Background:

In 1993 Robert Latimer killed her 12 year old daughter by carbon monoxide poisoning. He freely admitted his participation in this murder. His daughter had been diagnosed with cerebral palsy since birth and was physically and mentally handicap since the beginning. Due to her physical disability was forced to undergo a myriad of surgeries just to stay alive. Out of so called mercy he decided to end her life. Many in the jury that tried him agreed with his point of view and gave him a light sentence. However those who fight for handicap rights challenged this ruling.

Dilemma:

This case brings up a 2 major dilemmas. The first one is euthanasia, should euthanasia be allowed in the first place, and if so who get’s to decide when it can be administered. The second is protecting and respecting the autonomy of those who are handicapped. Should Latimer’s point of view be accepted and this case taken as a precedent then it brings up the question of who is qualified to judge another person life as too painful to live and who get’s to say when they should be euthanised. If others are allowed to decide for those who are handicapped then where is the line drawn and many fear a slippery slope leading to abuse against handicapped people.

Discussion:

In life there is a limit to fighting, sometimes there are fights that we cannot win. Part of being wise is knowing when to thrown the towel and give in as sometimes it just not worth fighting. Thus in my personal opinion euthanasia should be a perfectly legal. In this case Latimer’s daughter’s life was not a life worth living. Her being bound both physically and mentally into a twisted shell of a body that requires painful surgery just to keep going. Her life is not what I would call living, that is merely existing. Should she live to adulthood she would still be bound to her parents and be unable to do anything on her own. At that point she is worse off than a rock as she feels pain but can’t move, can’t think straight, and in essence can’t live a life worth living. The fact that she has no autonomy bring into the slippery slope argument but there are degrees to this and her condition definitely constituted an instance where proxy action is required.

This is a similar problem seen in cancer patients who must undergo painful chemotherapy which may prolong their life only of so long. In the name of preserving life they must live life under constant pain and yet in a poll given to Germany doctors, 50% of them declared they would not undergo the same procedures and rather just let themselves die happy. Thus euthanasia I think is something that should be handled on a case by base basis. Instead of trying to preserve life above all else, quality of life should be factored in and “mercy killing” be allowed. Instead of running away from the issue there should be a standardization or laws that generate criteria that the majority of physicians can agree upon. This should in turn would help combat the worries of the slippery slope where euthanasia may be used against the will of handicap dependent patients.

By setting up a defined set of laws or at least a basic framework that would help decide when euthanasia can be declared and bringing this issue out into the open those who would abuse will be forced to go through the law and protection would be provided for those who cannot stand up for themselves.

Citations:

Scurr, Martin. “Why MOST Doctors like Me Would Rather DIE than Endure the Pain of Treatment We Inflict on Others for Terminal Diseases: Insider Smashes Medicine’s Big Taboo.” Mail Online. Associated Newspapers, 14 Feb. 2012. Web. 26 Feb. 2015.

Since the development of modern medicine, things such as euthanasia and physician-assisted suicide have frequently been the subject of media headlines and article titles, but furthermore this issue has been the focus of many medical, legal, and ethical discussions.  There are numerous reasons for this, but I argue that what attracts these cases to such extensive debates is the amount of ambiguity that complicates the dilemma, and this ambiguity is often filled in by personal belief or paternalistically skewed rationale.  But within these debates are the concepts or (a) sanctity vs. quality of life, (b) interests and consent, (c) the dying vs. non-dying, and  (d) active vs. passive measures (Thomas, Waluchow, & Gedge 210-213).  The two cases discussed in the book Well and Good serve as examples of the moral confusion that can arise from ambiguity in the obligatory duties for the physician, who is faced with the decision to either prolong the patient’s life or not, along with the countless considerations, both legally and ethically, to be made.

Carole is an 81-year-old woman on life support that makes it possible to sustain her semi-conscious state, where she is incapable of rational thought and communication.  The patient has no local family other than a son, who requests, despite the chronicity of his mother’s condition, that the doctors prolong her life by resuming life support treatment.  That is, until he can earn an unrealistic amount of money to fly his mother to Jamaica so she can pass away there or if someone is able to lift the curse that she put on him.  In other words, the physicians are faced with the decision to either continue providing the services and resources necessary to keep the woman at a state that straddles the line between life and death, or deny the woman of such needs as well as her son’s wishes to the doctor.  Obviously, as a healthcare professional, there is always an underlying obligation to preserve lives, but in many cases, perfectly exemplified by this scenario, it seems not only acceptable but right to discontinue the life, thereby reserving those resources for someone who could more genuinely benefit from the treatment, one of the points mentioned by Thomas et. al. (212).  What we ought to do if we were the physician can be determined by considering the situation from the angle of each of the four topics mentioned above that are outlined by Thomas et. al.

(a) Sanctity of life vs. Quality of life

People can say that every life is worth saving, but I think it would be tough to make an argument in cases such as this.  We can’t know for sure what is going on in Carole’s mind, but we can be confident in assuming she’s not having the best time of her life being connected to machines that she would die without.  There is no quality of life to evaluate for her and no real chance of her ever having a life of any true quality, so this life is not as sacred or valuable as a person with a chance of surviving/regaining a better quality of life.  Therefore, we can’t say that it would be reasonable or fair to turn away a patient who needs the same equipment and attention being given to Carole if it is likely that the treatment would have a greater impact on the new patient’s health and well-being.

(b) Interests and Consent

The patient in this case is clearly unable to make any rational decisions for herself, so the issue of consent is justly directed towards her immediate family, her son.  It is understandable for the son to want to prevent his mom’s death, but at one point or another, he will have to deal with the loss and its consequences.  It cannot be the physician’s responsibility to see to it that every patient’s dying wish is granted.  This is a situation where the amount of care and resources would outweigh the physician’s responsibility to maintain treatment, given the state of the patient and the unrealistic request by the son.

(c) Dying vs. Non-dying

The distinction made between patients who are dying or not dying is not necessarily applicable to this case.  It is more of a concern for those patients who are not dying but are requesting to die.  Clearly for Carole because of her incapacity to communicate, we can’t be sure what her desires are, but it is likely that discontinuing treatment would save her a good amount of suffering.

(d) Active vs. Passive measures

When assessing the moral correctness of a decision that involves the death of a patient, one of the primary details is whether the physician’s behavior reflected an active or passive effort in contributing to the patient’s survival.  Additionally, this idea is commonly associated with the killing vs. letting die debate.  In the particular case of Carole, however, the physician’s action of discontinuing life support is difficult to evaluate ethically because in order for the patient to die of “natural” causes, the plug would first need to be pulled.  So it seems that you could pin the doctor with killing the patient, although her services prolonged the life significantly.  I don’t think it is fair to judge the doctor’s actions in this way.

Overall, after analyzing the case and the details within it that pertain to the four principle dilemmas described above, I think it would be just to cease life support treatment for the patient if another patient requires the use of the same equipment.  This is a very economical way of viewing the situation, but it is suitable because it would be impossible to consider any input from the patient.

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. New York: Broadview, 2014.

Beauchamp and Childress outline the difference between killing and letting die. Both require moral discussion because they bring up moral dilemmas of nonmalefence, and in some cases, autonomy. Killing involves one imposing some sort of intervention on the patient that ends his life, such as providing euthanasia. Letting die means that a medical intervention is not used and the patient therefore will die, such as disconnecting a patient from a breathing machine when he does not have functioning lungs. There are some cases when killing or letting die are always wrong, and other cases where the moral lines are less clear. Beauchamp and Childress describe how the action alone is not the moral dilemma, “rightness and wrongness depend on the merit of the justification underlying the action, not on whether it is an instance of killing or of letting die”(p. 176). Killing and letting die are instead unique acts that are incredibly dependent on a specific situation when trying to morally justify them.
Many laws surrounding killing and letting die are very restrictive because of this. Laws do not govern specifics situations, but all situations. Because killing and letting die could occur in situations that would make the acts morally wrong, laws are overly cautious and restrictive of this. One of the most controversially debated issues today is the state-by-state legality of late-term abortions after twenty weeks of pregnancy. This relates to the issues of killing and letting die because many of the women who seek late-term abortions are pregnant with fetuses with severe medical issues.
Fetuses always are complicated to discuss because there is disagreement about whether or not they should be morally considered in the same way as living humans. Conversations surrounding abortion, however, consider the fetus much more after twenty weeks of pregnancy because the fetus is viable outside the womb and therefor could become a person. Many states have outlawed abortion after twenty weeks because of this, thinking it is comparable to infanticide. One of the biggest arguments against this, though, is that it can be very harmful to both women and fetuses with health complications to not allow abortion.
With advanced obstetric technology today, health complications in utero can be detected most of the time. Some of these complications like severe spina bifida, heart problems, and brain tissue damage are known by doctors to cause a baby to die shortly after birth. Nonmaleficence is used to justify abortion in this case because it eliminates the pain the newborn baby will face shortly before death. It also eliminates the emotional pain and trauma parents go through by carrying a fatal fetus to term and then watching it die shortly after birth.
In these cases, abortion proponents argue that killing the fetus by aborting the pregnancy causes the least amount of harm for both the parents and the fetus. Often times the fetus can feel pain in utero and in almost every single case will feel pain after it is born. Opponents of abortion argue that killing a fetus is always wrong and that the fetus dying naturally in utero or after birth is the best approach. Letting die could also apply to babies born with health complications. Many parents who find out about the health complications before the child’s birth choose not to intervene when the child is born. They often feel that surgeries and medical interventions will only cause the child pain for a small chance of recovery. Opponents of abortion often support this approach because it avoids killing the fetus, but also minimizes additional pain the baby could feel.

Citation: Beauchamp, Tom L., and James F. Childress. “Nonmaleficence.” Principles of Biomedical Ethics. 7th ed. New York, NY: Oxford UP, 2013. 174-78. Print.

Sanctity of Life Vs. Quality of life: Teri Schiavo

            The cases this week made me draw from one of the most well known cases in “the right to die” realm. It is clear that the line between killing and letting someone die is a very blurred one ethically. Is becoming, in essence, a sideline spectator more morally justifiable than aiding in an act? What constitutes assistance with regard to nonmaleficence? Does this all boil down to semantics? The difference between quality of life and a life quality is also important to take into consideration. Sanctity subscribers would argue that life is life regardless of condition. (Thomas) While others in the quality camp would argue that life quality is marked by certain qualifiers. (Thomas)  In the Koch article there is an interesting line with regard to surrogate perception. “The external determination of a diminished or unacceptable life quality is often not shared by the person whose life is being judged” (Koch). This is a truly disturbing thought because one is forced to question the line between discrimination against disabled persons via bias and fear, and a life that is unacceptable to the person. On one hand is maleficence and the other nonmaleficence.

Background:

Teri Schiavo was a young vibrant woman until 1990 when she suffered a heart attack that left her anoxic, completely oxygen deprived. The significant amount of brain damage led to a coma, which her doctors later updated to persistent vegetative state. (Perry 2005) Cumulous amounts of physical and speech therapy was tried with no success.  Teri had no living will. After eight years her husband decided enough was enough and that Teri’s feeding tube should be removed, however her parents did not agree. Thus began a legal battle that would not conclude until 2005. This battle went all the way to the United States Supreme Court.

            Who should act as a surrogate with regards to the principle of nonmaleficence? Teri’s husband says that his wife would not want to continue to exist in this state, and that since her state had not improved in fifteen years she should be allowed to die via starvation. Her family argues that it is a violation of human rights to purposefully starve a person, and that this decision preyed on her disability in line with some of Koch’s thought.  Also that it was a violation of their Catholic faith to be euthanized via nutrient deprivation.

Course of Action:

            With regards to nonmaleficence, I agree with the decision eventually came to by the supreme court to remove Teri’s feeding tube. Teri had been in a vegetative state for fifteen years her husband is the one that should be granted surrogacy. Her husband if deemed to be competent, in good standing with Teri prior to the accident, and not motivated by something else would have the best idea of her wishes.  He would have the best idea if there is anything left in Teri’s life that she values, which constitutes quality of life (Thomas). Her brain activity suggested that she had been brain dead for a while now. With regards to maleficence there is very little harm being done by removing her feeding tube and letting nature take its course. Her parents argument that nutrient deprivation is against their religion is valid, however it can be argued and supported with text that this is just allowing her body to take its natural course. Also since she had no real choice in the matter her soul would be spared from judgment.

Sources

Perry JE, Churchill LR, Kirshner HS. The Terri Schiavo Case: Legal, Ethical, and Medical Perspectives. Ann Intern Med 143:744-748 (2005).

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. New York: Broadview, 2014.

(Image source: http://www.cbc.ca/news/canada/compassionate-homicide-the-law-and-robert-latimer-1.972561)

Society agrees upon nonmaleficence, the avoidance of causation of harm, as a fundamental principle of biomedical ethics (Beauchamp and Childress 13). For example, the idea of “do not kill” guides many in everyday actions. However, society has specified the aforementioned principle to include exceptions, such as “in the case of self defense”. Case 6.3 with Robert Latimer and his daughter Tracy exemplify another specification on the idea of “do not kill”, for Robert argues not to kill an individual unless in the best interest of the individual. For example, “Robert’s defence was that his act was “mercy killing” and that he had acted only to relieve his daughter’s continued and inevitable suffering,” (Thomas, Waluchow, and Gedge 222-223). Thus, he killed Tracy to protect her from a future life of pain. As a result, the judicial system classified this case as a “compassionate homicide”. The term “compassionate homicide” seems oxymoronical, for the principle of maleficence typically does not align with beneficence. For instance, beneficence would not justify an act of killing. However, the idea of “compassionate homicide” argues that beneficence, a connotation for acts of kindness and mercy (Thomas, Waluchow, and Gedge 202), promotes nonmaleficence. Thus, perhaps one principle of biomedical ethics can outweigh another principle.

(Image source: http://becuo.com/uneven-balance-scale)

Nonetheless, this case highlights many other ethical issues as well. For example, as an individual with cerebral palsy, the murder of Tracy challenges the rights of the disabled. The text articulates the slippery slope with regard to parallel scenarios, such as the withdrawal of life-support and physician-assisted suicide. However, the permissible violation of the fundamental right to life for people with disabilities can lead to the slippery slope of others further specifying “do not kill” to include other groups, such as the terminally ill. Thus, the judicial system opened up a frightening path for discrimination. In addition, this case questions the role of a medical proxy for an individual who cannot competently make a decision for himself or herself, because Robert made the medical decisions for Tracy. In Robert’s decision to end Tracy’s life, he acted on an extension of his duty to decide the treatment in the best interest of Tracy. As previously mentioned, Robert claimed that he killed Tracy to free her from future pain and suffering. However, his justification relies on an assumption that Tracy did not want to experience pain and preferred to die. The judicial system, for the context of this case, cannot assume that Tracy would have expressed the aforementioned desires. Unfortunately, however, the media influences individuals’ beliefs. For instance, news stations broadcasted the story of Brittany Maynard, a woman diagnosed with a brain tumor and only six months to live (Maynard). As a result of her poor projected quality of life, Maynard chose to undergo “death with dignity” and end her life instead of living in pain (Maynard). Thus, one can understand Robert’s justification for the “compassionate homicide” due to the influence, but Tracy could not express the sentiment of preferring a high quality of life rather than life at all like Maynard. Therefore, society and the judicial system should not justify the violation of “do no harm” and nonmaleficence on an influenced assumption of beneficence.

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

Maynard, Brittany. “My Right to Death with Dignity at 29.” CNN. Cable News Network, 02 Nov. 2014. Web. 26 Feb. 2015. <http://www.cnn.com/2014/10/07/opinion/maynard-assisted-suicide-cancer-dignity/>.

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. New York: Broadview, 2014. Print.

I find Beauchamps and Childress’s explanation of killing vs. letting die inadequate. I believe that they overlook a foundational question and that they contradict themselves. The authors argue that “in ordinary language, killing is a causal action that brings about death, whereas letting die is an intentional avoidance of causal intervention so that disease, system failure, or injury causes death” (175).  Death is the obvious result of both of these explanations, but Beauchamps and Childress barely address death in the explanations they give. I would define killing as the taking life and letting die as the allowance of death. While my definition is very simple, I believe it focuses on the foundation of the distinguishment: death.

I believe the core question is “when is death acceptable in a medical setting”? One flaw that the authors have is the lack of specification. They justify their explanations with non-medical examples that apply conceptually, but not in practice. For example, they support the claim that killing “does not entail a wrongful act or crime, or even an intentional action” with the case of one driver killing another in an automobile accident (175). Conceptually, this example could apply in a medical setting because a doctor and a driver could kill a person. I believe it does not apply in practice to a medical setting because a doctor has more responsibility to a patient than a driver has to a fellow driver or pedestrian. A doctor has an obligation to try and improve the life of his/her patient, while a driver has an obligation not to interfere with others drivers. I do not believe that the responsibility that a driver has can be compared to that of a doctor because a doctor has an obligation to improve the other but a driver has an obligation not to interfere. Therefore, I believe that the driving example is inadequate to support the claim that killing “does not entail a wrongful act or crime, or even an intentional action” (175).

Furthermore, Beauchamps and Childress go on to contradict the claim that killing “does not entail a wrongful act or crime, or even an intentional action” (175) by stating that “killing has traditionally been conceptually and morally connected to unacceptable acts (176). By definition an act that is unacceptable is wrong; therefore, killing has to be wrong if it is unacceptable. Now, it is possible for something to be wrong, but acceptable. For example, some doctors over treat patients and that is wrong, but it is acceptable.  The authors try to justify their contradictory claim by giving examples of cases that do not apply to the foundation of the issue. They list a series of circumstances in which killing is justified. I believe that this does not apply when making the distinguishment between killing and letting die because you cannot use exceptions to create the rule. At the foundation, killing will always be wrong because it is unacceptable. There is a difference between justification and acceptability. Things that are accepted are the norm and apply in majority of circumstances; but there are some circumstances in which things can be justified in order to be accepted, but they are not the norm. I believe that the authors support their arguments in this section based upon the exceptions and not the norms. You cannot build a strong argument based off of exceptions. Thus, I find their distinguishment between letting die and killing to be inadequate.

Dilemma

A son’s mother, Carole, has been in the ICU for several weeks, is semi-conscious, and is now almost completely unaware of her surroundings. All of Carole’s attending physicians agree that her breathing muscles are irreparable and that she will suffer more cardiac arrests. Thus, since she is completely dependent on a machine in order to continue surviving and is no longer able to return to a life outside of the confining walls of the ICU, I believe her attending physicians are justified in issuing a “do not resuscitate” (DNR) order.

Analysis

Over the course of the past several weeks, her attending physicians have had sufficient time to carefully and properly assess her condition and consult with each other. The decision is not being made hastily, in an emergency room setting. Nor is the decision being made by a sole attending physician.

One opposing argument I foresee considers the religious and cultural concerns of this case. The healthcare team must be cautious of respecting the religious and cultural identity of a patient and a patient’s immediate family. But to what extent? The son argues that his mother’s soul is at stake if she passes away in a foreign land. Additionally, he will be cursed if he cannot return his mother to her homeland prior to her death. In their religious and cultural context, both of these concerns are valid. However, the son is (realistically) unable to fulfill his mother’s and his own personal wish in a timely manner, because he is “penniless and unemployed”. In this situation, the healthcare team must balance these different factors and determine what course of action is in the best interests of the patient’s health, especially since she can no longer provide her informed consent. (Apparently, she can no longer even carry out a rational conversation.)

Her health will deteriorate even more with additional cardiac arrests, while prolonging her stay in the ICU will increase her dependency on the machines. It seems that Carole’s quality of life is decreasing. Since both the son and his mother are deeply religious, I wonder whether the healthcare team could have a holistic conversation with the son, together with a trusted religious figure, about his mother’s realistic health outcomes, her suffering, and her quality of life. This approach could help the son think beyond the threat of a curse and consider an alternative decision.

Works Cited

Thomas, John E., and Wilfrid J. Waluchow. Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. Toronto: Broadview, 2014. Print.

Case 8.1 “Don’t Let My Mother Die”

Background:

Mrs. Jones is an 81-year old, deeply religious Jamaican native. Although we are not informed as to what type of religion Mrs. Jones’ practices, one might assume that it is a some sort of mix of Christianity and Myalism. Myalism is a religion deeply rooted in African tradition, adopted by Jamaican slaves to recreate their past. In the late 18^th century, the beliefs and practices of Myalism began to be mixed with Christian traditions to form a religion that is still practiced by many Jamaicans today (Morrish 45-47). Having identified closely with her homeland’s traditions, she believes that her soul will be “condemned to wander the universe aimlessly for an eternity (Thomas and Waluchow 175)” if she dies in a foreign land, a belief consistent with Myalism. We are told that, at some point in time, Mrs. Jones moved to Edmonton, Canada with her son.  A “fair bit of time (Thomas and Waluchow 175)” later, Mrs. Jones’ health began to decline and her breathing muscles eventually became paralyzed, resulting in multiple cardio-respiratory arrests. Due to the paralysis of her breathing muscles, Mrs. Jones had to be placed on a respirator and was admitted to the Intensive Care Unit. Despite attempts to wean her off of the respirator, she was unable to regain the ability to breathe on her own and, we are told, likely never would. Additionally, Mrs. Jones has lapsed into semi-consciousness and is unaware of her surroundings. Before losing consciousness, Mrs. Jones placed a curse on her son should he not return her to Jamaica to die. Although the son wants to arrange her return, he lacks the financial means. The hospital is also unable to transport her back to her native land. The attending physicians, recognizing the likelihood of a future cardiac arrest, are trying to decide whether or not a Do-Not-Resuscitate order should be issued.

Dilemma:

The dilemma that the attending physicians face is three-fold. The first dilemma is whether or not it is moral to passively cause the death of Mrs. Jones. Is passively causing death a violation of the moral principle of non- maleficence? The second concerns how best to minimize harm and what types of harm they should minimize. More specifically, should they minimize biological harm to Mrs. Jones by not resuscitating? Or should they resuscitate in hopes of returning Mrs. Jones to Jamaica and thus minimizing spiritual harm to both Mrs. Jones and her son? This raises an interesting question about what rights someone has in choosing how they die (if they are to die in the first place). The second dilemma involves autonomy and whether or not surrogate autonomy should be awarded to Mrs. Jones’ son.

Analysis:

I believe that the attending physicians should grant Mrs. Jones’ son surrogate autonomy and thus allow him to make the decision as to whether or not Mrs. Jones should be resuscitated if she suffers another cardiac arrest. Additionally, I think that Mrs. Jones’ son should demand that the physicians attempt to resuscitate Mrs. Jones while arrangements for her return to Jamaica are being made.

According to Warren and Fletcher, a human life must have the following distinctive qualities to be worthy of protection: rationality, self-awareness, and autonomy. In Mrs. Jones’ semi-conscious state she is both unaware of her surroundings and unable to hold rational conversations. Due to this limited capacity, Mrs. Jones is regarded as a non-autonomous being and deemed incapable of giving informed consent by the attending physicians. One might conclude that, by Warren and Fletcher’s standards, Mrs. Jones’ life is no longer worthy of protection and that she should therefore not be resuscitated should she suffer another cardiac arrest. Although I recognize that Mrs. Jones’ quality of life in her present state is very low, I believe that protections should still be granted for her “afterlife” and that one should not only respect the sanctity of life, but the sanctity of death as well.

When looking at this case from a solely biomedical perspective, it is easy to dismiss Mrs. Jones and her son’s wishes concerning the fate of their souls. Along the same vein, it is easy to be critical of a Jehovah’s Witness who declines a life-saving blood transfusion. However, it is important to recognize that the experiences of health, illness, and death are not just biological, but cultural, religious and social. When considering non-maleficence, then, we must consider not only the harm done to the person physically, but socially, mentally, and spiritually as well.  Just as a Jehovah’s Witness would mourn the loss of their soul if they were to receive blood products, so too would Mrs. Jones’ son suffer if he was not able to return his mother to her native land to die. Along with extreme guilt, he would also likely feel paranoid about having a conditional curse put on him.

Additionally, it is important to consider that Mrs. Jones’ son is perfectly capable of assuming surrogate autonomy. Although his inability to pay for Mrs. Jones’ trip to Jamaica makes the return to her native land more complicated and less likely, this in no way inhibits his ability to make a decision about whether or not to resuscitate on his mother’s behalf.

Works Cited:

Beauchamp, Tom L., James F. Childress. Principles of Biomedical Ethics. 7th ed. N.p.: Oxford

University Press, 2012. Print.

Thomas, John E., and Wilfrid J. Waluchow. Well and Good: A Case Study Approach to Health

Care Ethics. 4th ed. Toronto: Broadview, 2014. Print.

Background

There are two very important cases presented in Well and Good titled “Don’t Let My Mother Die” and “Please Let Me Die.” I will be focusing on the latter. In this case you have a 26-year-old man named John who has been suffering with a neurological disease commonly known as “the elephant man’s disease” for 20 years now. Ultimately, over the course of his life he has had over 100 operations to remove tumors, which have lead to total deafness, partial blindness, total paralysis except for some movement in his right shoulder and total impairment of his breathing muscles. So John would be stuck on a respirator for the rest of his life and consequently, after everything, John does not want any more surgeries and he wants to die.

Dilemma

This case raises multiple concerns. One would be addressing the difference between letting someone die and killing them. However, the main moral issue here is whether to respect the patient’s autonomy or act out of nonmaleficence. Up to this point in John’s life it had been easy for the physicians to do both, considering that John agreed to his past procedures and by doing so the physicians were acting nonmaleficently. However, now John’s wishes would require the physicians to go against the principle of nonmaleficence because John now wishes to die. So what do you do here? Do you respect John’s decision and act based on his autonomy? Or do you act out of nonmaleficence and go against your patient’s wishes?

Analysis

Personally, I believe that the physicians must respect John’s decision and take him off of the respirator. There are many reasons behind my view. First of all, I believe that John has the right to make this decision and that he autonomy should be respected because of certain factors. The first factor being that John has been dealing with this disease for nearly all of his life, he has been dealing with it for 20 years. So when John finally decides that he would like to die, it is not like he has had this disease for one or two years and decides then that he doesn’t want to live anymore, he has been dealing with this for basically all his life, and since 20 years have gone by and the physicians know and tell him that there is no chance for remission, John’s decision is plausible. Moreover, respect for autonomy goes hand in hand with a competent, autonomous patient, and John was proven by his medical staff and social workers to be “fully alert, conscious, and in control of his mental faculties; he is able to make rational decisions and choices.” So where is the confusion? John’s decision must be upheld.

Furthermore, there is great controversy in the distinction between “letting die” and “killing.” Beeauchamp and Childress address this problem. They say that “letting die” is “prima facie acceptable in medicine under one of two conditions,” the condition relevant in this case is the second one stating that “patients or their authorized surrogates validly refused a medical technology.” That is, if the patient’s refusal of treatment is valid, then letting that patient die is acceptable, and in the above paragraph it is shown that John’s refusal is definitely valid.

Now some may want to argue that since John’s family was at first against letting him die, but after several counseling session finally came around to his decision, their decision was not their own but rather one they were most likely persuaded into. But even so, if they are truly trying to act in the best interest of John then they would respect his wishes. We have to look at John’s life in the long run. The physicians have told him that there is no chance of remission, and John has been living a paralyzed and physically disabled life for 20 years now. Even though John can continue to live he is severely depressed and will not live a happy or fulfilling life is he is to continue with the respirator and surgeries. So his family wanting him to live is a selfish desire, and they aren’t acting out of beneficence for John, but rather what would make them happy. So ultimately, I strongly believe that John’s autonomy must be respected in this case and his medical team is entirely morally justified in disconnecting his respirator.

Works Cited

Beauchamp, Tom L., James F. Childress. Principles of Biomedical Ethics. 7th ed. N.p.: Oxford University Press, 2012. Print.

Thomas, John E., and Wilfrid J. Waluchow. Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. Toronto: Broadview, 2014. Print.

Background

On October 24, 1993, Robert Latimer decided to end the life of his 12 year-old daughter, Tracy, who suffered from cerebral palsy.   He placed his daughter in the back of his pick-up truck and piped in carbon monoxide, which ultimately caused her death.   Robert justified his act by arguing that he committed a “mercy killing” for his daughter who was perpetually suffering despite undergoing numerous surgeries.  Ultimately, the court decided to convict Robert Latimer of second-degree murder and sentenced him to one year in prison and one year of house arrest.  Advocacy groups on end of the debate were outraged because they argued that court’s response is sending a message that the life of people with disabilities “is of diminished value” (Thomas & Waluchow 193). However, the court saw the Mr. Latimer’s action as one of “compassionate homicide” and that he was assuming the role of a “surrogate decision-maker”(Thomas & Waluchow 195).

Analysis 

Interestingly, in this case, the court’s decision reflects more of an adherence to moral principles as opposed to judicial laws.   Although his decision was in “clear conflict with the law” (Thomas & Waluchow 195), the court’s decision to give a “lighter” punishment seems to suggest otherwise.   This case illustrates that illegal actions are not necessarily unethical actions. After considering how the principle of non-maleficence applies in this case, I would agree with the court’s decisions. In the “Non-maleficence” chapter, Beauchamp and Childress outline a set of qualifications of surrogate decision makers for incompetent patients (Beauchamp & Childress 190). These qualifications include:

1. Ability to make reasoned judgments (competence)
2.  Adequate knowledge and information
3. Emotional Stability
4. A commitment to the incompetent patient’s interests, free of conflicts of interests and free of controlling influence by those who might not act in the patient’s best interests.

When taking these qualifications and applying it to this particular case, then Mr. Latimer’s decision seems to be morally justified.  His ability to make reasonable judgments is suggested by the fact that he characterized by others as “responsible and hardworking”.  It was also made clear that he was not in need of any sort of rehabilitation (Thomas & Waluchow 194).   As for the second qualification, it can be assumed that as the father and primary caregiver of his daughter that he had a lot of information about his daughter’s health  (past effectiveness of drugs/treatments as well as prognosis for quality of life).  Opponents would most likely argue that he lacks a medical background to fully understand the impact of future surgeries on Tracy’s health. However, he is probably more likely to understand the extent of her suffering because he is around his daughter far more than any other healthcare professional. Thirdly, Mr. Latimer’s emotional stability is not completely clear; though, those around him that describe him as “responsible” does suggest that he acts according to rationale as opposed to pure emotion. The final qualification is quite evident in Mr. Latimer.  The evidence showed that “his relationship with Tracy was that of a loving and protective parent” (Thomas & Waluchow 194).  Thus, after evaluating Mr. Latimer’s actions on the basis of these qualifications, his actions do seem morally “right” as he claims them to be.

Much of the resistance to permitting non-voluntary euthanasia as well as aid-in-dying requests seems to stem from feelings of fear of what may happen in the future if it is widely permitted across different cases. Pat Danforth of the Council of Canadians with Disabilities, expressed his concerns that the decision made in Robert’s Latimer’s case sends a message to “every senior citizen, every quadriplegic, anyone in a car accident that their life is of diminished value” (Thomas & Waluchow 193). There is an underlying fear that if these actions and requests are permitted, that it will result in unnecessary deaths based on poor judgments and/or hasty decision-making.  Moreover, there seems to be an assumption that the use of euthanasia i is also an is an indication of how an individual’s life is valued  which is something I find particularly problematic.  Mr. Latimer’s decision to relieve his daughter’s continuous pain does not suggest that he does not value his daughter’s life.  Rather, his actions show that he values her enough to make a difficult decision and end her pain away. Fear of what may happen in the future is not adequate reasoning to prohibit aid-in-dying where it may be the sensible course of action as well and the action that the patient or surrogate decision-maker may want. With proper protocol, non-voluntary euthanasia and aid-in-dying can be implemented in a systematic manner into healthcare systems.

Work Cited

Thomas, John E., and Wilfrid J. Waluchow. “When Physicians and Family Disagree.”Well and Good: A Case Study Approach to Biomedical Ethics. 3rd ed. Peterborough, Ont.: Broadview, 1998. 192-199. Print.

Beauchamp, Tom L., and James F. Childress. “Nonmaleficence” Principles of Biomedical Ethics. Seventh ed. New York: Oxford UP, 2013. 150-193. Print.