Respect for autonomy is one of the fundamental principles of medical profession and I would argue that it must be given a special status because of its history in the medical profession. Until the mid-20^th century, Paternalistic behavior on behalf of the physicians towards the patients was encouraged with the mindset that physicians know best and the patients should not be bothered with medical decisions that involves complex science and often weak evidence. However, this attitude changed during the mid-20^th century because of the revelations of Nazi human experimentation after the World War 2, for the most part.

I was very concerned during our class discussion about moral status when few people argued that prisoners could potentially be given a lower moral status as a result of their moral transgressions. The notion of seeing a fellow human as a lesser moral agent has very disastrous consequences and must never be entertained regardless of the person’s transgressions or supposed inferiority. The absolutely chilling nature of Nazi human experimentation and the justifications given for it by the German physicians involved serve as an irrefutable evidence for my argument.

During the World War 2, a number of German physicians conducted extremely painful and deadly experiments on thousands of prisoners in the concentration camps. The experiments range from the ones aimed to improve the survival of soldiers in the battlefields such as high-altitude experiments, freezing experiments and seawater consumption experiments, to the ones aimed at creating pharmaceuticals and treatments of diseases such as malaria, typhus, TB, typhoid, hepatitis (United). Some prisoners were exposed to phosgene and mustard gas in order to test antidotes (United). The experiments also included the ones aimed that sought to advance the racial and ideological views of Nazi Germany. Such experiments included experiments on conjoined twins, sterilization procedures and serological experiments to determine the differential immunity of different “races” (United). Some were also aimed at establishing “Jewish racial inferiority” (United). The accounts of these experiments is testament to the horrid consequences of a very twisted ideology.

During the Nuremberg trials, German physicians gave justifications for their experiments. One of them, Dr. Gerhard Rose said:

“Without these experiments, the vaccines, which were recognized as useless, would not have been produced in large quantities. The victims of this Buchenwald typhus test did not suffer in vain and did not die in vain. There was only one choice, the sacrifice of human lives, of persons determined for the purpose, or to let things run their course, to endanger the lives of innumerable human beings… Aside from the self-experimentation of doctor, which represents a small minority if such experiments, the extent to which subjects are volunteers is often deceptive. In the majority of such cases, if we ethically examine facts, we find an exploitation of the ignorance, the frivolity, the economic distress, or other emergency on the part of the experimental subjects” (Jay).

The extent to which these physicians tried to justify their actions, is beyond our imagination. How can someone stay blind to these extremely repugnant sights in front of them, while looking at its possible utility in the future.

The principles of autonomy and beneficence are at stake here. Nazi physicians justified that inflicting extreme amounts of pain to a single person is proper if the results from it can save thousands of lives. The prisoners had no say whatsoever in participating in these experiments. The data collected by the physicians did give them insights into various diseases and possible treatments. But, is it morally admissible to go to such lengths in order to discover something that may or may not have any use. I strongly argue that there are some lines that must never be crossed no matter what you see on the other side. Respect for autonomy is a very hard earned principle in medical profession and therefore must be defended more than others.

Citations:

Jay Katz, Experimentation with Human Beings (New York: Russell Sage, 1972), p. 300.

United States Holocaust Memorial Museum. “Nazi Medical Experiments.” United States Holocaust Memorial Museum. United States Holocaust Memorial Museum, n.d. Web. 28 Jan. 2017

Beauchamp and Childress outline four main principles of healthcare ethics: respect for autonomy, nonmaleficence, beneficence, and justice. In my opinion, no other issue blends these principles together as well as the requirement of informed consent in medical research. Informed consent is a vital component of the trust between a healthcare professional and a patient. If a patient is not given all the information regarding a medical treatment, that trust becomes void. The US Congress defines informed consent as

“including information about the nature of the experimental procedure, the reasonably foreseeable risks or discomforts, the benefits to the subjects or others, alternatives, the extent of the confidentiality of the records, possible compensation for injuries, the obligation to contact subjects if problems arise, and the right of subjects to refuse to participate or to withdraw.”  (Brody & Engelhard 288)

It seems that voluntary consent should be of utmost importance when practicing ethical healthcare. However, this has not been the norm in all forms of research. One of the most appalling of these instances occurred during World War II, when the Nazi regime funded medical experiments performed on subjects who were not given the right to withdraw or refuse to participate. These experiments were implemented without the consent of the participants, in conditions so inhumane they led to the death and suffering of hundreds of innocents. One of the doctors responsible for these atrocities justified his actions by stating that his research prevented the endangerment of innumerable human beings. He emphasized that those deaths were not in vain because they led to medical breakthroughs that helped a great number of people.

The case concerning the Jewish Chronic Disease Hospital involved researchers who neglected to inform patients of their participation in an experiment where they were injected with cancerous cells. Instead, the patients were told they were “receiving a skin test for immunity or response” (Coppenger 106). Despite this course of action, the experiment led to valuable results in the field of cancer research. Withholding information from participants is a violation of their right to consent. Subjects cannot agree to participate when they are not aware of the true parameters of a study. Taking cases like this into account, the question remains: is it morally justifiable to disavow informed consent when the results of an investigation could lead to a “greater good”?

This is a problematic situation from a moral and ethical standpoint. On one hand, the autonomy of a patient is compromised due to their inability to consent to an experiment or a procedure. On the other hand, successful research could prove to save or improve the lives of countless individuals. Whether the ends justify the means is an age-old question. I believe the sovereignty and safety of patients should not be compromised under any circumstances. Some researchers argue that denying consent is ethical when evaluating specific cases. I disagree with this opinion. If we apply a spectrum of ethical excuses debating the morality of the right to consent, where do we draw the line? At which point do we deem it acceptable to sacrifice the lives of the few to save the lives of the many? That line of thinking produced the Nazi ideology that allowed for dozens of experiments performed on unwilling victims. The essential respect for autonomy should not be granted for some and denied for others. “Informed consent is a fundamental principle of health care.” (Cordasco 1)

Works Cited

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2013. Print.

Brody, Baruch A., and H. Tristram Engelhardt. “Consent of Adults to Experimentation.” Bioethics: Readings & Cases. Englewoods Cliffs, NJ: Prentice-Hall, 1987. 286-90. Print.

Coppenger, Mark T. “Hyman vs. Jewish Chronic Disease Hospital.” Bioethics: A Casebook. Englewood Cliffs, NJ: Prentice-Hall, 1985. 105-06. Print.

Cordasco, Kristina M. “Obtaining Informed Consent From Patients: Brief Update Review.” Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices.U.S. National Library of Medicine, n.d. Web. 27 Jan. 2017.

This case deals with a woman, Marie, who has just undergone surgery to remove both ovaries and soon after had a splitting of the suture, which caused colon leakage. Besides that issue, she was stable and able to communicate. When the physicians explained she needed another operation to fix the potentially fatal matter, she refused stating that she no longer trusted their medical staff after the problematic first surgery and would call the police if they attempted to operate. Her family did not agree with her reasoning and her son, Jacques, who claimed his mother was in a compromised cognitive state, threatened to take legal action if the physicians did not operate (Thomas et al., 2014).

As a decision is made, we consider weighting two principles: patient autonomy and physician’s obligation (Beauchamp, 2009). The patient clearly expressed her wishes and it is the responsibility of the physician to respect that. In this case, the physician’s obligation to provide necessary medical treatment is in direct conflict with the obligation to respect the patient’s autonomy. Which principle has greater value? As stand-alone rights, neither remains valid. If patient autonomy and refusing treatment were an absolute right, then medical ethics would boil down to just the wishes of the patient. On the other hand, physician’s obligation as an absolute right would mean their word trumped all, disregarding the patient as an object. Neither is the case, and therefore some kind of middle ground needs to be found in order to reach a decision to act or not.

Another component of making a decision is the question of Marie’s competence. It comes into play when her son arrives at the hospital and deems his mother incompetent. Her refusal to consent to the operation is taken at face-value in the beginning, as she appears to be fully competent. But what else has to happen in order for her consent to be deemed legitimate? For her consent to be considered valid, two criteria have to be met: necessary and sufficient information must be presented and that information must be presented in a manner familiar to the recipient (Appelbaum, 2007). The physicians seem to stress how critical this procedure is to her survival and provide relevant information to aid her in making an informed decision so in my opinion, they have done due diligence. So if she is determined competent, her consent should be considered valid. However, if her competency remains in question, who else can consent to the surgery?

If it can be demonstrated that Marie’s judgment is out of character and irrational, her expressed wishes do not have to be respected by her physicians. In that case, surrogate consent can be granted to her family and they are responsible for “promoting the patient’s best interests” (Thomas et al., 2014). There is much ambiguity in this description and it shows the consistent struggle between the two principles at either end of the argument. To promote Marie’s best interests her son should consider not only the importance of his mother’s survival but also honoring her values that are in direct opposition of the first point. Simply put, it’s a decision of life and quality of her potential future life. If her survival meant a lifetime of pain and suffering, then death being the favored option can be considered rational. But since the second surgery gives her a much better chance at survival and full recovery, I believe if her son is granted surrogate consent, he should promote her best interest for the future, which is to go through with the second operation.

Sources:

Appelbaum PS. Assessment of patient’s competence to consent to treatment. New England Journal of Medicine. 2007; 357: 1834-1840.

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York: Oxford University Press, 2013. Print.

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

The surgeon in this case is faced with legal and moral obligations to the woman and her family, and it is important to understand the law and the necessity of effectively measuring competence, regardless of how the surgeon feels about the woman’s decision.

From a strictly legal standpoint there is very little that the surgeon can do to force the woman to accept a surgery, even if he feels her decision to refuse care is medically or morally irrational. An example of a Supreme Court case that illustrates this point is Lane v. Candura in which a woman refused an amputation that would save her life. The woman’s daughter attempted to gain the rights of guardianship, and by extension right to force her mother to receive the amputation, but the court stated that the woman had the right to refuse treatment and was fully competent to do so. While the woman’s child in case 1.1 is not seeking full guardianship and control over his mother like the child in the Supreme Court case, and the specific reasons for refusing further treatment are somewhat different between the two cases, there is a strong parallel between these cases. In the Supreme Court decision, the woman was allowed to refuse the amputation surgery, and it seems that the woman in case study 1.1 has a similarly justifiable ability to refuse treatment.

Regardless of the law, it is a good idea for the surgeon to perform a comprehensive analysis of the woman’s competency in order to avoid oversight that might clear up a moral ambiguity or be necessary to protect himself in the event that the woman or her family sues him. Dr. Leo’s list of questions provided in his article titled “Competency and the Capacity to Make Treatment Decisions” provides a solid list of questions that can be used to determine a patient’s ability to understand the nature of the treatment in question and the results of their decision.

Based on the information presented in the case, the woman appears to be able to understand her treatment options and the severe likelihood of death if she chooses to forego any addition medical care.

With this in mind, the main cause for concern about the woman’s competency is ensuring that there aren’t any controlling factors, especially relating to the pain and frustration she is feeling, or potential animosity towards her family. The surgeon might want to ask about the woman’s pain levels, her relationship with other family members, and what she is most frustrated by. It might even be appropriate to ask some of these questions after the respirator has been removed since it can cause discomfort and frustration. It could also be helpful to attempt to regain the woman’s trust in surgeons by trying to connect with her at a more personal level.

If the woman remains adamant, especially if pain levels are low and she is not feeling pressured or upset by her family, then the surgeon does not have many options but to allow her to refuse treatment and possibly face an eventual suit from the son.

Citations:

Leo, Raphael J. “Competency and the Capacity to Make Treatment Decisions: A Primer for Primary Care Physicians.” The Primary Care Companion to The Journal of Clinical Psychiatry 01.05 (1999): 131-41. Web.

In medicine, many of the moral issues that arise are based on different medical risks. Personally, I believe that it is the right of the patient to know any and all risks involved with his or her condition. However, the doctor from Well and Good Case 10.3 seems to disagree with me. In the case, the doctor failed to notify the patient of the risk of death because “in his view … death in such circumstances was rare enough that to mention it would unduly alarm patients” (Thomas, Waluchow and Gedge 300-301). Lo and behold, the patient died from the routine procedure that the doctor was to perform.

The failure of the doctor to notify the patient of the risk of death is unjustifiable for two main reasons. The most prominent of these reasons is that, as a human being with complete moral status (the patient was healthy and had no reason for anyone to question his moral status), the patient had the right to be alive. What follows from this is that the patient’s contemporaries have an obligation to not do anything that impedes on his ability to live without his express consent. In this case, the doctor did not obtain proper consent to do this procedure that threatened the patient’s life, no matter how minimal the chance of death was. While the doctor appealed to his professional morality code, which states that he did not need to inform the patient in order to avoid harming him by giving him unnecessary anxiety over the procedure, the doctor still had a common morality obligation to inform the patient that the risk of death was on the table. In my view, the doctor has violated common morality, even though he adhered to his professional morality.

The second major reason that the doctor’s lack of action is unjustifiable is that he clearly violated the patient’s autonomy. According to Beauchamp and Childress, “At a minimum, personal autonomy encompasses self-rule that is free from both controlling interference by others and limitations that prevent meaningful choice, such as inadequate understanding” (Beauchamp and Childress 101). The doctor has clearly violated every part of this definition. First, interfered in the patient’s decision-making by withholding information about the risk of death. Since information was withheld, it cannot be said that the patient had adequate understanding to consent to the procedure, as he had no knowledge of the full scope of the risks associated with the procedure. Beauchamp and Childress go on to write that “the autonomous individual acts freely in accordance with a self-chosen plan” (Beauchamp and Childress 101). While the doctor can say that he respected the patient’s autonomy by giving him the option to opt out of the procedure, he really did not. If I was in the patient’s position, and the doctor told me that there was a chance that the procedure in question could kill me, then I would very seriously reconsider undergoing that procedure.

This case reminds me of a similar situation that I found myself in a few years ago. When I was in high school, I had really bad acne, and my dermatologist prescribed a medication for me. I took this medication for several months, and it did little to alleviate my acne. A few weeks after stopping the medication, I remember talking to my mom, who told me that the medication I was on had a potential side effect of causing my eyes to become filled with fluid that could have impaired my vision. Of course, I was quite upset that the dermatologist had not told me this. Just like the patient in this case, I felt like my autonomy had been violated in a sense.

Bibliography

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York: Oxford University Press, 2013. Print.

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

In Case 10.3, Joe Mulroney experiences a fatal reaction to an angiogram.  After Joe’s death, the anesthetist admits that he did not warn Joe of the possibility of death because the risk was so small.  However, Sean, Joe’s son, argues that his father should have been told about the risk of death (Thomas et al., 2014). Should the anesthetist have informed Joe of the remote risks of the procedure?

The anesthetist violated Joe’s autonomy by withholding information about fatal consequences of the procedure.  Joe is considered a competent patient, yet the anesthetist does not respect patient autonomy in that he makes his own judgement in whether or not the risks of the angiogram should be provided. Joe is willing and able to give informed consent for the procedure in that he is not young, ill, mentally impaired, or unconscious, meaning that he is competent in making this decision (O’Neil, 2003).  However, would Joe have agreed to the angiogram if he had known about the possibility of death? How can the healthcare professional respect a patient’s choice, when the patient is not given all of the information to make an informed decision?

Through the intentional nondisclosure of the risk of death by the anesthetist, the moral principles of beneficence and non-maleficence are not upheld. The anesthetist argues that explaining circumstances such as death can be alarming or frightening to patients and that “over 5,000 angiograms had been done there over a decade without a single fatality” (Thomas et al., 2014).

The anesthetist makes an assumption based on a single encounter with Joe that he is “a very reasonable man, and most reasonable people choose the angiogram” (Thomas et al., 2014).  Just because the anesthetist characterizes Joe as a “reasonable” man does not give him the authority to withhold the remote risks of death.  The anesthetist is making a clear choice to withhold information from Joe.

Despite there being three legal exceptions when health professionals are explaining informed consent, none of them apply in this scenario.  In the situation, Joe is not in a case of emergency, he is competent, and has not waived his rights. Even though Joe gave consent to the procedure, he was not fully informed when making his decision. One controversial exception related to the topic of informed consent is the therapeutic privilege, which states that a “physician may legitimately withhold information based on a sound medical judgment that divulging the information would potentially harm a depressed, emotionally drained, or unstable patient” (Beauchamp & Childress, 2009). The facts of the case do not lead us to believe that Joe falls under this category, meaning that the therapeutic privilege does not apply in this situation. The anesthetist thought he was preventing the patient from harm by not providing the information about the risks of death, but I agree with Sean in that it is the responsibility and obligation of the health professional to explain any and all risks of procedures when patients are competent and stable.  The anesthetist should not necessarily be blamed for Joe’s death, but should have explained the possibility of death before Joe consented to the angiogram procedure.

Works Cited:

Beauchamp, T. & Childress, J. (2009). Principles of Biomedical Ethics. Oxford University Press, 7, pp. 127.

O’Neill, O. “Some limits of informed consent.” Journal of Medical Ethics 29.1 (2003): 4-7. Web.

Thomas, J.; Waluchow, W.; Gedge, E. (2014). Well and Good. Broadview Press, 4, pp. 300-302.

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.

Photo Reference

The aforementioned case is a difficult one as it presents a moral dilemma between two guiding principles in conflict: beneficence and respect for patient autonomy (Beauchamp, 2009). In Marie’s case, she does not consent to the recommended surgery and the consequences could be lethal (Thomas et al., 2014). To add more complexity to this case, Marie’s family members urge the physician to operate against the patient’s wishes. So, what is the physician to do?

In order to provide an informed decision for this dilemma, one must consider both sides of the argument. I will first focus on the importance of respecting patient autonomy and discuss its applicability in this case. In its broadest sense, respect for autonomy is respect of the decisions of a competent patient (Davenport, 1997). So, what is competence? According to doctor of medicine and law, John Davenport, a physician must consider three aspects of the patient’s decision-making ability before determining their competence. These include (1) the demonstration of a clear understanding about the proposed treatment, (2) the ability to explain their decision in accordance with their values, and (3) consistent choices over a period of time (Davenport, 1997).

In Marie’s case, the evaluation of competency is a little more complex. Before her most recent diagnosis, Marie opted for the surgery that fixed one problem but led to another. Until Marie was notified of the need for a second operation, she appeared “rational and sensible” (Thomas et al., 2014). However, immediately after she learned of the necessary treatment, she refused to give consent, even after the surgeon explained the deadly alternative. Her reasoning for refusing the surgery was due to her mistrust in healthcare professionals. Up until now, Marie is meeting the 2/3 qualifications for a competent individual. She has been informed about the procedure, explained her reasoning, and is consistent with her choice. However, it is unclear if she has a solid grasp of the benefits of the treatment as her thoughts may be muddled by her fear and distrust.

Soon after, her family arrives and asks to override Marie’s decision. Most notably, her son states that his mother is exhibiting abnormal behavior and believes she does not fully understand the consequences of her decision. This is where the physician’s determination of her competency comes into question. Does Marie truly understand the impact of her refusal of surgery or is she simply afraid of another surgical mistake? Does her distrust in the surgical staff warrant her refusal of a lifesaving surgery?

In this case, it would be ideal to give Marie some time to calm down and really consider the impact of her decision. However, if a quick decision was necessary, I would proceed with the surgery for two reasons. First, I believe Marie is not in the right mind to make this decision. Even though she was determined to be sensible early on, her response following the surgical recommendation was inconsistent with her prior behavior. She was hostile, threatening to call the police and demanding to be released from the hospital. This sudden change in demeanor is inconsistent with her previous actions and it is most likely due to her fear and distrust of medical professionals. This is further evidenced by the son’s account of her abnormal behavior. As stated by the authors of Well and Good, “respect for autonomy of individuals does not require respecting their expressed wishes if these can be shown to be seriously out of character and irrational” (Thomas et al., 2014). In Georgia, for example, physicians can complete a 1013 form which authorizes involuntary transport to an admitting facility (Blow, 2016). To be eligible for this, the individual must meet one or more of the following criteria: recent threats toward others, recent acts of violence toward oneself, or the presentation of an “imminently life endangering crisis to self because he/she is unable to care for his/her own health and safety” (Blow, 2016). In my opinion, Marie meets the first and last criteria, which gives the physician a justified reason to override patient autonomy in this case. The second reason I would proceed with the surgery stems from the principle of beneficence. As this is a life-threatening condition, it is the duty of any physician to help the patient and relieve them from pain. As supporters of the 1013 form assert, it is in the patient’s best interest to save their life, even if that means denying their right to self-determination (Blow, 2016).

REFERENCES

Beauchamp, T. & Childress, J. (2009). Principles of Biomedical Ethics. Oxford University Press, 7, pp. 13.

Blow, R. (2016). The Ethical Use of 1013s in Georgia and Client’s Rights. Development Counts. Retrieved from http://developmentcounts.com/ethical-use-1013s/

Davenport, J. (1997). Ethical Principles in Clinical Practice. The Permanente Journal. 1 (1), pp 21-24. Retrieved from http://www.thepermanentejournal.org/files/Summer1997/principles.pdf

Thomas, J.; Waluchow, W.; Gedge, E. (2014). Well and Good. Broadview Press, 4, pp. 71-76.

In this case, a woman “G” is pregnant with a child but is also battling an addiction to glue-sniffing. Because of her addiction, she was remanded to a treatment facility against her will by Child and Family Services due to her addiction causing physical and mental disabilities to her children born from prior pregnancies. However, Manitoba Court of Appeals overrules the decision of the lower court. G is allowed out of the facility and gives birth to a healthy baby. It was also noted that she has control over her addiction ad is expecting another child.

The issue that arises here is if G should have been sent to the treatment facility against her will due to the potential harm to the fetus due to her addiction. I personally believed that G, being a competent adult, should not have been put into the facility due to her addiction. Unless she was arrested for a crime and her sentence was to be served at the treatment facility, it was unlawful to commit her to the facility. The reason behind this is that the “harm” is hypothetical at this point. Sending G to the treatment facility, although preventative, was against her rights as an able-bodied and mind woman. As the book notes, this case opens the door for a “slippery slope” effect where the line of rights for an unborn child and rights for the living-woman is blurred. (p. 203) The book also points out, what would be the case for women that smoke or drink during pregnancies? Although those actions are not illegal they also prove to cause potential problems for a fetus. Would those actions also constitute a woman’s involuntary admission to a treatment facility? Since that is not the case, it should not be the case for G as well.

Another issue that comes about in this case, is whose rights is to be protected in this situation. Although protecting fetus is important, it must be considered that the fetus is not a living person, in the sense that it is existing in the world without biologically depending on its mother. Because of this, can we assume that it should have the same rights as its mother? I think not. G is the only living person in this case and therefore her rights should be the ones enforced. The state is supposed to enforce the rights of its inhabitants, and prior to giving birth G is the only one who is a citizen in this case. Treating her fetus as a living child, whose rights are to be enforced would be an over-reach. In Canada, abortion is legal at all stages of pregnancies, and there are no legal obstacles in getting an abortion. But if the life of G’s fetus is recognized and her addiction is seen as endangerment, why is abortion not considered a homicide or even a manslaughter? The stipulated definition of life should be carried out throughout all legal situations.

Bioethics post #1

Dilemma: Dr. Sandra Selleck was conducting a research study on the effects of an Alzheimer’s drug called THA, which has the potential to slow the progression of Alzheimer’s disease. In search of participants in her study, Dr. Selleck reached out to a large regional nursing home St. Mary’s. She knew the sample would include many patients eligible for her study and wanted the opportunity to visit the home to interview patients for the study. Dr. Selleck discussed the inclusion criteria of the study with St. Mary’s director Ann Wilson, which included patient consent, consent from the patient’s closest relative, and no objections from the care staff at St. Mary’s. Dr. Selleck stressed the importance of competency of the patients in terms of enrollment in her study. After hearing this proposal, Ann decided she didn’t want any of the individuals at St. Mary’s to be enrolled in the study. She felt as though the study was exploiting elderly people and treating the patients as guinea pigs. Dr. Selleck was surprised at this response since her study had been reviewed by many ethics boards and was given considerable endorsement. Was Ann right to turn down Dr. Selleck’s request? Is Dr. Selleck’s study exploiting a vulnerable elderly population?

Discussion: I think there are many important questions at play here. For one I think the concept of patient autonomy and competency in Alzheimer’s populations is a difficult situation. Alzheimer’s disease is a progressive disease that causes a decline in memory and other mental faculties. A patient is not always lucid and therefore can’t always be deemed mentally competent. This makes it difficult to decide whether a patient has autonomy in something such as a medical trial. This then brings into effect the importance of the patient’s closest relative, clinical staff at St. Mary’s, and any doctors that may be treating the patient. Alzheimer’s populations are especially vulnerable groups but should they be given the chance to participate in a potentially lifesaving trial? How can their competency be judged? I believe to a degree that enrolling elderly Alzheimer’s patients in a clinical trial based on competency has some level of exploitation but this must be weighed with the notion of ‘do no harm’. If there is a potential drug on the market that could help a patient live for a couple more years or save the lives of future victims, then the line blurs a bit. The question is whether Ann is protecting the patients or keeping them from a lifesaving drug. This also brings up the question of whether this decision is rightfully Ann’s to make for the entire population of St. Mary’s. A decision such as this should be made by the patients at the home, the close relatives to those patients, as well as the doctors closely involved in the cases of these patients. As much as competency can be questioned, it is still the patients and their governing body’s decision about whether to participate in a situation such as this. The patients have a right to be informed on the study and then make the decision for themselves about whether to participate. These patients deserve a voice and Ann is taking that away from them. A balance has to be reached between respecting patient autonomy and nonmaleficence. These individuals deserve a discussion in their own treatment while at the same time having a governing body that is accounting for the vulnerability of Alzheimer’s patients. This brings into question whether Ann is really protecting them by not allowing them to participate in this study.

Works Cited:

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York, NY: Oxford University Press, 2001.
Mayo Clinic Staff Print. “Alzheimer’s disease.” Overview – Alzheimer’s disease – Mayo Clinic. N.p., 22 Dec. 2015. Web. 21 Jan. 2017.

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