Martha and her partner are both unemployed parents of three children. After the failure of home remedies and realizing that she may have a serious oral healthcare situation, Martha decided to see a physician. To her dismay, though, she understood that she was not going to be able to get the real help she needed as she did not have dental care coverage or the government supplement to reduce the cost of the medical treatment. Martha decided to stick with her home remedies and hope for the best. In the more recent years, a serious issue amongst low-income families has arose. With the costs of healthcare rising and the rate of employment declining, more and more people are becoming uninsured and unable to afford healthcare for themselves and their families. This leads to the question of what to do about this rising issue. Currently, there are policies in place that help offset costs/provide minimal healthcare for children and disabled persons. Unfortunately, though, many people do not qualify under these circumstances to receive help. This leaves people stranded and without insurance.

Utilitarian arguments point in the direction of support for public funding that provides healthcare for all of these people. Which, if agreed upon, is absolutely doable and has been done before in other countries. One of the largest counterarguments to this, though, is the overwhelming “inverse relationships between socioeconomic status (SES) and unhealthy behaviors such as tobacco use, physical inactivity, and poor nutrition” (Pampel). There has been enough credible research done that points out the fact that the vast majority of people that fall under lower socioeconomic status are less likely to carry out healthy practices. Essentially the argument is that they bring the health problems onto themselves. Many anti-supporters of this movement believe it would be a waste of money to invest in healthcare for these persons, as they are going to cost the people and the government too much money due to their unhealthy habits.

While this argument is not necessarily invalid, it is important to realize the correlations between low socioeconomic status and lack of education. It is very likely that many of these people who practice these unhealthy habits are not educated in what is healthy and what is not. I’m sure many of them wouldn’t smoke a pack a day if they were aware of the severe health risks. Ethically, it is wrong that people must be excluded from receiving healthcare to keep them healthy and alive just because they cannot afford it. The right to be a healthy individual is not and should not be considered something that only the wealthier members of society are entitled to. Providing healthcare to all citizens of your government should be a top priority for all countries, as health people are happy people and you have the potential to stop this epidemic of unhealthy poverty stricken areas.

There is even research that shows children with low socioeconomic status are more likely to get sick. This is why it is unethical not to provide healthcare for people of low SES.

Works Cited:

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

Pampel, Fred C., Patrick M. Krueger, and Justin T. Denney. “Socioeconomic Disparities in Health Behaviors.” Annual Review of Sociology 36.1 (2010): 349-70. National Library of Medicine. Web.

Thomas, John E, et al. “Case 2.2: Social Determinants of Health.” Well and Good: Case Studies in Biomedical Ethics, Broadview P, 2014.

We define respect for autonomy as “[requiring] that autonomous actions not be subjected to controlling constraints by others” (Beauchamp and Childress, 107). At the core, it seems essentially unreasonable for a physician to disregard respect for autonomy as by this definition one would be “controlling” a patient in need. Where the lines begin to blur, though, is when you bring in the patient’s state of being to the table. A patient’s impediment to their ability to make autonomous decision can range from mental and physical capacity, emotional state, social and cultural limitations, among other things. These “various kinds of constraints can impede autonomous behavior” (Ackerman, 15). The question we ask is when is it okay for doctors to step in and override a patient’s wishes?

In previous cases we have studied, we see this dilemma quite often. For example, in our latest case we saw a 21-year-old anorexia patient who refused to be force-fed, even though she would likely go into cardiac arrest after a few days. Our patient, Amelda, seems to fit all the criteria for being considered mentally stable, minus the fact that she does not comprehend the full consequences of her decision not to be force-fed. The argument here was that she was determine incapable of making her own decisions without probable cause. This blurs yet another line between the patient-physician relationship of when a patient can be determined incapable of making his/her own choices. Amelda’s doctor and parents considered her inept to make sound decisions in this case, but had she gotten a second opinion, another physician may have disagreed. Different opinions from different physicians essentially causes human error when evaluating whether or not a patient’s autonomy should be rightfully violated.

Violating a patient’s autonomy leads to a slippery slope of violating the principle of informed consent as well. In Amelda’s case, when the doctors gave her a feeding tube against her will, her autonomy was violated as she did not explicitly ask for the treatment. In turn, this means that she did not give informed consent and that that principle was violated as well. Essentially, by not respecting a patient’s autonomy in the context of a given treatment, even when it is lifesaving, both informed consent and autonomy are not upheld in an ethical sense. While this could be considered a case by case basis, the principles and rights of a patient are all the same and it should be considered no different if a person refuses a cosmetic surgery or a lifesaving surgery. In any situation, a patient’s autonomy should be maintained despite the possible consequences due to the slippery slope that would quickly ensue if that right was not upheld. In the end, no doctor should not intervene in a patient’s decision to forgo or continue treatments; only give support and information to the best of their ability.

Works Cited:

Ackerman, Terrence F. “Why Doctors Should Intervene.” The Hastings Center Report 12.4 (1982): 14-17. JSTOR.

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

Thomas, John E, et al. “Case 3.3: Discontinuing Forced Feeding of an Anorexia Nervosa Patient.” Well and Good: Case Studies in Biomedical Ethics, Broadview P, 2014.

Voluntariness falls under both the informed consent and the autonomous actions category in bioethics making it an important factor in a lot of medical practices; specifically, human medical research. Here we define voluntariness according The Nuremberg Code which states that a research subject “should be so situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, over-reaching, or other ulterior form of constraint or coercion” (Beauchamp, 137-138). In general, this is a very lengthy and detailed definition the term, but it brings up some very interesting points about a case we have previously studied, specifically about the voluntariness of consent.

In the case of “Research Involving Alzheimer’s Patients” we are faced with a director of a nursing home for Alzheimer’s patients who is asked to allow her residents to participate in study to test a new drug that promises to reduce the onset of the disease in subjects. After a swift denial of the researcher’s offer, we are asked to evaluate the director’s decision and conclude whether or not this was a violation of the patient’s autonomy. Initially, I noticed that the general consensus amongst our class was that the patients should be able to make their own decision and if a patient lacked the mental capacity to do so, the closest relative who knew him/her best could make the decision on their behalf. After analyzing the definition of voluntariness, though, this decision our class made fell short on the side of allowing a family member to make the call. While these terms could be interpreted differently, allowing another person to make a decision for a less than coherent individual could fall under many of the listed “intervention” elements, opposing the idea of voluntariness in medical research.

Voluntariness is a hard subject to study because no one research subject is the same. “Voluntariness of consent has been more resistant to investigation, leaving policy-makers with little guidance for their efforts to insure that prospective research subjects are able to exercise meaningful choice about whether to participate in research” (Applebaum et.al, 2009). Things such as the case we discusses above are reasons why voluntariness of consent can become incredibly complicated especially when it comes to policy-making. When you have to take a look at mental capacity of a subject and analyze every element given in the formal definition, you find that is it hard to have a concrete idea of what exactly voluntariness is in a particular situation. In the case with the Alzheimer’s patients, I believe that voluntariness was violated in the patients who are of the coherence to make a decision about his/her participation, but I do not think that it was violated in the cases of patients who did not have full mental capacity as that could have crossed the line into force, over-reaching, etc. Essentially, voluntariness has its flaws as an element of informed consent and autonomous action, but it is important to take into account especially when considering human subjects for a research proposal.

Works Cited:

Applebaum, Paul S., Charles W. Lidz, and Robert Klitzman. “Voluntariness of Consent to Research: A Preliminary Empirical Investigation.” IRB: Ethics and Human Research 31.6 (2009). The Hastings Center

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

Thomas, John E, et al. “Case 3.1: Research Involving Alzheimer’s Patients.” Well and Good: Case Studies in Biomedical Ethics, Broadview P, 1987.

Background:

A pregnant young woman, “G”, has a history of glue-sniffing addiction. She currently has three other children, all taken away by the Winnipeg Child and Family Service for their own well-being. Due to their mother’s addiction, two of these children are physically and mentally disabled. Considering “G’s” addiction and parenting history, The Child and Family Services Agency was able to have her put in a treatment facility, against her will, in an attempt to prevent “G’s” unborn child from harm. According to the Canadian Charter of Rights and Freedom, though, individuals are guaranteed a right to security. With this in mind, the Manitoba Court of Appeal overturned the decision to admit “G” and despite Supreme Court appeal, “G” remained out of treatment. Eventually, “G” stopped sniffing glue, gave birth to a healthy baby, and is now expecting another child. The dilemma here is based on if the state or court should have control over a woman’s body if she could possibly endanger an unborn child, but also what rights an unborn child technically has in this situation.

Discussion:

When beginning a discussion on this case, two things must be taken into consideration: the rights of the mother and the rights of the unborn child, if they even exist. As a woman, “G” by law has the right to control her own body and put into her body what she pleases. Where the line begins to blur is when “G” moves from a woman to a pregnant woman. According to the law by the Canadian Chart of Rights and Freedoms, “every individual [is guaranteed] a right to security of the person” despite whether that person is with child or not. Essentially, by law, a pregnant woman is able to ingest and do as she pleases and the state cannot force her to do anything that she does not necessarily want to.

Where this case begins to get complicated, though, is when we take into account the rights, if any, of the unborn child. Personhood is a human being’s status of having individual rights and has been a highly debated topic in many abortion discussions. At what point do we consider when a fetus has the same rights to life and protection as a born human being? Almost all laws and principles alike state that a person has the right to be protected from harm, but do not clarify what is considered a “person”. Based on current abortion law (in the United States), some fetuses can be considered human beings that have these rights as early as 24 weeks into a pregnancy. In this case then, technically one could say that the state does have the right to place “G” in a treatment facility in order to protect the well-being of this unborn child who also has rights to that protection from harm.

This argument, though, leads to a slippery slope of debating whose rights take a higher priority: the rights of the mother who is born and capable of speaking her own opinion or the unborn child who is essentially helpless as he/she has no way of voicing an opinion or even asking for help. Furthermore, is a state able to determine if a mother is fit enough to make the decision of whether she can properly protect the well-being of the fetus outside of a treatment facility? The court here is placed in a moral versus lawful dilemma of wanting to protect the unborn child from mother-inflicted maltreatment and honoring the written law to protect a woman’s right to her body. In this case, while I do agree that it seems unlawful to force “G” into a treatment facility, I strongly believe in the idea that an unborn child, who is entirely helpless, deserves a chance at life that is unaltered by his/her mother’s actions that he/she cannot control. The court and the state should remain out of the decision of women’s reproductive rights, until the well-being and potential harm of the fetus comes into play.

Topic Relevance: 

Personhood was a very debated topic during the Presidential Debate series and throughout the entire 2016 election. It remains, and will likely remain, one of the most disagreed upon subjects in modern politics.

Works cited:

Beauchamp, Tom L, and James F. Childress. “A Theory Based on Human Properties.” Principles of Biomedical Ethics, Oxford UP, 2001, p. 66-68.

Beckwith, Francis J. “Abortion, Bioethics, and Personhood: A Philosophical Reflection.” The Center for Bioethics and Human Dignity, Trinity International University, 2001.

“Bioethical Issues- Abortion.” Adelaide Centre for Bioethics and Culture, 2014. http://www.bioethics.org.au/Resources/Resource%20Topics/Abortion.html

Thomas, John E, et al. “Case 5.4: Protecting an Unborn Child.” Well and Good: Case Studies in Biomedical Ethics, Broadview P, 1987.