“Morality requires not only that we treat persons autonomously and refrain from harming them, but also that we contribute to their welfare” (Beauchamp and Childress, 202). The principles of Beneficence states it is our duty to help others. Specifically, positive beneficence demands that we “provide positive benefits to others” ( 202). Consider the following case: Dr. Arman Asadour is a physician who works with a non-governmental organization or NGO. He is sent to South Sudan to help refugees who’ve arrived from a war. The people are in horrible conditions physically, mentally, and health wise. Cholera breaks outs in the town. The NGO that Dr. Asadour is a part of, set up a station that treats Cholera patients only. Those who have conditions other than Cholera have to be sent to the local hospital. The local hospital is already overcrowded.  It is Dr. Asadour’s duty to help those with Cholera but is it his duty to help non-Cholera individuals as opposed to letting them to go to the hospital knowing the rule? (Thomas, Waluchow, and Gedge, 267).

One aspect to consider is how much help the local hospital can provide for individuals with other conditions. The local hospital is already overcrowded and the cost of transportation and medication are other factors that cause more problem. These refugees have no money so they cannot help cover transportation or their own medicine. Sending them to the local hospital is essentially letting them go to a space with scarce resources to die. Positive beneficence argues that we produce positive benefits to others. Transferring individuals to the local hospital does not provide benefits. Instead, there are negative outcomes because there is no guarantee that these individuals will get treated due to limited resources. There is no guarantee that these individuals will even get looked at the same day seeing as the hospital is overcrowded.

Dr. Asadour should help treat non-cholera persons because he holds the same obligation to them. These individuals do not have Cholera but they are sick and they need treatment.They can possibly die from their condition just like the people with Cholera. There is no guarantee that the local hospital can save them.  A solution that will allow Dr. Asadour to help the others is for Dr. Asadour and the NGO to set up another work station for individuals with other conditions.  This station will allow Dr. Asadour to persons in both categories. Beauchamp and Childress provided some rules for obligatory beneficence that are applicable to why Dr. Asadour should non-cholera. Some of the rules include: “prevent harm from occurring to others” and  “remove conditions that will cause harm to others” (204). By deciding to treat them, Dr. Asadour is preventing harm from occurring to others meaning that the non-cholera individuals will not be able to spread their conditions to those at the hospitals nor will they get sick from others at the hospital. The other rule is the removal of conditions that will cause harm to others. Setting up another work station will separate the cholera and the non-cholera individuals. This separation removes the condition of exposure to the other.

Dr. Asadour should treat non-cholera persons because as a doctor, it is his duty to help others. By helping these individuals he is fulfilling the rules of beneficence. He is contributing to the welfare of these individuals and providing positive benefits.

Works Cited:

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York: Oxford UP, 2009. Print.

Thomas, J. E., Waluchow, W. J., & Gedge, E. (2014). Well and good: a case study approach to health care ethics (4th ed.). Peterborough, Ontario: Broadview Press.

Paternalism and Autonomy are two topics that are highly discussed in the field of Bioethics. Often times, there is a juggle between which should be considered to be the most important factor to recognize and whether that decision can be justified. The following case deals with these topics. Harald and Jim are a couple. Harald has AIDS. Around the time, researchers were conducting clinical trials with antiretroviral drugs on individuals with the disease, but they were only accepting those with early diagnosis, and screened out those who had a poor health status. Harald was screened out of the clinical trial and found out people who also got screened out were finding ways to still access the drugs (Well and Good, 256). In looking at this case, should the principle of autonomy have priority or the researchers correct in making the decision for the people?

One side of the argument is that the principle of autonomy should govern at all times. Harald and all the other subjects who were rejected should have been given the chance to make an autonomous decision knowing what the risks are. They have the right to decide what should be done to their bodies. The fact that the researchers screened them out without allowing them to decide for themselves is a violation of their rights. Beauchamp and Childress talked about anti-paternalism and how proponents of anti-paternalism argue that paternalism treats autonomous agents as “less-than- independent determiners of their own good,” and “if others impose their conception of good on us, they deny us the respect they owe us, even if they have a better conception of our needs than we do” (Beauchamp and Childress, 220). By deciding for them in the clinical trial, the researchers were undermining the capabilities of Harald and the others to decide what is best for them. In addition, people were already find ways around the trials by getting the drugs from those who were already in the trial. Essentially, the people were going to do what they needed to do get the drugs so there was no point in denying them access in the first place.
On the other hand, it can argued that the researchers were correct in making the decision to screen out those who do not fit the criteria. In other words, the paternalistic approach should have priority. The goal of paternalistic actions is to provide benefit and avoid harm. Researchers of this clinical trial had to think about the risks and the harms that could be done to the subjects. Beauchamp and Childress talked about hard paternalism and the conditions in which it can  be justified. One of the conditions is “the paternalistic action will probably prevent the harm” (222). In this case, perhaps the risks of this clinical trial could have caused even more harms and other negative health outcomes in addition to the disease. As the old saying goes, “better safe than sorry” By choosing to reject them, the researchers were saving them from even more problems. In addition, the mindset of these individuals must be examined. Some of the individuals were catastrophically ill so they were desperate to find any means that will get them well. If that was the mindset of some, then they would have been choosing to participate in a trial that could have detrimental effects on them because they did not care about the risks. In this case, it can be said that the paternalistic action was justified.

Cites:

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York: Oxford UP, 2009. Print.

Thomas, J. E., Waluchow, W. J., & Gedge, E. (2014). Well and good: a case study approach to health care ethics (4th ed.). Peterborough, Ontario: Broadview Press.

Informed consent and disclosure are two very important aspects of conversation in bioethics. Beauchamp and Childress discuss how informed consent has been put in place to “protect autonomous choice, to avoid manipulation, and to respect persons’ rights” ( Beauchamp and Childress, 121). With informed consent, patients and subjects must authorize and gave permission to researchers and physicians for a specific task, whether for research or a medical procedure. In order for patients and subjects to consent, they must be competent enough to understand the information and be in the right frame of mind to make a decision. Along with informed consent is disclosure. Beauchamp and Childress explain the obligation of researchers and physicians to disclose necessary information to their patients and subjects. Patients and subjects have every right to know all the information that pertains to them, especially when the outcomes may negatively impact them. Informed consent and disclosure are essential in research. Researchers must provide subjects with every single detail of the research. Taking that statement into consideration, consider the following the case. Dr. Richard Ward is a researcher who wanted to conduct research on the Nuu chah nulth, an aboriginal group suffering from arthritis. He approached the council and asked to perform an experiment to help understand the  genetics behind arthritis. The council gave him permission. Dr. Ward goes on to collect blood from the people and begins his research. Dr. Ward failed to disclose information about another research he is conducting on the history of First Nations by looking at their DNA. The blood samples show no genetic link to arthritis, so he continues with his other research. Dr. Ward does not share any of this information with the Nuu chah nulth.  Dr. Ward shared the blood samples of the aboriginal people with other researchers, and published a paper on the results of his second research, creating unwanted attention to the Nuu chah nulth community. (Thomas et al., 289). This case raises many issues in terms of informed consent and disclosure.

The first issue is that Dr. Ward intentionally withheld information from the council and from the subjects. He intentionally did not speak to the council about his second research and failed to report that he found no link to arthritis. His choice violates the basis of informed consent. Dr. Ward manipulated and abused the rights of the people. The fact that Dr. Ward chose not to disclose information about his other research brings into question about whether he  truly wanted to conduct research to understand the genetics of arthritis or if it was a cover up for his second research.

In addition, Dr. Ward’s failure to disclose information violates the trust of the subjects and the council. Research is a field that requires trust, considering it demands interacting with strangers. Subjects trust that the researchers are being honest about what they are doing and that the research is in their best interest. The council and the people trusted that Dr. Ward was going to discover important information about the disease that was hurting them and find ways to treat the disease. They trusted this man, this stranger, with sensitive information about their community in hope that he would provide answers, but that was not the case.

Informed consent and disclosure must play a role in patient/subject-physician/researchers relationships to ensure that patients and subjects are protected.

Works Cited:

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York: Oxford UP, 2009. Print.

Thomas, J. E., Waluchow, W. J., & Gedge, E. (2014). Well and good: a case study approach to health care ethics (4th ed.). Peterborough, Ontario: Broadview Press.

Beauchamp and Childress talk about how we make decisions based on facts and values, but sometimes decision making becomes complicated when we consider abstract principles such as autonomy and non maleficence (Beauchamp and Childress, 13). The complication becomes whether we make the decision with autonomy as the ruling factor or non maleficence.  In “Emergency and Trauma Nurses: When to Give Bad News,” the ethical concern presented in this case is “when to tell the truth in situations when, given, the physical and psychological conditions, delivering devastating news might jeopardize the patient’s life, and possibly life” ( Yeo, Moorhouse, and Khan 232).  Presented is Amira and Casey and their daughter who were involved in a car accident. The daughter and Amira survive, but Casey did not. Amira is in critical condition and needs to go into surgery. Doctors and nurses are afraid that any upsetting news will worsen her conditions. While in this state, Amira asks the nurses about her daughter and her partner. Do they tell Amira that her partner died and risk losing her too? Or do they wait to tell her after her surgery? How do the nurses decide? Do they make the decision based on protecting Amira’s health? or do they make a decision based on their obligation to answer Amira’s question?

One side of the argument is that Amira should be told the truth because honesty is the best policy. Lying to Amira is not only unethical but it creates a dishonest relationship between her and the nurses. There is a possibility that Amira will be upset with the nurses for lying to her. As a result, Amira may no longer trust the nurses. She may shut down and never cooperate with the nurses and doctors during her recovery.  In addition, if the nurses do not tell Amira, then they are denying her information she requested. Withholding information from Amira is acting upon paternalism–not respecting her autonomy. Amira has every right to know about what happened to her family. Failing to tell the truth, is taking those rights away from her. Although the truth will indeed hurt Amira, the nurses who told her will be there to support her through the process.

The other side of the argument is to not tell Amira because the news may cost her her life. Amira’s conditions are already worsening ,so telling her the news will cause even more distress. Nurses are taught the principle of non maleficence, to chose the option that will cause little to no harm. Choosing to not tell Amira the truth is for the sake of protecting her health status and possibly saving her life . If Amira is told the truth about her partner’s death, there is a chance that the news will also kill her. Furthermore, Amira’s conditions deem her incompetent ; she is not in the right frame of mind to understand the news about the death of her partner.  Another aspect that needs to be take into consideration is the child. If Amira dies, then the daughter will be left with no parents.

I think the question of when to give  bad news depends on the state of  the patient. The news will hurt regardless, but the mental and physical state does play an important role. If I were to decide, I would chose to not tell Amira the truth because her life is at stake. Waiting to tell Amira when she is more stable is the best option because she can make sense of the situation a little better. In saving her life, Amira gets to live not only for her, but for her daughter too.

Works Cited

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York: Oxford UP, 2009. Print.

Yeo, M., A. Moorhouse and P. Khan “Case 3: Emergency and Trauma Nurses: When to Give Bad News” Concepts and Cases in Nursing Ethics.