In this particular case, Janet Green is in urgent need of a dialysis machine, as she is experiencing acute kidney failure. After seeking admission to two nearby hospitals, the patient was denied treatment due to a shortage of dialysis machines. The hospitals have implemented “first come, first serve” policies for the machines, rather than analyzing the specific patient’s need for treatment and their unique situation. This simplistic, egalitarian policy avoids necessary discussions concerning the patient’s specific condition. It is imperative to analyze principals of distributive justice to reach an ethical conclusion concerning the allocation of scare medical resources.

Distributive justice is the “fair, equitable, and appropriate allocation of benefits and burdens determined by norms that structure the terms of social cooperation” (Beauchamp and Childress, 250). As demand for certain medical treatments exceeds the existing supply, it is necessary to determine a fair process to allocate resources. In my opinion, the hospitals’ existing “first come, first serve” policy is not appropriate, as it fails to maximize social utility. In other words, I believe that the policies should create the most good for the greatest number of people. Therefore, a utilitarian perspective should be utilized to reevaluate and revise the hospitals’ existing policies.

It is imperative to define what specific benefit or function to maximize when applying the theory of utilitarianism. Essentially, physicians and medical personnel must determine which patient will receive the most benefit from the treatment. Specifically, one must consider medical criteria that include likelihood of benefit, urgency of need, change in quality of life, and duration of benefit (American Medical Association). This particular criterion will help patients with the utmost medical need, while offering the best possible outcome by evaluating an individual’s future quality of life.

In my opinion, it is precarious to maximize functions that stray outside the realm of medicine, as this practice may favor specific patient populations. Specifically, non-medical criteria including ability to pay, social worth, and patient contribution to illness may place vulnerable, low-income populations at increased risk (American Medical Association, 228). A strong focus on non-medical factors is rather insensitive, as it places a high burden on the individual. Additionally, the practice neglects the idea that individuals can turn their lives around, and make changes that will increase their social worth.

As a counterargument to using medical criteria under utilitarianism, one may state that this approach fails to capture equality of persons (Persad, 427). In other words, this practice “neglects the importance of fair distribution” (Persad, 429). Essentially, it is rather difficult to determine optimal principals for resource allocation, as each diverse policy presents new, complex issues. However, I argue that focusing on maximizing future benefits to certain patients will create the greatest good across society. The process and utilization of medical criteria favors individuals with the highest risk, and who will receive the greatest benefit from treatment.

The hospital’s current policy may be fair and easy to quantify, yet it is highly insufficient. The policy does not consider the relevant differences that exist between patients, which may hinder the hospital’s ability to allocate resources in an efficient manner. Additionally, the “first come, first serve” model may be detrimental, as it favors individuals who are well informed, wealthy, and who may travel faster (Persad, 424). Therefore, vulnerable, low socioeconomic patients may not have a fair chance at receiving care.

WORKS CITED:

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

Persad, Govind, Alan Wertheimer, and Ezekiel J. Emanuel. “Principles for Allocation of Scarce Medical Interventions.” The Lancet 373.9661 (2009): 423-31. Web.

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well And Good: A Case Study Approach to Health Care Ethics. N.p.: Broadview, 2014. Print.

Virtual Mentor. “AMA Code of Medical Ethics’ Opinions on Allocating Medical Resources.” American Medical Association 13.4 (2011): 228-29. Web.

Dr. Anne O’Byrne gave a rather interesting lecture regarding kinship and belonging. Essentially, humans are inherently drawn towards both understanding and discovering bonds of blood. Our society constantly seeks to answer the questions—where am I from, and who do I come from? These two questions are becoming deeply intertwined, as humans have a tendency to associate their identity with a location, rather than a human lineage. This shift has emerged due to both a decrease in the usage of oral histories and the increasing complexity of family trees.

In my opinion, the discussion of linguistics was the most interesting aspect of the lecture. The word genocide is derived from the Greek word génos, meaning kin, and cide, the act of killing. The concept of kin emphasizes belonging to a particular group, while simultaneously provoking separation within the world. Essentially, we cannot belong to all worlds and social groups.

After the discussion of belonging and kin, I thought that it was interesting to tie the topic back to health. Often times, physicians are encouraged to maintain appropriate boundaries with patients—this practice may diverge with the concept of kin relationships (Pilgrim 2001). Essentially, the patient may lack the proper medical knowledge to fully understand and navigate the healthcare system without proper assistance. Therefore, the patient may perceive a lack of belonging within the complex healthcare sector. Should it be up to the physician to build stronger relationships with patients to foster a sense of belonging within the healthcare system? Or should they strive to maintain the existing boundaries? In my opinion, I think it is important for the physician to emphasize with the patient—however, the development of a stronger patient-physician relationship may slightly impinge on the patient’s autonomy.

References:

Pilgrim, David, Floris Tomasini, and Ivaylo Vassilev. Examining Trust in Healthcare: A Multidisciplinary Perspective. Basingstoke: Palgrave Macmillan, 2011. Print.

In their essay, Mappes and Zembaty explore the complex relationship between patient autonomy and familial obligations. Essentially, they argue that the concept of autonomy must be reevaluated, as there is a profound need to clarify the influence of family interests in a patient’s decision for treatment. After resolving the definition of autonomy, it is imperative to consider the need for hard paternalism when patient decisions diverge from family interests.

Although medical treatments apply to individual patients, the patients must consider factors beyond themselves when determining the best course of action, such as external issues and individuals.  A patient may consider a diverse range of issues, including financial burdens or familial stress, when choosing between various treatment options. As a result, the patient may evaluate external factors outside of the medical realm. One might argue that this particular practice threatens the conventional concept of autonomy, as family members exert undue influence and pressures on a patient to act in a certain manner (Ho). Under this particular argument, family members appear to threaten the patient’s decision-making ability. Thus, a fundamental question arises: does the consideration of family interests limit a patient’s autonomy, as the patient is not acting without controlling influences?

In this particular debate, it is imperative to consider the patient’s acknowledgement of familial interests. Generally, it is nearly impossible for a patient to make a decision without considering the impact on his or her family—patients tend to evaluate external factors that extend beyond their own health, happiness, and general being. Therefore, a patient’s interests can become easily intertwined with their family’s preferences. Despite the perhaps inevitable consideration of external familial interests, patients have the full authority to either act on or ignore the family’s preferences. Therefore, the consideration of family interests does not violate the patient’s autonomy, as the patient has the ability to weigh the potentially diverging obligations and determine the best course of action based on their personal preferences and values.

After establishing the preservation of autonomy in the presence of familial interests, it is important to clarify the role of the physician. Specifically, one must acknowledge the potential requirement of hard paternalism in cases when a patient’s decision does not align with the family’s interests. In the essay, the authors describe a case in which a competent stroke patient wants to rely on his wife as a caregiver, rather than entering into a nursing home (Mappes and Zembaty). If the physician respected the patient’s decision, then an intense burden will be placed on the frail wife. In addition, the patient does not yield a profound benefit by receiving care from his spouse, as he would receive better medical treatment in a nursing home. Therefore, the principals of nonmaleficence and beneficence outweigh the patient’s autonomy. Thus, the physician is justified in asserting hard paternalism to ensure the best outcome for the patient and his family.

References:

Hardwig, John. “What about the Family?” The Hastings Center Report 20.2 (1990): Web.

Ho, Anita. “Relational Autonomy or Undue Pressure? Family’s Role in Medical Decision-making.” JSTOR, 5 Feb. 2008. Web.

Mappes, T. A. & Zembaty, J. S. “Patient Choices, Family Interests, and Physician Obligations.” Kennedy Institute of Ethics Journal, vol. 4 no. 1, 1994, pp. 27-46. Project MUSE

In this particular case, Robert Latimer deliberately killed his 12-year-old daughter to relieve her from her pain and suffering. At birth, Tracy Latimer was diagnosed with severe cerebral palsy, which left her physically and mentally disabled. It is imperative to consider both the nature of her illness and the effectiveness of her ongoing treatments to reach an ethical conclusion. Additionally, one must analyze the role of nonmaleficence, which is the principal that obliges us to impose no harm to others (Beauchamp & Childress 2001).

Outsiders have a duty to respect and support an individual’s personal healthcare decisions, as autonomy is a well-regarded moral principal. However, Tracy Latimer lacks the ability to express her thoughts and wishes due to the nature of her illness. Therefore, her father has assumed the sole role of a surrogate decision maker, which allows him to make health care decisions on his daughter’s behalf. As a surrogate, Robert needs to balance the best interests of his daughter with the competing interest to maximize benefits and minimize harms (Harrison 2004).

Throughout her lifetime, Tracy has undergone numerous surgeries to correct musculoskeletal and orthopedic problems (Thomas 2104). Despite Tracy’s inability to speak, there is well-documented evidence that the radical corrective treatments caused her severe pain. As there is no treatment to cure cerebral palsy, the surgeries merely attempted to alleviate the patient’s long-term suffering. In my opinion, the surrogate is merely tasked with choosing the lesser of two evils, as there is no decision available that will diminish the patient’s pain. Essentially, the surrogate could choose to continue surgery or withdraw surgery—however, neither of these options relieve Tracy’s pain and suffering. Therefore, Robert sought out an alternative and illegal course of action, known as active non-voluntary euthanasia.

Although there is no ideal course of action, it’s imperative to consider the duration and nature of the patient’s suffering. There is no denying that all children—regardless of physical or mental disability—have a claim to respect, protection, and medical treatment that serves their best interests (Harrison 2004). Often times, the patient’s best interest is to survive. However, it can be difficult to see how continued existence constitutes as a benefit for patients who will spend their lives in a chronic state of suffering and pain (Manninen 2006). It is fair to assume that Robert attempted to act in good faith, as he believed a continued existence for his daughter would be filled with suffering and pain.

In my opinion, Robert Latimer’s actions were understandable yet highly unethical, as he violated the principal of nonmaleficence. The father imposed intentional harm on his daughter without fully understanding her quality of life and suffering. In fact, no one will be able to fully respect Tracy’s autonomy, as she cannot express her own desires. However, Robert should have consulted additional family members and physicians before conducting non-voluntary euthanasia.

Essentially, I believe that Robert’s case sets a dangerous precedent for the future. Mentally disabled children are a highly vulnerable population and deserve additional consideration—physicians and surrogates cannot make judgments regarding a patient’s quality of life and existence, as they can merely claim that they are acting within the patient’s best interest.

WORKS CITED

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

Harrison, Christine. “Treatment decisions regarding infants, children and adolescents.” Paediatrics & Child Health. Pulsus Group Inc, Feb. 2004. Web. 17 Feb. 2017.

Manninen, B. A. “A Case for Justified Non‐voluntary Active Euthanasia: Exploring the Ethics of the Groningen Protocol.” Journal of Medical Ethics. BMJ Group, Nov. 2006. Web. 17 Feb. 2017.

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well And Good: A Case Study Approach to Health Care Ethics. N.p.: Broadview, 2014. Print.

“Rex Murphy on Robert Latimer.” YouTube, uploaded by Stubby3492, 1 March 2008, https://www.youtube.com/watch?v=ZruMTCnq39k.

In this particular case, a moral dilemma has emerged due to a physician’s inability to provide information regarding the risk of a medical procedure. Although the probability of death was low, the patient ultimately died from the procedure. The physician was reluctant to provide the proper information, as the patient would experience unnecessary fear from a low-risk, life-saving procedure. This raises an intriguing question: was the physician acting in an ethical manner by withholding information concerning the remote risk of the procedure?

There are two ethical principals to consider and balance in this case. The first ethical principal is autonomy—the norm of respecting and supporting independent decisions (Beauchamp and Childress 13). In this case, the patient was not fully informed about the risks of the procedure. Therefore, the physician undermined the patient’s autonomy. The second ethical principal to consider is beneficence—a set of norms pertaining to relieving, lessening, or preventing harm and providing benefits (Beauchamp and Childress 13). The physician wanted to lessen the burden of fear, while providing adequate treatment for the patient’s heart disease. Essentially, the physician was acting in a paternalistic manner, as he justified his actions by preventing harm to the patient whose preferences or actions were overridden (Beauchamp and Childress 215).

It is imperative to consider both sides of the ethical dilemma in order to reach a sound conclusion. First, one must evaluate the role of beneficence within this case. The physician did not want to place an unnecessary burden of fear on the patient by informing him of the rare, remote risk of death. In fact, a strong focus on exhaustive information about low health risks may harm the patient (Palmboom et al.). The patient can be overloaded with a plethora of information that can impair, rather than facilitate understanding and decision-making (Epstein et al.). This cognitive overload can be exacerbated by the patient already experiencing emotional and physical distress due to the nature of their illness. Therefore, it can be argued the physician acted in an ethical manner by restricting the patient’s access to information—however, it is important to balance beneficence with autonomy to successfully resolve this ethical dilemma.

In regards to autonomy, the patient was unable to make an informed decision, as the physician did not fully disclose the risks of the angiogram. As the physician has highly specialized knowledge that the patient lacks, the physician had a duty to relay the risk and possibility of death. However, the physician acted on the patient’s behalf in a manner that undermined the patient’s autonomy. The doctor should have acted as an advisor, rather than the sole decision maker. The physician should “disclose as much information about the risks and benefits that the patient becomes sufficiently informed to participate in shared decision-making” (Murray).

Although it is unclear whether or not the patient would be alive if informed, the physician neglected his duty to respect the patient’s autonomy. The physician declared assumptions concerning the patient, stating that he was a “reasonable man, and most reasonable people choose the angiogram” (Thomas et al. 301). However, the patient was not granted the decision to make an informed choice. The physician has a duty to inform, despite the potential emotional risk that may emerge. The patient should be informed of all risks, along with the associated probability of occurrence. Essentially, the physician should be willing to negotiate with the patient in order to reach the best option for treatment, while considering the patient’s interests.

In this particular case, the physician’s blatant violation of autonomy brands the doctor’s actions as unethical. After balancing both autonomy and beneficence, the consequences of violating autonomy severely hinder the doctor-patient relationship in a detrimental manner. Therefore, the physician should have disclosed all information in this case.

REFERENCES:

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

Epstein, Ronald M., David N. Korones, and Timothy E. Quill. “Withholding Information from Patients — When Less Is More.” The New England Journal of Medicine (2010): n. pag. 4 Feb. 2010. Web. 27 Jan. 2017.

Palmboom, G. G., D. L. Willems, N. B A T Janssen, and J C J M De Haes. “Doctor’s Views on Disclosing or Withholding Information on Low Risks of Complication.” Journal of Medical Ethics. BMJ Group, Feb. 2007. Web. 27 Jan. 2017.

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well And Good: A Case Study Approach to Health Care Ethics. N.p.: Broadview, 2014. Print.

Murray, Bryan. “Informed Consent: What Must a Physician Disclose to a Patient?” AMA Journal of Ethics (2012): n. pag. Web.