In the past blogs, the idea of non-maleficence vs autonomy has been discussed to determine a course of action for a patient. However, this week, the readings look at the idea of beneficence and its role in guiding decisions. While the principle of non-maleficence tells us to not harm the patient, the principle of beneficence demands that an actor also perform positive steps to help a patient. For this week’s blog, I read the case involving the dialogue between Dax Cowart and Robert Burt. After a propane gas explosion, Dax’s father had died but Dax had been admitted into the hospital for treatment. However, throughout his treatment Dax made claims of wanting to die rather than to continue living. He tried to take his own life on multiple occasions and it was evident that he was in immense pain. However the doctors refused to let him die and treated him until he was able to carry out day to day tasks on his own.

This case study looks at the dilemma the doctors were presented with on whether treating Dax had been the correct decision. Dax’s autonomy had been violated but the doctor’s acted appropriately when accounting for the principle of beneficence. The dilemma of this case revolves around the idea of whether the patient’s right to die needs to be respected. Though he had been labeled as clinically competent, doctors did not agree with Dax’s terms of dying even though Dax wanted them to stop treating him. Dax may have been viewed as being too emotional to weigh the costs and benefits of treatment due to his dad’s recent death but being labeled as  clinically competent puts an interesting twist on this case. It could be argued that it was Dax’s autonomous decision to die and the doctor’s decision not to respect that wish violates a moral parameter.

By comparing the principle of beneficence to the principle of autonomy, I believe that the doctors made the right decision in treating Dax. The doctors followed their own moral compass on not only conducting actions that were to the benefit of the patient but also not putting the patient in greater harm. When admitted into the hospital, Dax was very emotional due to the family death. However, the achievements that Dax accomplished after his treatments and his changed view of life show that the doctors made the right decision. Though Dax’s autonomy had been violated, the decision his clinical providers made turned out to impact Dax’s life in a positive way both physically and with his new career maybe even mentally.

Works Cited

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

Cowart, Dax, and Robert Burt. “Confronting Death Who Chooses, Who Controls?” JSTOR. The Hastings Center, n.d. Web. 18 Mar. 2015. <http://www.jstor.org/stable/3527969>

Beauchamp and Childress’s preliminary discussion of beneficence distinguished between general and specific beneficence as well as the nature of role obligation and special relations. I found the example of the physician-stranger relationship to be a very interesting intersection among these distinctions. A doctor at the scene of an emergency represents, “a gray area between a role-specific obligation and a non-role specific obligation” (Beauchamp and Childress 206). A doctor inhabits a specific role, entailed by his or her special training and knowledge, but whether or not his or her beneficence is due to the general population or only to specific patients is a valid question. From the discussions of beneficence as well as discussions about the nature of physicians involved with in-flight emergencies, I maintain that the nature of the definition of beneficence makes it morally obligatory for a physician to take action in an emergency situation, even among strangers.

At stake here is Beauchamp and Childress’s position that a physician stranger is not, “morally required to assume the same level of commitment and risk that a prior contractual relationship with a patient or hospital would morally require” (206). This takes into account risk, which of course, a doctor may take into account both in an emergency situation as well as when caring for highly abusive or contagious patients. However, I think that doctors occupy a highly specialized role which brings with it a moral obligation to care for all people needing immediate care. This is echoed by the Hippocratic Oath, which posits that, “a doctor has a special obligation to all human beings” (Sheperd http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1676316/). Especially in cases in which a doctor is the solitary medical caregiver during an in-flight emergency, there are few to no risks posed to the doctor’s well-being as long as he or she acts within the limits of, “ their qualifications and experience,” and ensures, “ consent and documentation” ( Sheperd). I think these provisions are relatively basic and demonstrate that a doctor’s role-specific obligation of acting beneficently is preserved at all times in an in-flight emergency scenario.

Five conditions were presented by Beauchamp and Childress in justifying whether or not a person X is obligated to rescue person Y. The condition most at stake in physician-stranger scenarios is condition 4, “X’s action would not present very significant risks, costs, or burdens to X” (202). Of course, there are emergency scenarios in which a physician would have to put his or herself at bodily risk in order to assist a stranger. However, even in a specific hospital setting, dangerous situations would require that health care professionals evaluate their course of action. In a hospital setting, it has been argued by Clark that the moral principle of beneficence and utility dictates that a physician assist despite risks since, “ training not only increases the value of the aid, it may also reduce the risk associated with providing it”(Huberhttp://www.tandfonline.com/doi/pdf/10.1162/152651604773067497 ). Since this argument can be made to justify involvement even in potentially dangerous, formal patient-physician relationships, it can also be applied in emergency situations.

Overall, the Hippocratic Oath, the example of an in-flight emergency scenario, and the argument by Clark that physicians are the least likely to be affected by risks of helping since they are indeed so highly qualified leads me to conclude that physicians are morally obligated to help all patients in all scenarios. Thus, the general versus specific moral obligation of beneficence does not apply to physicians in almost all cases.

Beauchamp, Tom L, and James F. Childress. Principles of Biomedical Ethics. New York: Oxford University Press, 2009. Print.

Huber, Samuel & Matthew K. Wynia (2004) When Pestilence Prevails…Physician Responsibilities in Epidemics, The American Journal of Bioethics, 4:1, 5-11, DOI:10.1162/152651604773067497

http://www.tandfonline.com/doi/pdf/10.1162/152651604773067497

Shepherd, B, D Macpherson, and C M B Edwards. “In-Flight Emergencies: Playing The Good Samaritan.” Journal of the Royal Society of Medicine 99.12 (2006): 628–631. Print.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1676316/

Background

In the case, “Confronting Death: Who Chooses, Who Controls?” a man named Dax Cowart was severely injured in a propane gasoline accident. Most of his body suffered from deep burns, in addition to leaving him blind and losing the use of his hands. His father was killed in the explosion, which left him in emotional pain aside from his physical agony. He endured burn treatments the following year that were extremely painful. Dax also made two videos, one of which was entitled “Please Let Me Die.”

Dilemma

The main ethical dilemma involves whether a patient’s decision to die should be respected. Dax had wanted to stop his treatments and requested to die. Even though the psychiatrist stated he was competent, the doctors did not listen to his request. A critical issue involves at what point does the patient understand all the risks and benefits of his situation. His decision should be voluntary and based on informed consent. One side of the argument believes that although Dax had requested to die, they felt he was emotional because of his disability now and since his father had just died. On the other side, Dax was in extreme pain and was declared competent. It was his autonomous decision whether to die.

Reflection

The central issue in this case can be argued for both sides. In my opinion, the doctors felt he did not clearly understand his situation concerning recovery. As doctors, they felt it was in his best interest to continue the treatments. Doctors have a duty to take care of their patients and to help them survive if it is possible. If the doctors believed that they could improve his quality of life, then it is in the patient’s best interest to have the surgery or treatment. For this reason, the doctors did not listen to Dax’s wish to die. Additionally, I think people often become more irrational and feel as if there is no way out when they are in such pain. Was Dax in the state of mind to make these decisions correctly? In this state of suffering, the patient may only be able to see the short-term picture of the situation. The doctor is able to see the long-term picture and come to a proper decision. Dax later admitted that he didn’t understand that he could have the quality of life that he has now. If he had been in less pain when he was being treated, then he may have wanted to continue to live. He states, “Today I am happy; in fact I even feel that I’m happier than most people. I’m more active physically than I thought I ever would be” (RD p. 17). Today Dax is a practicing attorney in Texas. Therefore, I believe the doctors were correct in disregarding Dax’s decision to die. They made an ethical choice to do what they felt was in the best interest of their patient with the possibility that he could recover and live a quality life. Dax recognized that he would be “willing to forgo some of my own autonomy in the interest of better decisions being made (RD p. 24).

Works Cited

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

Cowart, Dax, and Robert Burt. “Confronting Death Who Chooses, Who Controls?” JSTOR. The Hastings Center, n.d. Web. 18 Mar. 2015. <http://www.jstor.org/stable/3527969>

In his article, Ackerman addresses the topic of autonomy, and discusses how non-interference is often classified as the key feature in respect for personal autonomy. Ackerman rejects this claim, and argues that in order to truly respect a patient’s autonomy, a doctor must go beyond the lines of mere honesty and proper instruction.

A person’s autonomy is not set in stone, and has the potential to fluctuate depending on whether or not there are impeding constraints. Starting with the most obvious of constraints, there is no argument that the effects of a patient’s illness can alter their viewpoints and perspectives, or even render them as incompetent if such illness is severe enough. In PBE, Beauchamp and Childress argue that there are three criteria for autonomous actions; intentionality, understanding, and lacking controlling influences. In the case of a patient who is suffering from a debilitating illness, there is a clear pathway for the first two aspects of the theory to be violated, and while these two criteria are easy ways for a doctor to be morally sound in evoking paternalism, I believe it is the third criteria on noncontrolling influences that poses the biggest issue for doctors and the concept of non-interference in regards to patient autonomy.

Illnesses and the side effects that go along with them, while not always straightforward and parallel among patients are essentially simple ways for a healthcare physician to assess a person’s autonomy and determine whether intervening should be necessary. For example, if the patient underwent severe trauma to their frontal lobe, the brain region known for being in charge of executive decision making, the doctor should be fast to intervene and exert a certain air of paternalism. All that is required of the doctor in this case is a thorough knowledge in the medical field. Figuratively speaking, my neuroscience textbook could have come to the same conclusion. Unfortunately, determining one’s level of autonomy is not solely based off of physical and health constraints, but also social and psychological constraints. A patient could be physically healthy, but if influenced by their family or friends enough, there’s no telling what decision they could come to. Similarly, if a patient has psychological constraints such as depression, fear, or anxiety, that could also lead them into making influenced decisions. While these constraints would violate Beauchamp and Childress’ third criteria of autonomous action, should the doctor be so quick to disregard the patient’s autonomy, or should the doctor work towards restoring that patient’s autonomy before using their power advantage to take control of the situation? In regards to this question, I have to take the side of Eric Cassell in The Healer’s Art where he determines the most destructive aspect to the sick to be their loss of control, and it is the doctor’s duty to return that control to the patient.

The question now lingers, how can doctors return control to a patient? I can tell you definitively that non-interference is not the answer. In order for a doctor to be able to return control to a patient, the doctor needs to go far beyond the role of technician and information database, and must move into a totally different realm of doctor patient interaction. This entails that the doctor, while not expected to know every detail about their patient’s life and character, should have a decent way of gauging how their patient is thinking and feeling, and altering treatment and/or the dispersal of information accordingly. For example if the doctor is dealing with a timid fearful patient, he should be expected to speak in a friendly manner and be careful not to further scare the patient, especially if the patient fears life saving surgery.

In conclusion, while a patient’s autonomy and ability to maintain control should maintain a number one priority when being dealt with, it would be ironic to say that the means to achieve this is through non-interference. If doctors practiced medicine solely on the basis of providing their honesty and accurate information, we would already have robots taking over the jobs of physicians. However, there are many cases where only through a doctor’s interference can a patient maintain their own autonomy in the face of controlling factors, and might also be the reason your doctor isn’t an M.D C.P.U.

Works Cited:

Ackerman, Terrance “Why Doctors Should Intervene” The Hastings Center Report 12 (4): 14-17 (1982)

Beauchamp, Tom L., and James F. Childress. “Respect For Autonomy.” Principles of Biomedical Ethics. New York: Oxford UP, 2013. 101-41. Print.

Cassell, Eric J. The Healer’s Art. Cambridge, MA: MIT, 1985. 44. Print.

http://i.kinja-img.com/gawker-media/image/upload/s–asXqXq-r–/187qi10x34gxijpg.jpg

Background

The transcript of public remarks made by Dax Cowart and Robert Burt presents a dialogue that unearths the morality behind physician-assisted suicide. As defined by the American Medical Association, physician-assisted suicide occurs when a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act (AMA). In the case of Donald (Dax) Cowart, the ethical issues raised by efforts to sustain his life against his wishes have made him famous. After a propane gas explosion, despite Dax’s insistence to be left for dead, he was rushed to the hospital alongside his father who died en route. Dax’s hospital treatments included immersion in chlorinated baths and having bandages stripped and replaced. Dax was left blind, without the use of his hands and with more than two-thirds of his body burned (RD p. 1). Throughout this nightmare Dax continually demanded to die by refusing consent to his treatments but his wishes were not approved.

Dilemma

As has been the trend up until this point in class, the two main issues at stake here revolve around the two ethical principles of autonomy and beneficence. The general definition for the ethical principle of beneficence rationalizes it as an “action that is done for the benefit of others,” actions that “can be taken to help prevent or remove harms” as well as actions done “simply to improve the situations of others” (UCSF). On the other hand, autonomy (respect for persons) can be defined as acknowledging a person’s right to make choices, to hold views, and to take actions based on personal values and beliefs (Bishop).

The main issue brought to light incorporates these two principles in an effort to determine whether or not Dax’s physicians had the right to go against his wishes. The dialogue proves Dax’s insistence of requesting to be let die – “I don’t want treatment” – however, Dax was put through the treatments regardless (RD p. 5). While Dax has been blessed after the accident with a life full of achievements, the debate in regards to this case questions whether or not the actions taken by the physicians were justified.

It could be argued that the action most in line with the principle of beneficence would have been for the physicians to respect Dax’s wishes and let him die. Dax’s suffering was evident to the physicians not only through his physical conditions but also through his constant emotional pleas – “the immediate issue, the urgent issue, was that my pain was not being taken care of. That was why I wanted to die (RD p. 15).” In letting Dax die, the physicians would be choosing the course of action that would be done for Dax’s benefit, help to remove and prevent harm, and also simply improve his situation by ending his suffering.

Additionally, in terms of autonomy it could be argued that Dax’s competence rules him to be completely capable of making his own life decisions.

Reflection

In this case, the dilemma revolves around the balance between the principles of beneficence and autonomy – the physicians are faced with a tough choice in confronting death. Looking back on the situation, I think it is important to consider Dax’s mental state at the time regardless of his state of mental competency. Take into account the reflection that Dax presents in the case – “I tried to take my life twice – three times if you count the time I crawled over the hospital bed rails trying to get to the window to jump out an eight-story window” (RD p. 21). A man willing to go to such extremes is clearly experiencing a great deal of pain and suffering – is it possible that he is not mentally competent and instead is so caught up in the pain and suffering felt at the moment that he cannot see a future? The doctors disagree with Dax’s grim outlook on life – their main reason for continuing with the surgeries and procedures despite his objections. Although the physicians’ decision did not respect Dax’s autonomy and did not immediately relieve Dax’s suffering, I believe they made their choice with a clear outlook on his future and therefore I stand with their decision.

Works Cited

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

“Beneficence vs. Nonmaleficence.” UCSF School of Medicine . N.p., n.d. Web. 20 Mar. 2015. <http://missinglink.ucsf.edu/lm/ethi cs/Content%20Pages/fast_fact_bene_nonmal.htm>.

Bishop, Laura. “Principles — Respect, Justice, Nonmaleficence, Beneficence.” Ethics Background. N.p., n.d. Web. 28 Jan. 2015. <http://nwabr.org/sites/default/files/Pri nciples.pdf>

“Opinion 2.211 – Physician-Assisted Suicide.” American Medical Association. N.p., n.d. Web. 16 Mar. 2015. <http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2211.page?>.

Image Webpage:

https://www.regionshospital.com/ucm/groups/public/@hp/@public/documents/webasset/dev_015033.jpg

When doctors should and should interfere is the basis of many bioethical questions. The wide range of scenarios that doctors face on a day to day basis, from whether or not they should force feed a patient to issuing a Do Not Resuscitate order, all share a common core that asks if the doctor should interfere or not. But what does it mean to interfere? Is interference anything that goes against the choice of the patient? But if the patient would benefit from the action is it interfering? Or is interference justified by the principle of beneficence? These questions, and many more are necessary in deciding what is the moral action in many bioethical decisions.

The Merriam-Webster dictionary defines interference as, “involvement in the activities and concerns of other people when your involvement is not wanted.” By this definition, any action taken by a health care professional that is not in agreement with the wishes of the patient is interference. So in order to respect a patient’s autonomy the physician must act according to what the patient wants and exercise no interference. However, the issue with this logic is that physicians, by the very nature of their profession, will encounter patients who do not want their involvement, but are not competent to make that choice. While every situation is different, Terrance Ackerman argues why doctors should intervene. He explains many reasons and justifications of when doctors should exercise their power and override the decision of the patient. While in the case of mental illnesses where competence and decision-making are compromised, I agree that decisions need to be made by a clear-thinking person, but I do not agree with many of the justification that Ackerman discusses.

One such discussion is surrounding fear. The article describes “fear as a cripple of patients to choose and make an autonomous choice.” It cites a story of a young man who refused neurosurgery because of the posiblity of neurologic damage who later died because of delayed treatment. I do understand that it must be difficult for physicians to see a patient refuse a life saving treatment, however ultimately it is their body, and they have the final decision if they are competent. Fear is a reaction to a person’s experiences and thoughts, which are difference for every individual and does not affect their competency. A competent individual should not be viewed as less autonomous because they have a differing opinion than a physician. Ackerman also quotes a phrase from The Healer’s Dilemma by Eric Cassell: “If I had to pick the aspect of illness that is most destructive to the sick, I would choose the loss of control. Maintaining control over ones self is so vital to all of us that one might see all of the other phenomena of illness as doing harm in their own right but doubly so as they reinforce the sick person perception that he is no longer in control.” If physicians abuse their power to override a competent patient’s autonomous decision because of fear, than physicians may lose the ability to override the decisions of patients who are not competent to make their own decisions and do need their assistance.

http://www.merriam-webster.com/dictionary/interference

Ackerman, Terrance “Why Doctors Should Intervene” The Hastings Center Report 12 (4): 14-17 (1982)

Much of this week’s reading concerned paternalism, particularly the point at which beneficence overrides autonomy. One of the most significant examples of this is the right to commit suicide. Historically this has been something prevented at all costs, even to the point of being illegal. However things are changing, very few people in the modern world would suggest that it should be a criminal and prosecutable offence. Beliefs go all the way to the other end of the spectrum as well, four states having authorized physician assisted death, in certain cases. However there is still debate about the right of competent and autonomous patients to commit suicide.

First let us look at the necessary requirements in those states where it is permissible. To begin the process most states require at least 2 oral requests and a written request in a period of no shorter than 15 days. The common requirements across three of the states include at least 18, that the next-of-kin is informed, and informed knowledge of alternatives. The two crucial requirements are the diagnoses of a terminal illness with an expected life span of less than 6 months and clear evidence of complete competence. Both of these must also be certified by a corroborating physician.

These requirements are those required to actively end a life, by the hand of the patient. However, many cases involving suicidal patients do not require active interference by the physician or anyone else. Simply a passive lack of intervention will lead to the patient’s death. The moral dilemma then becomes whether to act or not to.  This hinges on the idea that there is the possibility that there are situations that people have no wish to live through, and that this process is reasonable. Examples of this include incredibly painful or risky treatment that would be lifesaving. The exemplar case of this scenario is Dax Cowart, who was severely burned and underwent horrendously painful skin grafts to survive. He still insists years later that the doctors should have ceased treatment at his request and let him pass.

The important point here is that Dax did not meet the criterion that would allow a physician to let him kill himself, for the purpose of this argument we will ignore the anachronous nature of the rules compared to the case at hand. If these are the qualifications required to let someone end their life, would it not be morally wrong to do the same in a case such as Dax’s? He has given consent but suffers from no terminal illness and despite his declaration as competent by Dr. White, his judgment is ruled by his pain. This is the same effect that could be seen in broken torture victims. The patient only has the capability to make an informed choice after the completion of the treatment, when he is capable of understanding his quality of life and his judgment is not altered by pain. Given his probable recuperation and possibility to lead a functional and productive life, the doctor who follow the rules have a moral obligation to continue the treatment.

Works Cited

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

“State-by-State Guide to Physician-Assisted Suicide.” ProConorg Headlines. N.p., Feb. 2015. Web. 20 Mar. 2015. <http://euthanasia.procon.org/view.resource.php?resourceID=000132>.

How much are we supposed to care for the others? Autonomy and nonmaleficence make sense because we should respect opinions of others and not harm people, but how and where should we draw the line for the beneficence? The question rises from the base that people do not want to be involved in a situation where doing good for the others would cost them something in turn. This is the exact dilemma presented in the case study with Robert McFall and his cousin David Shimp in the Principles of Bioethics.

Robert McFall was diagnosed with aplastic anemia, needing bone marrow transplant, and he wanted his cousin David Shimp to undergo two exams to determine if he were a genetically compatible donor. However, Shimp refused after taking the first exam, which determined his tissue to be compatible to those of McFall. McFall sued his cousin for not willing to take the second exam and donate if he were to be fully compatible. The judge ruled that the law can’t force Shimp, but his refusal was morally indefensible (Principles of Bioethics). Apparently, there are generous people who are genuinely concerned about others and would donate blood even if the patient is not related to the donor as shown in the case of the Atlanta Journal Constitution blog (AJC Parenting Blog). I am not saying that Shimp should also act heroically and go through the medical procedures to donate to his cousin, but I agree with the judge’s the ruling that Shimp’s act was morally indefensible.

Beauchamp and Childress present five premises of obligatory beneficence. The first premise is met since McFall is at risk of significant damage to life. There is no doubt that he might actually die. From Shimp’s standpoint, the application of second and third premises can be questionable, though. With the chance of survival increasing from 25% to about 50% in average, Shimp’s action may not prevent McFall’s death and thereby not be considered as a necessary action he must take for McFall (Principles of Bioethics). However, fourth and fifth premises about balancing the benefits and risks for the receiver and the donor respectively may make McFall’s suing argument strong while undermining what Shimp had to present. Pondering upon these premises it can be hard to determine whether Shimp’s refusal can be viewed as morally indefensible or not.

Specifically, counterargument might bring out this point: why is the autonomy of donor not respected and why does the case seem to imply that obligatory beneficence triumphs over autonomy? Autonomy is defined as something that “encompasses self-rule that is free from both controlling interference by others and limitations that prevent meaningful choice” (Principles of Bioethics). The counterargument may state that this should not only be applied to the patients but also to everyone and especially to the donors as well who actually have control over the choice whether to donate or not. I agree; nevertheless the same standards to determine whether one is autonomous and competent must be applied to everyone as well. Therefore, Shimp’s beliefs must be evaluated for rationality.

In other words, if his beliefs are irrational, then his choice of not to go through the second exam can’t be considered as an autonomous decision and can further be seen as an immoral one. Shimp believed that 100 to 150 punctures of pelvic bone and 1 in 10,000 chance of death from anesthesia were too much of risks for his part. Is this a rational belief? In a research done by Harvard School of Public Health, there is 1 in 6,700 chance of death from car accident (Best Health Degrees). His belief is irrational because I am logically assuming that he drives around to work, to grocery stores, and to many other places risking his life while refusing to go through a procedure to save his cousin, which involves lower risks. I don’t want to say he should be forced to be the donor, but he is “morally indefensible” as the judge stated. His beliefs are irrational, and there is no valid counterargument that can say his autonomy triumphs over beneficence.

References

Beauchamp, Tom L., and James F. Childress. “Respect For Autonomy.” Principles of Biomedical Ethics. New York: Oxford UP, 2013. 101-41. Print.

Beauchamp, Tom L., and James F. Childress. “The Duty of Rescue as Obligatory Beneficence.” Principles of Biomedical Ethics. New York: Oxford UP, 2013. 206-08. Print.

Oliviero, Helena. “Georgia Girl Puts Spotlight on Life-saving Bone Marrow Transplants | AJC Parenting Blog.” AJC Parenting Blog. AJC, 3 Mar. 2015. Web. 18 Mar. 2015.

“Your Chances of Dying.” BestHealthDegrees.com. Best Health Degrees, n.d. Web. 19 Mar. 2015.

Beauchamp and Childress describe the principle of beneficence as a “statement of moral obligation to act for the benefit of other” one that “connotes acts of mercy, kindness [and] friendship” (B&C p. 203). In this case Dax Cowart was severely injured during a gasoline explosion, leaving the majority of his body very deeply burned. Not only was Dax severely physically injured (burned, blind, lost use of hands, and fingers amputated), but also he was emotionally distraught (lost father in accident).

In this case, the main dilemma that arises is did the physicians have the right to go against Dax’s wishes, even though he was competent? Dax endured the excruciating pain he was put through and has achieved many accomplishments since the accident, but does this make the actions of the physicians justified? Dax states, “I tried to take my life twice–three times if you count the time I crawled over the hospital bed rails trying to get to the window to jump out an eight-story window” (RD p.21). The desperation Dax felt was evident and the suffering was immense. I do not believe the doctors were sympathizing with Dax nor were they displaying mercy and kindness towards Dax, especially since Dax implied pain management treatment was withheld.

One could argue that Dax is not being realistic about his possible life quality after enduring the surgeries. Dax makes statements alluding to little success in his life post operation stating “you know, all I’m going to be able do is to sit on a street corner and sell pencils” (RD p.15). This is Dax’s opinion of what will happen, and an opinion the doctors seemed to disagree with and thus a reason why the doctors are continuing with the surgeries and procedures despite Dax’s unwavering objections. Now since Dax has surpassed both his own and the doctors expectations it is clear that he did not have a realistic image of his future. Does this make Dax incapable of being competent at the time? In the article, it states Dax was deemed competent at least twice. I do not believe just because Dax did not imagine a future with the quality of life he wanted to live, he should be deemed incompetent. Although his quality of life was much greater than he ever imagined, this may not have been the case and thus Dax is entitled to the uncertainty of the future and the right to make his decision based on his current state and not on a possible future state.

I will now consider the principles autonomy and non-maleficence. Since Dax was deemed competent multiple times he should hold autonomy and the “freedom…to make the wrong choices” (RD p.17) as he wishes. Furthermore, he is suffering immensely to such an extent that I believe the principle of non-maleficence is being violated. Two of the five rules specifying non-maleficence are “do not kill” and “do not cause pain or suffering” (B&C p. 154). In Dax’s case these two rules are in conflict. One could argue the principle of non-maleficence is supported as we are not killing Dax nor are we depriving him of the goods for life by conducting the surgeries. In fact, one may argue by doing the surgeries we even may be providing Dax the opportunity to enjoy the goods of life. However, the pain and suffering we are causing him through extensive replacement of skin grafts needs to be evaluated. Dax states, “the pain was so excruciating, it was so far beyond any pain that I ever knew was possible, that I simply could not endure it “ (RD p.17). Although one could argue by not performing these surgeries on Dax we are killing him, the intention is to relieve Dax of his suffering and respect his wishes. I support Dax’s current stance that his wishes to die should have been respected at the time.

Work Cited

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

Cowart, Dax, and Robert Burt. “Confronting Death Who Chooses, Who Controls?” JSTOR. The Hastings Center, n.d. Web. 18 Mar. 2015. <http://www.jstor.org/stable/3527969>

“Tag Archives: Doctor/patient Relationship.” Tag: Doctor/patient Relationship. N.p., n.d. Web. 18 Mar. 2015. <http://www.thehealthculture.com/tag/doctorpatient-relationship/>.

Background on Beneficence

Beuchamp and Childress describe beneficence as acts of mercy and kindness to benefit another person. Benevolence refers to the character trait or virtue when acting for the benefit of others. While some acts of beneficence are not obligatory, some forms of beneficence are obligatory. Although common morality does not have a principle of beneficence that requires extreme altruism, the principle of positive beneficence supports certain obligatory rules, such as:

• Protect and defend the rights of others
• Prevent harm from occurring to others
• Remove condition that may cause harm to others
• Help people with disabilities
• Rescue people in danger

Beneficience differs from nonmalefience in that the idea is to present positive requirements of action as oppose to prohibiting negative actions, as well as not needing to be impartial or provide reasoning for these positive actions. David Hume argued that the obligation to benefit others in society comes from social interactions: “All our obligations to do good to society seem to imply something reciprocal. I receive the benefits of society and therefore ought to promote its interests.”

Summary of AZT Case

During placebo-controlled trials of AZT (azidothymidine) in the treatment of aids, a conflict arose over the questionable use of a placebo. In the initial trial, patients were given AZT to determine its safely. Several of these patients showed clinical improvement. On account of this, many people argued that since AIDS was fatal, everyone should be receiving AZT if it appeared to have possible positive effects. However, due to federal law regulations, more placebo trials would have to be done before pharmaceutical companies were able to produce more of the drug. For several months, some groups of patients were given AZT and some were given placebos, and those on placebos began to die at a significantly higher rate. A data and safety monitoring board (DSMB) would be charged to consider the impact of research on future and current patients. In the AZT trial, it would have been most beneficial to stop the placebo trial early on and make more of the drug for all patients who were suffering and died early.

Analysis

A great test for analyzing obligations of beneficence is found in policies of expanded access and experimental products such as medication. Beuchamp and Childress discuss whether it is morally acceptable or morally obligatory to provide an investigational product to a seriously ill patient if they cannot enroll in a clinical study. These programs are known as either “compassionate use” or “expanded access” programs. They authorize access to these investigational products even though they do not have regulatory approval. We know that the primary goal of clinical research is to provide further understanding of a product and to test its effectiveness. Thus, there is no inherent right that researchers have to distribute products that are being tested to patients, until it is proven that the treatment option works.

However, I argue that there comes a point in a clinical trail where if there is enough reasonable evidence that a product works, and may benefit patients, the drug should be an option for patients to take if they are currently taking a placebo, or even if they are not enrolled in the study.  In the AZT example, patients did not have another good option at the time to help cure their AIDS, and may were dying. Whether or not the drug worked well there was enough evidence that it did something of good value, and if there was no alternative therapy available at the time I think pharmaceutical companies should have gone ahead and created more of the drug to give to suffering patients. This would have been in line with beneficence, as it would have been protecting the rights of those who wanted the best treatment option available and it would have prevented them from harm (or at least had the best chance of making them slightly improve from their condition). While I do understand the specific guidelines clinical trials must follow prior to allowing certain treatment options to become available on the market, if the primary goal of developing these treatments in the first place is to help cure patients, then if any improvement is being seen and a patient wishes to give this medication a try (if there are no other available options) then I think they should be allowed to try it. It would thus have been beneficent for AIDS patients to have been allowed to take AZT during the clinical trial.

Resources

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

David Hume, “Of Suicide,” in Essays Moral, Political, and Literary, ed. Eugene Miller      (Indianapolis, IN: Liberty Classics, 1985), pp. 577-89.

http://americanhistory.si.edu/blog/2010/09/a-brief-history-of-azt.html