains more benefits. If that is the main issue with the use of such a system, especially one that is already accepted as a social good for the elderly, I believe it is negligible and can be set aside to better public health policy.

In this week’s readings, we shift from focusing on the distinction between non-maleficence and autonomy and which takes precedence to the same dilemma that presents itself when beneficence is put into the equation. Beneficence, or the principle to only practice good and prevent harm, is in my opinion more at odds with autonomous decisions than non-maleficence. This is because non-maleficence implicates not causing harm, while beneficence affirms to practice good regardless of the medical staff’s own moral and ethical opinion of the autonomous decision made by a patient.

This apparent conflict between autonomy and beneficence is highlighted in the case of Dan Cowart. Dan was seriously injured in a propane explosion that caused burns all over his body and even the death of his father. Throughout the entirety of his treatment, Dan openly and lucidly expressed his desire to not persist with treatment and no longer endure the management of condition. However, physicians continued to treatment given their expert opinion that his prognosis for a good recovery was high- and he was eventually brought to healthy standards. That said, even after recovering from his injuries, Mr. Cowart maintains that his doctors should not have continued treatment and that if put in the same position, he would still desire to be allowed to succumb to his injuries.

In this particular case, we see the moral dilemma faced by the medical staff tending to Dan’s injuries and watching over his care. On one hand, we have a competent patient who is enduring excruciating amounts of pain in order to potentially get better and voicing that this is a recovery struggle that he does not wish to push through. On the other hand, we have a team of doctors that believe his prognosis is not nearly as grim as he is making it seem and, based on their expert conclusions, choose to override Mr Cowart’s decision and continue with treatment until he recovers. In my opinion, the doctors were wrong in pursuing treatment and submitting Dan to this course of action. Although the doctors were following the principle of beneficence and choosing to prevent further harm (in this case in the form of preventing Dan’s death), it is not within the scope of their responsibility to assume that in order to maintain this principle’s integrity, they must force Mr. Cowart to endure the incredibly painful ordeal that burn recovery is known to  be. The doctors are in no position to say that the pain he would go through with medical intervention was outweighed by the supposed benefits of surviving his injuries. This was ultimately Dan’s call but because letting him die when there was the potential to live weighed heavily on the shoulders and morals of the doctors, they chose to forgo adherence to Dan’s autonomous decision and follow the guidelines of beneficence instead.

Works Cited

1. Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York: Oxford University Press, 2013. Print.
2. Cowart, Dax, and Robert Burt. “Confronting Death Who Chooses, Who Controls?” The Hastings Center Report 28.1 (1998): 14-24. Web. 20 Mar. 2015.

Background

Mr. M is a patient afflicted with a vasculitis disease that has further compromised the integrity of his lung health. This brings him into the hospital where he at first informs his attending physician to forgo any treatments required to resuscitate him if he suddenly became unresponsive. This kind of request is known as a Do-Not-Resuscitate Order, or DNR. However, upon hearing this news, the wife persuades the patient to reconsider his DNR request and Mr. M consequently recants his previous statements. The attending doctor now is put into a situation where his patient’s right to self-determination and unobstructed autonomy has been impeded upon.

Dilemma

As noted by Ho in the article discussion entitled,”Relational autonomy or undue pressure? Family’s role in medical decision-making”, the most important aspect in the definition of self-determination is maintaining a free, unclouded, and not coersed selection to have.not, hav. Given this criteria, one draws the conclusion that there has been a clear violation of Mr. M’s autonomy since his desire for a DNR abruptly changed only after speaking with his wife. It also brings up the issue that were the patient to become unable to speak for himself, would his wife be a suitable candidate to act as his moral agent given their obviously different standpoints on necessary life-saving medical intervention?

Reflection

The most difficult aspect of this case is ultimately deciding whether the patient’s rights were infringed and to what extent has this right been violated. If the doctor concludes that the patient’s conversation with his wife singlehandedly led to the unnecessary and coersive change in is DNR request, the doctor will then not only need to find a way to speak privately with the patient again regarding his treatment but also make sure the patient is no longer allowed to be a lone with his family. Another issue that arises from this case is the idea of a moral agent and how they are assigned to cases. If someone like a spouse or parent, who is normally assigned as a moral agent for patients once they are deemed incapable of speaking for themselves, can have completely polarizing views to the patient’s, how can it be said that they are truly acting in the best interest of the patient? I believe that the conversation had by the patient with his wife was indeed coersive and gthat the doctor cannot merely overlook this change in opinion as a normal decision. However, if upon confrontation between the doctor and patient leads to the patient maintaining that they would like their DNR repealed, the doctor will need to abide by this new request. Ultimately, the coherent voiced opinion of a patient carries the weight necessary to allow a change of heart to be considered, likewise, valid.

Works Cited

1.) https://web-a-ebscohost-com.proxy.library.emory.edu/ehost/pdfviewer/pdfviewer?vid=2&sid=92980486-cd52-4bae-90a4-7f0c98d75e4d%40sessionmgr4005&hid=4212

Background

Mental illness has always been a taboo topic avoided in social circles and ignored within family discussions given its difficulty to understand, treat, and manage. Whether it be the degrees to which an individual is afflicted with a particular set of symptoms, the fear that a disorder is hereditary, or the fact that these diseases cannot be cured but rather only managed instills fear, confusion, and hostility in both the patients and their loved ones. And unfortunately, the brain continues to be an un-mapped and untapped realm of curiosities that keeps modern science from being able to truly pinpoint how and where behavioral malfunctions occur. How then does one handle a scenario where a patient is at risk of hurting themselves but the course of treatment may be just as hurtful?

The Case of Mr. S

Having attempted on taking his life in his home, Mr. S is taken into an institution where he is to be managed until he is deemed fit to return to his domicile.However, instead of getting better and flourishing during his stay, he begins to further deteriorate and spiral into a deep depression. His behavior becomes increasingly erratic, he continues to show that he is suicidal and willing to act on said impulses, and he no longer finds meaning in life. Given that a conventional course of medications did not help his situation, Mr. S’s psychiatrist suggests electroconvulsive shock therapy to help with his worsening condition since there is evidence that such treatment has shown significant improvements in the lives of depressed patients.

Analysis

There are multiple issues with this scenario, the most pressing being the idea of quality of life the patient is to have post-treatment. Mr. S repeatedly states that he does not wish to live on and that the depression he lives with stems from guilt concerning his mother’s death, which will never leave him in peace. Given that the psychiatrist said himself that the treatment would most likely cause temporary memory loss, if the treatment is applied Mr. S will still have the memories of the issues that are causing him this grief. There is also the concern of the treatment itself being inhumane in nature. The patient’s quality of life is being violated if there are multiple measures being implemented to minimize the repercussions of this treatment. The muscle relaxants, the restraints, the anesthesia, and the oxygen administration all show how stressful this kind of procedure can be on the body.

Therefore, it begs the question: if Mr. S is conscious of his surroundings, able to explain why he feels the way he feels, and reject the same treatment that his son is likewise refusing on his behalf, wouldn’t it be a violation of autonomy to do otherwise?

In my opinion, it absolutely would be. In order to force treatment on to a person, you must be able to prove beyond a reasonable doubt that they are a threat to themselves or society. The catch here is that the person in question must also be deemed unfit to make decisions for themselves. Such accounts would fit the criteria for a “Baker Act” to take place (that is, institutionalize an individual for up to 72 hours in order to administer drugs and treatment without their consent). However, here we have a patient that is capable of expressing themselves in a logical fashion, that is aware of what is happening around him and still refuses treatment. A line must be drawn on where a person’s autonomy over their own life and the state of their life is. Especially when the advocate for a person such as Mr. S is not entirely contradicting the wishes of the patient. Successful treatment requires the cooperation between the patient and doctor. If the patient does not wish for the treatment, then in the moment they may get better but the long term results will reverse everything and perhaps even make the situation worse. From the understanding of preserving one’s autonomy over their own life, Mr.S should not be treated with a procedure that may not only hurt him but also not work and cause further harm, as well as removing his capacity to end his suffering in the manner he consciously wishes it.

Image Source:

1)  http://academicdepartments.musc.edu/psychiatry/research/bsl/ect.htm