Martha is a mother, who was recently diagnosed with gum disease and was instructed to take certain medications and visit her dentist. Unfortunately, Martha is unemployed and cannot afford to see a dentist. This case is set in Canada, a country in which universal healthcare is provided to all their citizens. It seems, however, that dental care is not included and pharmaceuticals are difficult to acquire by the poor. Although this case is based off of the Canadian healthcare system, social determinants of health are virtually the same across the globe and access to health care should be a right no matter what country a person is living in. Because Martha is unemployed, this case raises the dilemma of whether health care should be available as a public good or whether Martha’s situation is a product of her own poor decision-making.

The case gives no reason to believe that Martha chose to be unemployed or was in some way making irresponsible choices. I think this case is representative of a number of other cases, specifically in the United States, when a person if faced with a drastic medical change or emergency and simply cannot afford care. These medical emergencies are never chosen and nor is their inability to pay for medical insurance. As Beauchamp and Childress argue, there are a number of other uncontrollable factors such as race, gender, and ethnicity that play into a personals health status (Beauchamp and Childress 264). Disparities such as these not only directly affect a person’s health, but they also influence whether or not they will have medical insurance if it is not universal.

In a number of other countries that are comparable to the United States in terms of economy and development, Great Britain, France, Germany, Taiwan, and Japan all provide healthcare for their citizens. While these countries may not face as vast of disparities in terms of race as the United States, they still have large inequalities based on socio-economic status. Depending on the country, they usually have higher taxes, but they are more efficient with the money in terms of health care spending. It is almost unheard of to go bankrupt over a medical bill, except for the United States where medical bills are one of the leading causes of bankruptcy. Although, longer life expectancy and overall better health cannot be pinpointed to better healthcare systems, it is definitely a large contributing factor.

Many other countries in the world are able to provide healthcare to every citizen without questioning whether or not health care service companies should be making a profit or whether providing coverage for everyone is infringing one’s rights to make decisions for themselves (Thomas, Waluchow, and Gedge 101). We would never say that someone could not have clean water because we want them to make a decision about whether they want to purchase Aquafina or Dasani and we would never say that their utility is maximized by making the decision about what type of water they want to purchase. Clean water is simply something that is expected to be provided because it is necessary for life. Likewise, a comprehensive health care package should be provided to Martha because it is necessary for her life.

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

Thomas, John, Wilfrid J. Waluchow, and Elisabeth Gedge. “Social Determinants of Health”.” Well and Good. Toronto: Broadview, 2014. Print.

Dax Cowart was in an explosive car accident that left him with severe burns, blinded, and in extreme pain. At the time, he had expressed wishes to not continue treatment, as he was in so much suffering and his prospects of a high quality of life were looking rather bleak. However, the doctors moved forward with the necessary treatment and Cowart lived. Although he realized seven years later that his quality of life was actually much greater than expected, he claimed that if he were put in this situation all over again, he would still refuse treatment. This raises the dilemma of whether the doctors should have respected Cowart’s wishes and on what grounds.

We first determine whether Cowart can be deemed competent in this situation. He was put through a traumatic life event, lost his father, and was in excruciating pain. While most would argue that Cowart cannot be considered as competent to make this decision as feelings of pain and suffering often cloud one’s judgment, Cowart argues that, “The right to control your own body is a right you’re born with, not something that you have to ask anyone else for, not the government, not your treating physician, not your next-of-kin” (Cowart and Burt 16). It is easy to say that everyone deserves to make choices about their own body and that violating one’s autonomy in one case can lead to a whole host of other issues, but what if it is to benefit the patient and to protect their life?

Beauchamp and Childress write that the rules of beneficence are: “1. Protect and defend the rights of others, 2. Prevent harm from occurring to others, 3. Remove conditions that will cause harm to others, 4. Help persons with disabilities, 5. Remove persons in danger” (Beauchamp and Childress 204). The principles of beneficence tend to look at more of the positive action versus nonmaleficence, which looks at “negative prohibitions of action” (Beauchamp and Childress 204). In this case the doctors were trying to protect Cowart’s right to life, help a man who was blinded and lost the use of his fingers, and keep him from experiencing any further damages from the car accident.

I think that the doctors had a moral obligation to treat Cowart as he was incompetent in making the decision about his life at the time. Despite his pain following the accident, under the principles of beneficence, the doctors were fulfilling their duties. I think this case is different than some of the others treat/do not treat dilemmas, such as the case of Stephen Dawson, in which his current pain and suffering would not improve after treatment nor would his circumstance of low quality of life (Thomas, Waluchow, and Gedge 229). Cowart had the possibility of being fully functioning and achieving many successes in life. Although he endured much pain and suffering, it was only temporary. This case was particularly interesting because we were able to see the long-term outcome of the physician’s decision and it turned out to be of benefit to the patient.

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

Cowart, Dax, and Robert Burt. “Confronting Death Who Chooses, Who Controls?” The Hastings Center Report 28.1 (1998): 14-24. Print.

Thomas, John, Wilfrid J. Waluchow, and Elisabeth Gedge. “Stephen Dawson: Should Severely Mentally Challenged Patients Be Treated?”.” Well and Good. Toronto: Broadview, 2014. Print.

The case “Stephen Dawson: Should Severely Mentally Challenged Patients Be Treated?” outlines the story of a young boy, Stephen Dawson, who suffered from extreme brain damage after contracting meningitis shortly after being born (Thomas, Waluchow, Gedge 229). Dawson received life support surgery at the age of five and was thereafter cared for by his parents. This was an exhausting job as Dawson required frequent doctor’s visits, seizure medicine multiple times a day, and could never be left alone. After contracting the flu, leaving Dawson in even worse condition, the family found a place for him at a care facility. A few years later, Dawson needed another surgery and would most likely die without it. This case presents the dilemma: not to operate, most likely resulting in death, but letting Dawson die in dignity; or operating, which would prolong his life but Dawson would most likely continue to live in pain and suffering. The surgery should not be performed for two reasons: the decision should lie in the hands of the parents and performing the surgery would not be improving Dawson’s quality of life.

The case argued that perhaps Dawson’s parents lacked information about his responsiveness and progress and therefore the caregivers at the facility should make the decision. However, it is important to remember that Dawson’s parents cared for him for many years and spent hours per day feeding him, giving him his medicine, and ensuring his wellness as best as possible. Although the case does not specify how many times the parents visited him in the care facility, it is unlikely that they were uniformed about his condition after they had spent years caring for him. Therefore making them competent decision makers in this case.

Judge Bryne also said that the surgery would, “…prolong a life inflicted with an incurable condition” and “constitute cruel and unusual treatment of Stephen” (Thomas, Waluchow, Gedge 231). As Beauchamp and Childress state, “…mental retardation is irrelevant in determining whether treatment is in the patient’s best interest. Proxies should not confuse quality of life for the patient with the value of the patient’s life for others” (Beauchamp and Childress 173). Based on Dawson’s intellectual disability, it is not reason enough to withhold the surgery. However, his constant discomfort and pain, blindness, epilepsy, and constant need for intense drugs gives enough reason to characterize his quality of life as very poor. The surgery would not be of benefit because it would do nothing to improve his existing conditions and would arguably cause him more harm than good.

In a journal from the American Academy of Pediatrics, they state that, “[f]or such serious matters as LSMT [life-sustaining medical treatment], the medical plan usually should conform to the values and choices of the patient and his or her family” (Guidelines on Forgoing Life-Sustaining Medical Treatment 532). Therefore, Dawson’s parents should be given the ability to make the decision for their son. Furthermore,“[p]hysicians and families should also consider whether continued treatment conforms with respect for the meaning of human life and accords with the interests of others, such as family members and other loved ones” (Guidelines on Forgoing Life-Sustaining Medical Treatment 535). Prolonging Dawson’s current condition does not fulfill the guideline of respecting “the meaning of human life” as his conditions make it difficult to live pain free. While withholding this surgery may seem like the equivalent to death, Dawson’s parents have argued that it would be better for him to die with dignity than to live suffering.

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

“Guidelines on Forgoing Life-Sustaining Medical Treatment.” American Academy of Pediatrics 93.3 (1994): 532-36. Pediatrics. Web. 20 Feb. 2015. <http://pediatrics.aappublications.org/content/93/3/532.full.pdf>.

Thomas, John, Wilfrid J. Waluchow, and Elisabeth Gedge. “Stephen Dawson: Should Severely Mentally Challenged Patients Be Treated?”.” Well and Good. Toronto: Broadview, 2014. Print.

The case of “Non-consensual Electroconvulsive Shock Therapy” is a prime example of two of Beauchamp and Childress’ principles of medical ethics opposing each other: non-maleficence and personal autonomy (Pugh). This case involves a man, Simon, who is heavily contemplating suicide and is refusing treatment that could potentially prevent him from completing suicide. When his son is asked to sign a waiver allowing his father to receive electroconvulsive shock therapy, he also declines it. This presents the dilemma of doctors overriding both Simon and his son’s wishes for the purpose of potentially saving his life, or respecting his and his son’s wishes and potentially leading to death (Wilfrid, Waluchow, Gedge 124 – 125).

As a blog from the University of Oxford states that, “…we intuitively believe that the principle of non-maleficence should trump what [Dr. Ronald Pies’] claims to be the patients autonomous choice…” (Pugh). Often times in medical ethics, it is believed that saving a life is the most important thing. However, this statement was in response to cases involving assisted suicide. Even though the case of “Non-consensual Electroconvulsive Shock Therapy” is trying to provide a treatment that could potentially save a life, the case actually poses many similarities to cases of physician assisted suicide (PAS). Most physician assisted suicide cases involve a patient who is terminally ill and in immense amounts of physical pain. While there have been numerous debates about the ethical nature of PAS, Oregon passed a law in the mid ‘90s, making it the only state to allow PAS (Dahl and Levy).

It seems like a stretch to compare the ECT to PAS, however both cases present opposing medical ethics principles of autonomy and non-maleficence, while also incorporating concepts of an informed decision or whether or not a patient is in a rational state of mind to make the decision. In Simon’s case, he was experiencing extreme depression and was mentally in excruciating pain. Even if Simon and his son, who is not experiencing depression and therefore considered to be more rational, both decide against ECT, does the doctor have the right to perform a treatment that may have other side effects even if the patient lives? Whereas in the state of Oregon, if a patient is physically very ill and in pain, a doctor legally can assist that patient in their death. How are we able to decide that mental pain is less important than physical pain and therefore a patient should have to continue to live in mental pain? As Wilfred, Waluchow, and Gedge asked, “May not quality of life be so poor, or be perceived to be so poor, that death may be rationally deemed preferable?” (Wilfred, Waluchow, and Gedge 130). In both cases of treating a patient with ECT or agreeing to PAS, one must ask themselves about the patient’s quality of life. If a patient’s quality of life is so poor, one might think that respecting autonomy is more important than practicing non-maleficence.

Dahl, E., and N. Levy. “The Case for Physician Assisted Suicide: How Can It Possibly Be Proven?” Journal of Medical Ethics 32.6 (2006): 335–338. US National Library of Medicine National Institutes of Health. BMJ Publishing Group Ltd & Institute of Medical Ethics. Web. 31 Jan. 2015. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2563370/>.

Pugh, Johnny. Practical Ethics. University of Oxford, 10 Oct. 2010. Web. 31 Jan. 2015. <http://blog.practicalethics.ox.ac.uk/2012/10/physician-assisted-suicide-and-the-conflict-between-autonomy-and-non-maleficence/>.

Thomas, John, Wilfrid Waluchow, and Elisabeth Gedge. “Non-Consensual Electroconvulsive Shock Therapy.” Well and Good. 4th ed. Toronto: Broadview, 2014. 124 – 130. Print.