As we have been discussing in class there are two ways to approach healthcare policies rooted in beneficence: utilitarianism which aims to create policies that do the most good for the greatest amount of people versus libertarianism which aims to create policies that maximize individual choice. Within the approach of utilitarianism there is an economic component known as Cost-Effectiveness Analysis (CEA) which “measures the benefits in nonmonetary terms, such as years of life, quality-adjusted life-years, or cases of disease,” (Beauchamp and Childress 231) in order to better understand the different values of outcomes for all patients. Within CEA, one of the ways to help decide which patients should be saved or which medical treatments to utilize, healthcare professionals have measured HALYs, health-adjusted life-years, which combine longevity of life with health status. Specific types of HALYs are QALYs, quality-adjusted life-years which “are calculated by estimating the year of life remaining for a patient following a particular pathway and weighting each year with a quality of life score” (Beauchamp and Childress 239). Thus, what this means is in situations where physicians are trying to determine which path of medical treatment to use, they incorporate the calculation of QALYs to figure out which treatment will not only give the patient the longest life possible but also the best quality of life.

Although the main goal of QALYs is to bring good to the greatest amount of people, there are some challenges and problems that accompany these calculations. First of all, QALYs require the measurement of quality of life which is a discussion that was brought up earlier in class which highlighted that there are many different interpretations of quality of life so it can be difficult to standardize such measurements. Despite this challenge, “analysts start with rough measures, such as physical mobility, freedom from pain and distress, and the capacity to perform the activities of daily life and to engage in social interactions” (Beauchamp and Childress 239). Secondly, as QALYs are used to create public health policies it is important that the notion of egalitarianism is maintained that way “each healthy life-year is equally valuable for everyone” (Beauchamp and Childress 240).

Lastly, the concept of Rule of Rescue which according to David Hadorn is “people’s perceived duty to save endangered life whenever possible” directly conflicts with QALYs since this rule demands out of beneficence that all lives should be saved if possible while QALYs limit that to saving only those who will have better outcomes. An interesting idea brought up by Shepley Orr and Jonathan Wolff in their article is that of a “rescue-adjusted QALY.” In their article, they propose the idea that when QALYs are calculated there would be an “additional value of rescue [where] rescue could be given extra weight in our calculations but not the apparent absolute weight called for by adherents of the rule of rescue” (Orr and Wolff 531). According to this idea, both the principle of beneficence and the concept of QALY policy would be better served by incorporating the element of rescue to the measurement of outcomes. This would enable beneficence to be more easily recognizable since the act of doing good through physical rescue would become pronounced. Also, the QALY policy side of the situation would also be represented since this adaption would not be removing the calculations of life-years or the quality life of those life-years but rather adding an extra component to be considered.

Work Cited:

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York, NY: Oxford University Press, 2001.

Orr, Shepley, and Jonathan Wolffe. “Reconciling Cost-Effectiveness with the Rule of Rescue: the Institutional Division of Moral Labour,” Theory and Decision. http://link.springer.com/article/10.1007/s11238-014-9434-3

The next principle of bioethics that is discussed is the concept of beneficence. The “principle of beneficence refers to a statement of moral obligation to act for the benefit of others” (Beauchamp and Childress 203). According to this statement, beneficence is all about acting positively toward creating benefits for others as opposed to the negative action of doing no harm as explained by the principle of nonmaleficence. With this in mind, there is another clear distinction between the two principles and that is “the rules of nonmaleficence must be followed impartially” while the “rules of beneficence need not always be followed impartially.” (Beauchamp and Childress 204). What this means is when it comes to nonmaleficence, every physician and healthcare professional has the obligation to not inflict harm on patients yet for beneficence, not every physician is obligated to provide beneficial aid to patients who need it. My question is why is it that all physicians are universally required to do no harm, yet not all physicians are required to “act for the benefit of others” and can even refuse to treat certain patients?

The concept of refusing to treat a patient directly contradicts with the principle of beneficence yet there are laws such as those within the American Medical Association which declare, “a physician shall in the provision of appropriate patient care, except in emergencies, be free to choose who to serve” (Hood). The AMA then went on to add to this decree that in the case of discrimination, the physicians’ right to refuse to treat is not allowed. Additionally, there have been other debates about physicians’ refusal to treat patients when not in the case of discrimination, which is why other reasons have been offered to justify this contradiction with beneficence. Some of these reasons are that there are a limited amount of resources so not everyone can be treated, the patient is seen as hostile, the physician’s personal religious beliefs contradict with the aid necessary, or the physician will be at risk (Hood).

The last reason explained by Hood of the physician being at risk is brought up by Beauchamp and Childress and is specifically described as “X’s [physician] action would not present significant risks, costs, or burdens to X,” and “the benefit that Y [patient] can be expected to gain outweighs any harms, costs, or burdens that X [physician] is likely to incur” (Beauchamp and Childress 207). Thus, there is a sensitive relationship established between the patient and the physician when dealing with treatment, so it is important to consider both sides of this relationship and how everyone is ultimately affected with the decisions made. Lastly, in light of my discussion, I believe as we begin to diverge into this new concept of beneficence, it is important to remember the previous concepts in which we have discussed that way we continue to question how they coexist with one another; without trying to understand the contradictions these principles have amongst each other, we will not be able to provide a moral balance in the new situations that arise.

Work Cited:

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York, NY: Oxford University Press, 2001.

Hood, Virginia L., “Can a Physician Refuse to Help a Patient? American Perspective,” http://pamw.pl/sites/default/files/pamw_06_hood_pogl_en.pdf.

In the case of Stephen Dawson, I agree that Justice Lloyd McKenzie of the Supreme Court was correct in assigning the Superintendent of Family and Child Services the responsibility of making the medical decisions for Stephen. My reason for agreeing is based on the determination of quality of life.

The concept of quality of life can be interpreted in many different ways but overall, the term generates the idea that the patient should always be considered to have a standard of health, comfort, and happiness. With this in mind, according to the medical professionals at the Sunny Hill facility, Stephen seemed to show a quality of life since he engaged with others through laughter as well as demonstrated potential for advancement. Because Stephen has shown signs of quality of life, just a different interpretation of what is normally the case, then it should only be morally fair for Stephen to receive this surgery that way his personal quality of life has the chance to be prolonged.

At the same time, however, Stephen’s parents believe this should not be the case, and he “should be allowed to die with dignity rather than continue to endure a life of suffering,” (Thomas, Waluchow, and Gedge 231) which rejects the performance of the surgery. According to their wishes, it seems as though Stephen’s parents believe Stephen lacks a quality of life and should not continue living in this state. However, I believe though that this assumption is lacking in support since the parents are judging Stephen’s quality of life or rather lack of on the premise of what they knew to be true when they were caring for him and not of how he actually exists in his current state at Sunny Hill. Additionally, Stephen’s parents could also be adopting the idea of considering their own quality of life because as much as parents have unconditional love for their children, sometimes in dire situations such as this case, if Stephen were no longer alive, then that would ease the parents’ emotional burden. Yet, this idea of imposing what is best for the family’s life against the patient’s medical best interest is in a sense improper (Beauchamp and Childress).

Additionally, when dealing with the quality of life of disabled people whether mentally, physically, or both, it is often seen that the quality of life can sometimes in a unique way be more rewarding than that of a person without disabilities. When it comes to having disabilities, many times the smaller things that non-disabled people take for granted are noticed and more appreciated. This idea of a greater sense of quality of life is explained more in the BBC News Magazine article “A Point of View: Happiness and Disability,” which states that “sometimes, the part of life that is difficult brings other benefits, such as a sense of perspective or true value that people who lead easier lives can miss out on. If we always remembered this, perhaps we would turn out to be more accepting of disability and less prejudiced against disabled people.” Thus, even though Stephen’s medical state and legal state as a whole are very serious, complex as well as far from “normal,” there is some evidence that his quality of life that exists within Sunny Hill, even as small as it may be, provides something better than the alternative of death.

Work Cited:

“A Point of View: Happiness and Disability,” BBC News Magazine, http://www.bbc.com/news/magazine-27554754

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York, NY: Oxford University Press, 2001.

Thomas, John E., and Wilfrid J. Waluchow. Well and Good: Case Studies in Biomedical Ethics. Ontario: Broadview Press, 1987.

Background: Dr. Sandra Selleck is conducting a clinical research trial sponsored by the Alzheimer’s Society, to test a new drug that can possibly slow down the progression of Alzheimer’s disease. This research requires the inclusion of patients with mild Alzheimer’s, which is why Dr. Selleck has reached out to the director of St. Mary’s Nursing Home for Alzheimer’s patients, Ann Wilson, asking for residents to become participants in this study. Dr. Selleck has specified though that in order for these patients to participate, there must be no objection by any of the staff at the nursing home of the patient’s participation, and that the patients need to provide written consent or have their closest relative provide written consent. After hearing these conditions, Ann rejected Dr. Selleck’s request deeming this research trial as an exploitation of “extremely vulnerable people” (Thomas, Waluchow, and Gedge 116-117). The primary moral dilemma in this situation is the question of whether or not Ann actually has the right to reject Dr. Selleck’s request.

Discussion: I think Ann should not have rejected the subjects’ participation in this research trial on the basis of respect for autonomy. Firstly, the concept of autonomy is a person’s right to make their own decisions as long as they are deemed legally competent, and if they are not competent, then they will have a medical proxy to make those decisions for them. In this case, Ann is simply the director of the nursing home and not a medical proxy for any of these patients indicating that she lacks the right to make this decision for any of these patients. Secondly, as a health care professional, Ann must abide by the principle of respect for autonomy, which obligates her to disclose information; because Ann responds to Dr. Selleck’s request without disclosing even the existence of the research trial with any of the patients or the patients’ families, she is failing to uphold this obligation. Without giving the patients and their families information about said research trial, they do not even have the opportunity to bring about their own decisions (Beauchamp and Childress 106-107).

Concurrently, a secondary moral dilemma of this case is whether or not human subjects should be participants in research studies.  According to Ann, this research should not be conducted on the residents because these patients are not at their best and “have been through enough in their lives” (Thomas, Waluchow, and Gedge 116-117). While some people may believe in this statement, I disagree because of the support this research has already acquired. The Alzheimer’s Society, which often partners with research programs to further knowledge about the disease and ways to aid patients, has sponsored this specific research suggesting its wholehearted support for this research. Additionally, two ethics committees which are probably similar or related to the roles of the Department of Bioethics’ Clinical Center Ethics Committee and Institutional Review Boards, have carefully reviewed all aspects of the research approving it on the grounds of having one of the major focal virtues—moral integrity; the committees’ thorough examination of the research has ensured that it is being done for the right reasons. Thus, Dr. Selleck should be able to have patients from the St. Mary’s Nursing Home participate in the research study should they choose to do so.

Works Cited:

“Alzheimer Society Research Program.” Alzheimer Society, http://www.alzheimer.ca/en/Research/Alzheimer-Society-Research-Program

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York, NY: Oxford University Press, 2001.

“The Department of Bioethics.” National Institutes of Health, https://www.bioethics.nih.gov/clinical/index.shtml

Thomas, John E., and Wilfrid J. Waluchow. Well and Good: Case Studies in Biomedical Ethics. Ontario: Broadview Press, 1987.