Case

This is a case about John, a 26-year-old man, who has Neurofibromatosis, also known as elephant man’s disease, a neurological disease in which non-malignant tumors attach to the body’s nerves. This disease causes severe disfigurement and radical impairment of bodily functions. John was first diagnosed when he was 7-years-old and in the last 20 years, he has had over 100 surgeries to try to remove the tumors. These surgeries have had severe side effects resulting in John being deaf, partially blind, almost entirely paralyzed, and in need of a respirator to keep breathing. The medical professionals that have been caring for him say that there is no chance of remission. Based on his past experience, John has requested to not have anymore surgeries and for the medical professionals disconnect him from the respirator, which will inevitably cause his death. His family initially strongly disagrees with John but is ultimately convinced to support him. The medical team says that he would be able to live for years on the respirator but they too are prepared to disconnect it (Tomas and Wilfrid 209).

Dilemma

In this case the doctors face a dilemma between nonmaleficence and respect for autonomy. They have previously been acting under the principles of autonomy and beneficence because John had given consent to his previous surgeries and the acts that were taken were done so to save his life. The situation has changed and now beneficence has turned into a question of nonmaleficence.

Discussion

I argue that the doctors ought to disconnect the respirator and allow John to die. Nonmaleficence is in question because if they unplug the respirator they are technically doing an act that will cause harm because they are aware that John’s body cannot sustain his life alone. Since John has changed his mind about what he consents to, the doctors now have to balance between their respect for his autonomy and their value of doing no harm. The basis of autonomy starts with John’s competence. The doctors have described him as “fully alert, conscious, and in control of his mental faculties” (Tomas and Wilfrid 209). That description proves that John is considered a competent patient. The doctors ought not to question John’s competence when he expressed his wishes to allow his disease to take his life. He has shown a full understanding of his situation. He is aware that he has had countless surgeries yet he is not improving. This case also calls one to look at the distinction between killing and letting die. These doctors are technically killing John because they are taking an action that will result in his life ending but it is not that clear. This case blurs the lines between killing and letting die. Once the doctors take that action they are letting him die because once he is unable to breath they will intentionally not put him back on a respirator. Beauchamp and Childress state that part of letting one die is that “disease, system failure, or injury causes death” (Beauchamp and Childress 175). I argue that John’s brain disease will ultimately end his life, not the doctors. The medical team also does not feel comfortable with giving him a strong enough dose of medication that will accelerate his death. They are morally correct in this because that would enter the realm of killing rather than letting him die. Beauchamp and Childress go on to state that it is acceptable to let one die if the “medical technology is useless… or patients or their authorized surrogates validly refused a medical technology” (Beauchamp and Childress 175-176). In John’s case both of these conditions are met. The medical technology, surgeries and a respirator, have not been successful in treating him rather they have just kept him alive and, as stated above, he has now refused the technology. McIntyre gives further support of the moral acceptability for a physician to withdraw a life sustaining treatment because he is doing it “only to respect his patient’s wishes and ‘to cease doing useless and futile or degrading things to the patient when [the patient] no longer stands to benefit from them” (McIntyre 62). Nonmaleficence can be further specified in this case as do no harm except if the patient is competently refusing medical treatment and has no real hope for improvement. The medical team ought to disconnect the respirator and is morally justified in doing so.

References

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.

Picture

http://geneticdisorders247.wikispaces.com/Neurofibromatosis

Background

In 1984 William Schroeder became the second man in the world to receive an artificial heart transplant after suffering from terminal arteriosclerosis, and being largely bedridden after a massive heart attack. While everything may have seemed to be going fine post-surgery, within a few months Schroeder had suffered two hemorrhages, and went on to die on the 11th of November, 1985. Important to this case is the fact that the Humana Hospital, where he was admitted, agreed to pay for the $15,500 artificial heart system, while also supplying Schroeder and his entire family with free accommodations within the hospital, and on top of that, providing the patient with a specifically designed house tailored to his medical needs should he become well enough to leave the hospital. There is no denying here that Schroeder is, in a sense, a very expensive patient.

Dilemma and Discussion

The issue with Schroeder’s case, and with patients in similar rare medical circumstances, is that their medical expenses are staggeringly high compared to most procedures available. To make this issue even bigger, there is only a minute portion of the population that would ever be affected by his condition (50,000 in US, 5,000 in Canada). Now the question begs, is it worth it to allocate resources towards such procedures that would only benefit a small number of people? Or would that money be better allocated elsewhere, where the needs of the many would outweigh the needs of the few?

Medical care no doubt improves our lives, but there are numerous other types of social goods that can improve the lives of many, maybe to an even greater extent than medical care can. Discussed in the reading is the difference between “needs” and “wants”, where health is considered a basic need, and “wants are inessential to human flourishing, but add quality to our lives”. In regards to needs, I am in accordance with what was said in the reading, but regarding their definition of “wants”, I have a few things to say.

While I agree that wants add quality to our lives, I disagree whole heartedly that wants are “inessential to human flourishing”. Studies have shown that an enriched lifestyle filled with wants, play a crucial role in brain development. To quote a specific study, rats were placed in either a nurturing environment, or a deprived environment, and it was shown that these rats turned out to have epigenetic differences and grew up to either be anxious (deprived) or calm rats (nurtured). The deprived rats also had a significantly higher stress response later in life. This study shows pretty clearly to me that wants definitely have the potential to allow for human flourishing. Who’s to say cultural institutions and churches don’t have as vast, or greater an impact on human flourishing than that of medical institutions?

Conclusion 

While it is clear that procedures like the one listed in this case are costly, and the money used would no doubt have the potential to save more lives if allocated differently, I believe that if money is put into procedures like this now, there is more hope in the future for it to become a regular routine life-saving procedure. The reading mentioned that at a point in time the pacemaker was considered extravagant, and now it has improved the condition of millions of lives. Artificial heart transplants might currently seem extravagant, but if resources are allotted to it now it has the potential to become a regular procedure that saves many lives, but it will not have a future if it is never invested in. On top of that, I also believe that cultural institutions and “wants” carry almost as equal weight in improving our lives, and while I believe medical care investment should receive more weight, our “wants” should not be dismissed so quickly.

Works Cited

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

Powledge T (2011). “Behavioral epigenetics: How nurture shapes nature”. BioScience 61 (8): 588–592.

“Behavioral Epigenetics.” Wikipedia. Wikimedia Foundation, n.d. Web. 22 Feb. 2015.

Pictures

http://learn.genetics.utah.edu/content/epigenetics/rats/images/Pup.jpg

http://www.papworthhospital.nhs.uk/docs/images/our_services/transplant/Total_Artificial_Heart_and_Human_Heart.jpg

Background

Mr. M is a patient afflicted with a vasculitis disease that has further compromised the integrity of his lung health. This brings him into the hospital where he at first informs his attending physician to forgo any treatments required to resuscitate him if he suddenly became unresponsive. This kind of request is known as a Do-Not-Resuscitate Order, or DNR. However, upon hearing this news, the wife persuades the patient to reconsider his DNR request and Mr. M consequently recants his previous statements. The attending doctor now is put into a situation where his patient’s right to self-determination and unobstructed autonomy has been impeded upon.

Dilemma

As noted by Ho in the article discussion entitled,”Relational autonomy or undue pressure? Family’s role in medical decision-making”, the most important aspect in the definition of self-determination is maintaining a free, unclouded, and not coersed selection to have.not, hav. Given this criteria, one draws the conclusion that there has been a clear violation of Mr. M’s autonomy since his desire for a DNR abruptly changed only after speaking with his wife. It also brings up the issue that were the patient to become unable to speak for himself, would his wife be a suitable candidate to act as his moral agent given their obviously different standpoints on necessary life-saving medical intervention?

Reflection

The most difficult aspect of this case is ultimately deciding whether the patient’s rights were infringed and to what extent has this right been violated. If the doctor concludes that the patient’s conversation with his wife singlehandedly led to the unnecessary and coersive change in is DNR request, the doctor will then not only need to find a way to speak privately with the patient again regarding his treatment but also make sure the patient is no longer allowed to be a lone with his family. Another issue that arises from this case is the idea of a moral agent and how they are assigned to cases. If someone like a spouse or parent, who is normally assigned as a moral agent for patients once they are deemed incapable of speaking for themselves, can have completely polarizing views to the patient’s, how can it be said that they are truly acting in the best interest of the patient? I believe that the conversation had by the patient with his wife was indeed coersive and gthat the doctor cannot merely overlook this change in opinion as a normal decision. However, if upon confrontation between the doctor and patient leads to the patient maintaining that they would like their DNR repealed, the doctor will need to abide by this new request. Ultimately, the coherent voiced opinion of a patient carries the weight necessary to allow a change of heart to be considered, likewise, valid.

Works Cited

1.) https://web-a-ebscohost-com.proxy.library.emory.edu/ehost/pdfviewer/pdfviewer?vid=2&sid=92980486-cd52-4bae-90a4-7f0c98d75e4d%40sessionmgr4005&hid=4212

Summary

William Schroeder, a previously healthy man with an active lifestyle suffered a massive heart attack that left him with terminal arteriosclerosis. This led to Schroeder becoming the second person ever to receive an artificial heart. Humana hospital agreed to cover the costs of the transplant and even build a special house for Schroeder to stay in after his recovery was complete. The procedure was a success and Schroeder would seemingly live out the rest of his days without much discomfort, but things gradually took a turn for the worst, and Schroeder suffered a total of 3 strokes and eventually passed away after living 620 days with the Jarvik-7 heart in his chest (2).

Case Discussion

The primary moral dilemma discussed in the text is about the allocation of funding in healthcare. Should we spend exorbitant amounts of money on things such as artificial hearts that would only benefit a small percentage of patients, or should this money be better allocated to other programs associated with early detection and prevention that could benefit more people?

While I think this is an interesting issue to consider, I was particularly interested in Schroeder’s individual experience. Namely, I am concerned with whether the principles of nonmaleficence were upheld by Schroeder’s healthcare team. Beauchamp and Childress state these 5 rules about nonmaleficence:

1. Do not kill
2. Do not cause pain or suffering
3. Do not incapacitate
4. Do not cause offense
5. Do not deprive others of the goods of life

Surely, by giving Schroeder the artificial heart, all of these rules were being upheld. However, after his first stroke, Schroeder was left with severely impaired speech and memory problems. The patients wife stated:

“I see it as more of a research experiment. The longer he lives, the more information [doctors] will get. Only for us it’s so hard sometimes.”

This brings up an interesting situation to consider. While doctors are upholding the first and last of the moral rules stated above, some might consider keeping Schroeder alive on the artificial heart as violating the second rule. We are given little insight into Schroeder’s mental state, but we are told that Barney Clark, the first to receive an artificial heart, complained to psychiatrists that he wanted to die on several occasions.

While I do not think it is any of the doctors intent to cause pain or suffering, one must think about who is benefitting more from the artificial heart, the doctors or the patient? The data being gathered from Schroeder’s experience could be invaluable to improving the procedure for future recipients of artificial hearts, but it seems that he is in considerable suffering without a hopeful chance for living a normal life. It would be interesting to read what was in the extensive consent form that Schroeder and his wife agreed to before undergoing the procedure.  Furthermore, I have been unsuccessful in finding any studies that assess mental health of artificial heart recipients.

References

1. Beauchamp, Tom L., and James F. Childress. “Nonmaleficence” Principles of Biomedical Ethics. New York, NY: Oxford UP, 2001. 150-193. Print.

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

In Case 6.4 Stephen Dawson: Should Severely Mentally Challenged Patients Be Treated in Well and Good, we are introduced to a seven-year old boy named Stephen with severe mental and physical handicaps in need of a simple but life-sustaining surgery. Stephen’s parents made the decision (since Stephen was a child, mentally handicapped, and non-verbal) that he should not receive the surgery and be “allowed to die with dignity rather than continue to endure a life of suffering” (Well and Good).  The main questions that this case presented to me was regarding who gets to make life and death decisions for the mentally handicapped, how much should the quality of life of the mentally handicapped affect their treatment options, and should treatment ever be ceased if we don’t know the will of the patient?

For me, the answer to the first question is fairly clear: the person with the most knowledge of the disabled person’s quality of life and day-to-day activities should be allowed to make the health decisions. This does not necessarily deem the parents or family members the most adequate to make decisions for the patient. I will have to agree with the authors of Well and Good and the courts deciding on Stephen’s case that in this situation, the parents aren’t the most fit to make decisions regarding treatment. Stephen had not been living with his parents the past couple of years, and workers at Sunny Hill argued that he had been understimulated and had a higher potential for mental capacity than what had shown and what his parents claimed he had.

The next two questions from the case are related and ask when, if ever, is it morally acceptable to cease life sustaining treatment of a disabled person, if you can’t know his or her will regarding the decision? For me, this wasn’t a question of whether or not disabled people have the right to the same life sustaining treatment that mentally competent people have because that answer is obviously yes. However, the question arises of how far you should go to sustain the life of a mentally disabled person with a very low quality of life when you cannot know their will. This is a question of non-maleficence, and whether or not a low quality of life does more harm to a person than death. If the person were mentally competent, we would simply allow them to make the decision on their own about whether their quality of life is worse than death. However, with Stephen being a child and mentally disabled, we cannot know anything definite about how he feels or how his quality of life is. We can only make assumptions about what we see. If Stephen had a chance of getting better, I believe this case would be much easier to decide. However, it is apparent that performing this surgery, despite its low risks, would simply be extending a life of low quality where he would continue to worsen until he died.

Despite all of these facts, I believe the judge was right to allow the State to make the decision to provide Stephen with the treatment. While to us it may seem like Stephen has nothing to live for, he could be a perfectly happy little boy. The problem with deciding that Stephen shouldn’t have the surgery is that we would be deciding for somebody else, who can’t tell us otherwise, that his life is no longer worth living. According to the President of the National Federation of the Blind, “when doubt exists at any time about whether to treat, a presumption always should be in favor of treatment” (“Medical Treatment of Disabled Infants”). This statement was made originally regarding disabled infants, but I believe the same logic should be applied to any young disabled child. They are not only too young to understand what is going on, but also don’t have the mentally capacity to tell us how they feel about their situation. The California Institute of Justice also released a set of amendments regarding the “legal rights of persons with disabilities, which also has a section on disabled infants that I believe applies to Stephen’s case. It says that “the[se] amendments attempt to ensure that decisions about medical treatment for handicapped infants are not made on the basis of subjective opinions concerning the future ‘quality of life’ of a person with a disability” (“Legal Rights of Persons with Disabilities, 65). The California Institute of Justice is making the same point I am making, that we cannot make life or death decisions for a mentally disabled person simply on what we think their quality of life is. We cannot know it for sure, and what if we are wrong and kill a little boy who was disabled but otherwise happy? In the end, I believe it would do more harm to the patient to guess about what he perceives his quality of life to be and allow him to die, than to continue to treat and allow him to live the rest of his life.

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 5th ed. New York, N.Y.: Oxford UP, 2001. Print.

Lockyear, Bill. “Legal Rights of Persons with Disabilities.” State of California Department of Justice. 1 Apr. 2006. Web. 21 Feb. 2015.

“Medical Treatment Of Disabled Infants.” National Federation of the Blind. 1 Mar. 1985. Web. 21 Feb. 2015.

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

How big of a role should our family play in our lives? Obviously, family members are significant others who have and will influence us in every aspect of our lives. However, when it comes down to making medical decisions, I believe that family members’ opinions should be carefully and critically evaluated. When patient’s autonomous decision clashes with those of family members, doctors should be able to follow the decision of the patients while respectfully letting go of what family members have to say and have decided.

Consider Mr. M who reversed his decision regarding resuscitation and other life-extending measures after talking with his wife (1). Mr. M is totally autonomous. He was fully conscious and was aware of what he was going to encounter; in other words, he was competent because he had the abilities to comprehend, process information, and reason about consequences of his actions, which we can somewhat assume from what is told from the short scenario (2). Therefore, there is no reason for considering his family member’s opinion at all. It may sound harsh, but here is my question: can we say it is moral for a person to defer his autonomy to another person when he is competent? This is completely different scenario from one giving informed consent to doctors to perform a surgery. In the latter case, there are voluntary, understanding, and authorizing actions that rise from one’s autonomy, while in the former case one is completely giving up his or her autonomy. Family members are very important involved in decision-making, but the final say should go to the patient who is competent.

http://statusmind.com/images/2013/04/FamilyFacebookStatusMindPictures-8573.jpg

One general belief of relationship between family members is that they aren’t based on temporary contracts but on empathy and beneficence family members have towards one another (1). This argument can be used to defend the view that family members have a say when making a medical-related decision. There is nothing wrong with this statement itself, but the interpretation of the meanings of empathy and beneficence may become problematic. For instance, one Jehovah’s Witness family member in the Well and Good would not support blood transfusion thinking that it will ruin one’s soul and ultimately turn into dust after death instead of being saved to enjoy the eternal life with God. However, there is the patient who is not as devout of a believer pleading to doctors to save her life (3). There are many issues to consider, but I would like to briefly focus on one of them here whether we can consider the family member’s point of view as beneficence.

The Jehovah’s Witness family member who doesn’t support blood transfusion holds irrational belief that prevents him from grasping true belief, which would allow him to have a reasonable argument to deny the surgery with blood transfusion if he had one. Doctors should be hesitant to respect his choice for his daughter because his opinion isn’t reasoned from a true belief and thereby is not rational (4). True belief comes from understanding the contextual information and applying those information to set one’s goal. The father believes that he is doing what is the best for his daughter by not giving blood transfusion and saving her soul, but since it’s based upon a false, irrational belief, it is a false beneficence that would actually harm and kill his daughter. I think it is important to realize that empathy and beneficence are what give family members a say to what the patient goes through in the hospital setting; nevertheless, it is also crucial to consider where the beliefs of the family members are coming from.

Generally, family members seek the best option for the patient, but doctors should still respect patient’s autonomy over the family’s input in patient’s decision because the values the family members hold may not necessarily correlate with what patients hold. Better yet, doctors need to be careful and put more weight on patients’ autonomy; family members’ views might not always be based off of a true belief, as it wasn’t in the Jehovah’s Witness case.

References:

1. Ho, Anita. “Relational Autonomy or Undue Pressure? Family’s Role in Medical Decision-making.” Nordic College of Caring Science (2008): 128-35. Print.
2. Beauchamp, Tom L., and James F. Childress. “Respect for Autonomy.” Principles of Biomedical Ethics. New York: Oxford UP, 2013. 117-40. Print.
3. Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. “Case 3.5 Religious Conflict over a Life-Saving Blood Transfusion.” Well and Good: A Case Study Approach to Health Care Ethics. N.p.: n.p., n.d. 142-50. Print.
4. Savulescu, J., and R. W. Momeyer. “Should Informed Consent Be Based on Rational Beliefs?” Journal of Medical Ethics 23.5 (1997): 282-88. Web.

In this week’s blog, I analyzed the reading discussing the idea of autonomy vs. pressure from family to make a decision about health.  The case that I looked at was Mr. M’s. He was admitted into the intensive care unit because of respiratory issues. Initially he had told the doctor that he did not want anything extraordinary done regarding procedures that may resuscitate him. However, his wife intervened and said Mr. M needs anything that can be done to extend his life and Mr. M changed his mind about his initial decision after speaking to his wife. The doctor believed that Mr. M’s autonomy had been compromised and as a result this case looks at familial pressures on autonomy.

The main dilemma in this case has to deal with whether the patient deserves an autonomous decision or if familial help is necessary to make a decision. When facing tough decisions in a weakened state, a patient relies heavily on their support system (family) to help them through tough times. Doctors thus need to be able to identify if a patient is making an autonomous decision during their vulnerable state while maintaining respect for the patient’s full entourage.

While looking at both sides, I believe the doctor should prefer to take the patient’s autonomous choice into account when making clinical decisions. This statement is particularly true when a patient has full control over their mind and is able to make decisions for themselves. In today’s diverse world, there are many different types of support groups that patients surround themselves with which are outside of the standard family concept. Doctors must be able to abide the principle of non-maleficence when handling the patients by doing no harm. A doctor’s relationship with a patient has a holistic point to it and comes from both being respectful to the patient and their body. By respecting a patient’ s familial concerns while keeping the interest of the patient in mind, doctor’s can make a decision with respecting both the principle of autonomy and non-maleficence. In the case of Mr. M, I believe that the doctor should respect what he wants to do even if he suspects coercion by the wife.

Works Cited

Ho, Anita. “Relational Autonomy or Undue Pressure? Family’s Role in Medical Decision-making.” Scandinavian Journal of Caring Sciences 22.1 (2008): 128-35. Web.

http://thumbs.dreamstime.com/x/indian-female-medical-doctor-patient-family-smiling-friendly-health-care-concept-isolated-white-background-32148934.jpg

http://aptelresearch.com/wp-content/uploads/2013/10/doctorpaitnttalking.jpg

The case of Stephen Dawson, a seven-year-old boy with severe mental disabilities, discusses many difficult ethical issues. The influence of this case impacts other cases with severely mentally ill patients, but additionally impacts larger cases including different moral principles.  The first issue the case discusses is who is responsible for making the health care decisions of those who are not competent to make the decisions themselves. Secondly, it discusses the difference between withdrawing and withholding treatment. Lastly, and the issue that I want to discuss, is the moral status of those with disabilities.

In the case of Stephen Dawson, I believe that the state was morally correct in usurping parental control over the child and performing the life-sustaining surgery. Despite Stephen’s severe physical issues, he is still a human to whom, dependent on which theory you subscribe to, the principles of moral status apply.  He has sentience and therefore feels physical and emotional pain. He has human properties, including human DNA and being of the human species. But, because of his disability, the suffering of others overpowers his ability to be treated as someone who is not disabled.

By electing to not complete the surgery on their son, the Dawsons are dismissing the value in the life of their son. In the case discussion, the Supreme Court Justice of British Columbia, Justice Lloyd McKenzie, stated the life of a severely handicapped child had been placed above a healthy child. All throughout this case, Stephen’s welfare was often not the priority, and his life was viewed as disposable. Many of the statements from Judge Bryne, who ruled that the Dawsons should “allow their son die”, discuss the great burden placed on parents of Stephen as evidence for his ruling. The needs of his parents were placed above the needs of Stephen. Additionally, when Stephen was removed Sunny Hill (the home for physically disabled children), he was placed into foster care, and not the care of his parents. The case does not explicitly state the reasoning for this placement, however, I suspect that it was to not burden the family of Stephen again after they had acclimated to having him outside the household, especially the life of their other, healthy child.  Overall, this case displays that the welfare of Stephen was not a priority to his parents and their lives, and the life of their other child was placed above their physically disabled son. Luckily for Stephen, the government of British Columbia fought for what the moral just ruling.

While this case in British Columbia eventually ruled in the favor of Stephen’s welfare, I question if the logic of Stephen’s parents and Judge Bryne, would have held in the United States.  The trend of placing the life of a healthy child over the right of a mentally or physically disabled child has been shown in the decreasing birth rates of Down Syndrome Children in the United States. Dr. Brian Skotoko, a pediatric geneticist at Children’s Hospital Boston showed a fifteen percent decreases in Down Syndrome children born in the United States between 1989 and 2005. This decrease may be attributed to the larger increase in women choosing to terminate their pregnancies with Down Syndrome Children. Without even discussing the dilemma of abortion, terminating a pregnancy with a Down Syndrome child that you would not have terminated otherwise, is a clear invalidation of the lives of disabled children.  Based on this data, would this case have been ruled different here in the United States?

Sources: 

Beauchamp, Tom L and James F. Childress, Principles of Biomedical Ethics (Oxford, Seventh Edition).

James, Susan Donaldson. “Down Syndrome Births Are Down in U.S.” ABC News. ABC News Network, 02 Nov. 2009. Web. 21 Feb. 2015. <http://abcnews.go.com/Health/w_ParentingResource/down-syndrome-births-drop-us-women-abort/story?id=8960803&page=2>.

Image: http://www.arlingtonheritagegroup.com/blog/wp-content/uploads/2013/09/Down-syndrome-little-girl-NIH.jpg

For the case of Mr. M, he was a patient who suffered from a severe case of vasculitis. Mr. M presented into the intensive care unit with severe respiratory failure. Mr. M had a very poor prognosis and when his physician informed him of this and asked him about the course of action he wanted to take, he said that he did not want any extraordinary measures to be taken in order to preserve his life. Upon hearing this, however, Mrs. M was extremely upset and insisted on Mr. M changing his mind. As a result they had a discussion during which Mrs. M was visibly upset. They spoke in a foreign language so the physician did not know of what was being discussed. However, it seemed clear from body language and emotional gestures that the discussion was coercive. From that point on, Mr. M agreed to have extraordinary life-saving measures taken and Mrs. M directed much of the treatment decisions. This, of course, puts the physician in an uncomfortable position because Mr. M’s autonomy is being compromised (Ho 128).

The dilemma in this case is that Mr. M is losing his sense of autonomy in the current situation. Ho defends the need for autonomism by saying that the patient (in this case Mr. M) is the one who is most knowledgeable and most invested in his own personal state (Ho 129). In addition, Ho defines the implications of autonomism as being the “rejection of the image of patients as passive care recipients and the suspicion against manipulative and/or paternalistic influence anyone may have on patients’ decision-making process” (Ho 129).

While the implications listed are definitely important, unfortunately that does not always lead to the best outcome for the patient. In this case, it is debatable that having Mr. M’s wishes defied would even provide a better outcome, but there are cases where patients may feel as if they are without hope, but because of life-saving decisions from physicians, they were able to rehabilitate to a healthy state. For Mr. M, however, it seems that he knows his prognosis is poor and that he is only inflicting on himself more pain and suffering by continuing treatment.

Another issue I have with Ho’s definition of why an autonomous person should be able to make his own decisions. Her assertion is based on the assumption that the patient knows what is best for himself. However, this is not always the case. Physicians are trained to see patients go through incredible stages of depression and hopelessness. For the patient, however, when he or she is in that state of hopelessness and despair he can’t make decisions based on his well-being because he is too focused on his current pain and suffering. This might be the case for Mr. M.

In this case, it is hard to draw the line for how much Mrs. M can have a say in Mr. M’s decision. We can’t know of his future and how he will end up if he makes it out of the hospital and therefore it may be in his best interest to continue to receive treatment. However, in order to preserve his state of being an autonomous being, he does have to be able to make his own decision. I think the best course of action would be to ask Mrs. M to leave and for him to make his decision without her presence. Afterwards, should he decide to refuse extraordinary treatment, Mrs. M should be asked to stay out of his room until she can maturely accept his decision and understand his wishes.

Works Cited

Ho, Anita. “Relational Autonomy or Undue Pressure? Family’s Role in Medical Decision-making.” Scandinavian Journal of Caring Sciences 22.1 (2008): 128-35. Web. 19 Feb. 2015.