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

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

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

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

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

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

Background

In Case 5.4: Protecting an “Unborn Child,” a mother referred to as “G” has an addiction to sniffing glue and using other solvents. She has already given birth to three children, who have all been given up to child services. Two of those children had mental and physical disabilities due to “G”’s addiction. Upon becoming pregnant again, child services wanted to protect her unborn child and had her placed in a treatment facility. Although the lower court agreed with child services, the Manitoba Court of Appeal overturned the decision and released her from the facility. The Court of Appeal ruled that “G” had the right to make her own decision.

Dilemma

Although there are many issues in this case, the main ethical conflict involves autonomy versus non-maleficence. Autonomy is the right to make one’s own choices. This case involves the right of “G” to care for her body during pregnancy. “G” has human rights that were infringed upon by forcing her into a treatment facility. Even if a treatment facility is the best place for her to be, she should still have the right to make her own decision. On the other side of the issue is non-maleficence, which means causing no harm to the physical body. In this case, non-maleficence concerns not harming the fetus. If the mother continues to harm her body through her addiction, the fetus could be affected as well. The ethical dilemma considers at what point the unborn child needs to be protected even if it means restricting the mother’s rights.

Reflection

The central issue in this case can be argued for both sides. In my opinion, it is important to respect “G”’s right to decide whether or not she wants to be in a treatment facility. We should respect a person’s human rights and freedom of choice. However, if “G” chooses to harm her unborn child by her addictions, then I feel the responsible thing to do is to protect the unborn child. Since the child cannot make a case for itself, someone needs to look after his or her rights. I believe that if “G” continues with her addiction, then she should temporarily be placed in the treatment facility for the benefit of the unborn child. “G” should feel that she has a moral obligation to take care of her unborn child while she is pregnant. In not doing so, she could appear unfit to be a mother. Therefore, the wisest decision is to place her in the facility so that she can receive the proper assistance. Treatment facilities have been created and are available to help in situations such as these. Child services are essential in finding cases like “G,”’s where a facility would be the correct course of action. The support of child services should be taken seriously. The ethical dilemma of autonomy versus non-maleficence is a difficult one. However, I am inclined to side with the argument that the benefits of protecting the unborn child outweighs the temporary restriction on “G”’s human rights. 

Works Cited

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

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.

Image Sources

http://www.salon.com/2011/05/18/what_not_to_ask_a_pregnant_woman/

http://homeopathic-treatments.com/?attachment_id=1174

A topic that is wrought with controversy in the present age is the topic of abortion. In the context of bioethics it is necessary to define what it is about the topic that seems so right or wrong.

Consider Kate’s case. Kate is a 17-year-old young lady who is 8 weeks pregnant. She is legally emancipated, works 30 hours a week and is still in high school. She has no family support and is no longer dating the ex-boyfriend who got her pregnant. Still, she is maintaining a 4.0 GPA and she has received a full-ride scholarship to attend a prestigious university (Rosell). Kate has stated that she doesn’t want to be a mom right now, but she also has undergone negative experiences with adoption and does not want to have her baby go through that. Therefore, Kate wants to get an abortion (Rosell).

The case is one that must be taken from different perspectives. All moral and religious beliefs aside, it seems like it makes the most sense to go through with the abortion because we have Kate’s wishes and even of her background. It may be useful, however, to analyze the situation through the perspective of moral status. For Kate, she obviously displays human properties in that she displays intelligence, memory, and moral capacity (Beauchamp, Childress 68). Also, even though she is only 17, she has displayed exceptional cognitive ability (Beauchamp 71) that seems unhindered by the hardships she has faced in her lifetime. In addition, she has also shown herself to be a moral agent (Beauchamp 74) in that she states she doesn’t want her baby to go through adoption because of what she is certain the baby will face. She has also revealed herself to be one who can experience pleasure and pain (Beauchamp 75-76) as she has recounted before the suffering she went through in the adoption system. Finally, the physician established a relationship with her a long time ago, because the case mentions that she has always gone to the medical establishment in question and now there is a moral obligation to help her that is on the physicians in this case (Beauchamp 79-81). Through every theory, we know that Kate has moral status. Judging by this alone we see that we need to act in Kate’s best interest.

But what about her unborn child?

The fetus is in its 8^th week of existence. At this point, the heart is developing and even beginning to beat at a regular rhythm. In addition, the nerve cells and brain are developing as well (Fetal Development). By many definitions, the fetus is already living. Yes, by many of the theories the fetus seems to have lower standing as far as moral status compared to Kate (seems less human, lower levels of cognition, not a moral agent, less sentient, and no established relationships), but to say that the fetus is afforded a lower moral status than Kate based solely on the 5 theories of moral status would be ridiculous and perhaps even arbitrary.

So the problem becomes one where Kate and her unborn child both have moral status and therefore have rights to moral protections, but carrying out the best interest or desire of each seems impossible (assuming that only the options presented are viable).

Works Cited

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 6th ed. New York: Oxford UP, 2009. Print.

“Fetal Development.” Medline Plus. National Institute of Health, 30 Sept. 2013. Web. 28 Jan. 2015.

Rosell, Tarris. “Abortion Rights And/or Wrongs.” Case Studies. Center for Practical Bioethics, n.d. Web. 29 Jan. 2015.

Background

When I first read ” ‘G’ was a pregnant 22-year-old […]” I paused and laughed and already knew I would be interested in this article because my first initial is “G” and I’m also 22. Fortunately, no, I am not pregnant, but I digress.

The real “G” is addicted to glue sniffing and other solvents and has already surrendered three children to family services, two of whom were both physically and mentally damaged as a result of their mother’s addiction (Thomas, 201).  Due to “G” ’s history, the doctor’s believed it was in the unborn child’s best interest to place “G” in a treatment facility and monitor “G” ’s activity. However, the Manitoba Court of Appeal ordered that “G” be released from the treatment facility on the grounds that every individual has the right to security of the person. Fortunately, the baby was born healthy and “G” is no longer suffering from her addiction.

Dilemma

The dilemma in this case is that of non-maleficence vs. autonomy. “G” ’s physicians have a duty to protect the unborn child. On the other hand, it is within “G” ’s legal right to do whatever she wants to her body. She does not have the right, however, to abuse her baby and inflict harm on another human being, which is exactly what she would be doing if she continued to abuse solvents and sniff glue.

My Stance

I believe that “G” ’s right to autonomy was rightfully outweighed in this situation. In terms of moral status and answering the question of whom we ought to be morally responsive, society has a duty to be morally responsive to the unborn child who cannot speak for itself. In addition, based on the Theory of Human Properties from Principles of Biomedical Ethics, all humans have rights because they are human; no human is excluded because it is a fetus, has brain damage, has a cognitive anomaly, etc.

I am not sure what the laws on substance abuse are in Canada, however in the United States, “18 states consider substance abuse during pregnancy to be child abuse under civil child-welfare statutes, and 3 consider it grounds for civil commitment” while, “15 states require health care professionals to report suspected prenatal drug abuse, and 4 states require them to test for prenatal drug exposure if they suspect abuse” (Guttmacher, 2015). I hope that more states and Canadian provinces will implement these laws in the near future.

For me personally, there was nothing to debate in this case, but then I ready Alexi Msays’ post, and I realized that if I were “G”, it would be completely wrong to have treatment forced upon me. As mentioned in the case study, ” […] feminists [argued] that the woman’s right to control her own body, whether pregnant or not, must be provided the strongest possible protection” (Thomas, 201). However, “G” ’s body is no longer solely hers. The child did not ask to be born, let alone to be born both physically and mentally impaired. “G” is fully capable of knowing how to prevent herself from getting pregnant, and she could have easily made the decision to abort the baby. However, since she has decided to keep the baby, “G” has a duty to keep her body healthy for the sake of the baby’s health as well. Fortunately, that duty was fulfilled, but on “G” ’s own accord.

Works Cited

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

Guttmacher Institute. “State Policies in Brief: Substance Abuse During Pregnancy.” Guttmacher Institute. Guttmacher Institute, 1 Jan. 2015. Web. 30Jan. 2015.<http://www.guttmacher.org/statecenter/spibs/spib_SADP.pdf>.

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.

Images:

http://www.russellmoore.com/2011/07/18/an-open-letter-to-an-unborn-baby/

https://richardwiseman.files.wordpress.com/2012/11/scales.jpg

http://www.treatment4addiction.com/images/article_images/addiction_drug_pregnancy.jpg

https://101careersinpublichealth.files.wordpress.com/2011/08/baby-and-mom-by-phanlop88-freedigitalphotos.jpg

Autonomy is one of the main moral principles. Beauchamp and Childress discuss how respecting autonomous agents involve acknowledging an individuals right to make choices and to take actions based on their values and beliefs. There are many elements that go into describing the principle of autonomy. The most present example of autonomy lies in the idea of informed consent.

Informed consent goes hand and hand with medicine these days. It is a concept that ties well with the principle of autonomy because it allows an individual an opportunity to satisfy the three condition theory (Beauchamp and Childress). In Principles of Biomedical Ethics, Beauchamp and Childress point out that there are three conditions that comprise the principle of autonomy. Choosers that display autonomy should act intentionally, with understanding, and without controlling influences that determine action. Intentional actions do not have to evoke a positive outcome; often times undesired outcomes are part of an intentional action. The point is to see that there was value in the decision made. In terms of understanding, an action should not be labeled as being autonomous if the individual does not adequately understand it. Poor understanding can be caused by absence of information  and deficiencies in the communication process. Finally, a person should be free of both internal and external sources that my take away from an individual’s self determination.

There are various cases that can allude to informed consent. The major paradox in the American healthcare system is the criticism that doctors do too many tests/procedures. However, the reason for the quantity of tests may not be due to just simply profit as many capitalists might have you believe but rather the nature of our Judicial system. Throughout American history, there have been numerous examples of doctors being held liable for their patients.

An example case could involve a surgeon doing a simple biopsy on a patient. This biopsy will be performed with the doctor obtaining informed consent. However, during the surgery, the doctor discovers a threatening tumor. The ethics behind this situation are important because the doctor can either choose to leave the tumor or take it out. The patient would have already been induced into a coma so there would be no autonomy on the patient’s side to choose what they would want (Murray). The doctor is then left with the choice of taking out the tumor but not following informed consent or leaving it alone. The situation is tough because if the doctor does take the tumor out, he stands to be liable because the patient had not given him permission to take out the tumor.

In my opinion, I would leave the tumor in the body and not risk having a malpractice lawsuit aimed at me. The tumor could be taken care of at a later time when proper protocols have been met. My decision is driven mainly by autonomy concerns of the patient and I believe that their thought process on the matter is what matters most. Thus, we must support the patient.

Works Cited:

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

Murray, Peter M. “The History of Informed Consent.” The Iowa Orthopaedic Journal 10 (1990): 104–109. Print.

The moral principle of autonomy is one of the four major principles of bioethics. Despite its monumental influence over the beliefs and choices of bioethicists, physicians, and patients’ families, it is difficult to specify the exact definition of this complex principle. In Principles of Biomedical Ethics, Beauchamp and Childress examine a variety of theories surrounding autonomy. In order to apply the principle of autonomy to any case, we must understand what makes a choice autonomous and who is able make an autonomous choice.

The Three Condition Theory of Autonomy outlines terms that are necessary for a choice to be deemed autonomous. An autonomous act must be intentional, have been executed with understanding, and without controlling influences over the action (Beauchamp and Childress). Using this basis, I would like to now apply this idea to the case of Simon, a 53 year old who is depressed and is denying Electroconvulsive Shock Therapy (Thomas, Waluchow & Gedge). The moral issue lies in deciding whether or not the psychiatrist should petition to force the Electroconvulsive Shock therapy and go against the principle of autonomy. In this case we must decide if the principle of autonomy should be placed higher than the principle of non-maleficence.  His decision was intentional as his action to refuse treatment is in accordance with his wish to be left alone (Andre). Also, his decision is not being influenced by any outside source. Which leaves the issue of if he understands the severity of refusing his potentially life-saving treatment.

It is difficult to determine in his depressed state if he fully understands the probable outcome of his life without the electroconvulsive shock therapy. Due to the complex nature of depression and our incomplete understanding of its influences over the brain and decision making skills, we are unable to determine if Simon is competent enough to understand his actions. In a similar case to Simon, Paul Henri Thomas tried to deny electroconvulsive shock therapy, however the court ruled he was incompetent to make his own decision. By allowing the deciding factor to be the competence of the patient, there is almost a guarantee that the patient will receive the treatment. In the eyes of physician, if a depressed patient is competent, they will accept the therapy, and if they deny the therapy, they are incompetent, and therefore the therapy should the forced upon them (Andre). This paradox makes Simon’s case difficult, however we have another person’s opinion to help us make a decision: Simon’s son.

The presence of Simon’s son, and his ability to be his proxy for his therapy choices greatly reduces the complexity of this ethical dilemma. Simon’s son is intentional in his actions, is not being influenced by an outside source (besides the patient himself), and understands the risk associated with the electroconvulsive shock therapy. My decision in this case is to respect the autonomy of not only Simon, but also his son. While it may be difficult as a physician to see a patient forgo a possibly life saving therapy, ultimately in this specific circumstance, they must support the patient.

Works Cited:

Andre, Linda. “Deciding Competence.” Ect.org. N.p., n.d. Web. 27 Jan. 2015. <http%3A%2F%2Fwww.ect.org%2Fnews%2Fcatch22.html>.

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

Thomas, John,  Wilfrid Waluchow, and Gedge, Elisabeth. Well and Good: A Case Study Approach to Biomedical Ethics. 3rd ed. Broadview Press Ltd., n.d. Print.

Image: http://t2.ftcdn.net/jpg/00/35/80/23/400_F_35802362_4M3IZvzwdiZwA4b5WpE4LZTRc1SZVk5Q.jpg

One of the most heavily debated ethical issues in contemporary society is the extent of rights an unborn child truly possesses. In this case study, we read about a woman “G” who has a prior history of abusing glue and various other solvents. “G” already has three children who have disabilities, and was pregnant with another child at the time the Winnipeg Child and Family Service Agency sought injunction to force “G” into a treatment facility against her will in order to protect her unborn child from what they deemed an unfit mother. After initially being taken into treatment against her will, higher courts ordered the her release from treatment facilities. Let the record also show that while “G” did have a past record of solvent abuse, she had been clean at the time, and gave birth to a healthy baby.

The major moral issue that this case addresses is whether it is fair to take basic human privileges from the mother, in favor of the unborn fetus’ human rights. Sniffing glue is not illegal, and neither is drinking or smoking, but there is no denying that these types of abuses can pose some serious health risks to an unborn child. The hard part is not in deciding what is right or what is wrong, but rather deciding who’s claim to human rights carries more weight: the living mother, or the unborn fetus. From a moral standpoint, it is undoubtedly wrong for a pregnant mother to abuse her body, but from a societal and legal standpoint, who is anyone to deny the mother of her basic human rights? What if the pregnant mother decided she wanted to start training for a marathon? As ludicrous as the idea sounds, it is fully within her rights, even if it does put strain on the growing baby in the womb. Does that mean the mother is unfit to take care of a child, and does this justify legal intervention? There are clearly conflicting rights here between the right to self determination on the pregnant mother’s side, and the right to life on the part of the fetus. Many argue however that the latter right should not even be considered, because the question looms as to whether a fetus can or should even be considered as a living person, and if not, if that fetus then has a claim to basic human rights and privileges.

In my personal opinion, which is open to dispute, I find the mother morally flawed in her decision to abuse solvents while pregnant, but in terms of the law I do not see a violation, and feel that she is well within her human rights even if it is at the expense of her baby’s health. I do believe that treatment, however, could prove to be extremely beneficial to her and her children, but not something that should be forced upon her.

– Alexi Msays

Works Cited 

Thomas, John and Wilfrid Waluchow. Well and Good: A Case Study Approach to Biomedical Ethics. 3rd ed. Broadview Press Ltd., n.d. Print.

Picture:  http://pages.jh.edu/~jhumag/0407web/wholly/p21drug.jpg

The moral issue involved in Case 5.4 Protecting an “Unborn Child,” is the dilemma of placing the mother, “G”, into a treatment facility against her will. The desire to place G into the treatment facility stems from the fact that G is addicted to glue-sniffing and the use of other solvents and is currently pregnant. G’s previous children have all been taken into the Winnipeg Child and Family service, and two of the children were “both physically and mentally damaged from birth as a result of their mother’s solvent addictions”(pg 201WG). Based on these results, it would seem logical to infer that without intervention of G’s addictive habits, her next child would have a significant chance of enduring physical and/or mental damage.

Johns Hopkins has a Center for Addiction and Pregnancy (CAP), which offers substance abuse treatment, psychiatric evaluation and care, obstetric evaluation and care, pediatric health care, and overnight stay services. The barriers of transportation and inconvenience are diminished in this program as CAP provides “comprehensive health care and complementary services in one convenient location” (Brooner, R). There are many treatment facilities like this available around the country for women like G, and thus G should take advantage of the opportunity to improve the health of her child.

The dilemma that is at stake here is one of autonomy versus non-maleficence. If the situation was to take place with autonomy for living beings predominating, than it could be suggested that the respect of the mother’s wishes take precedence and she not be placed in a treatment facility. However, if the argument were made in favor of non-maleficence, than there would be good reason to place the mother in a treatment facility. In an attempt to minimize the harm in this situation, the health of the unborn fetus should be considered greatly. One might argue that placing the mother in a treatment facility would harm her as it would go against her wishes, but this is not the opinion that should take priority. The mother is currently engaged in activities that are considered harmful, and thus society should not act to minimize her harm over the harm of the unborn fetus, which is only vulnerable to the actions of the mother.

In my opinion, it is our responsibility as a society to look out for the health of the unborn fetus. The case goes in to explain that it could become a “slippery slope” to limit freedoms on glue-sniffing while pregnant. Chief Justice Antonio Lamer expresses concerns that, “if we prevent pregnant women from sniffing glue…we will end up preventing women from drinking alcohol” (pg 204), a concern I do not find distressing. A pregnant woman should not be drinking alcohol. When a woman is pregnant it is her duty to provide the best nurturing environment for the unborn fetus as she is capable of providing. And yes, I feel this includes minimizing exposure to second hand smoke as much as possible, along with eliminating glue-sniffing, alcohol, and any other toxin that could reach the unborn fetus. Although it may go against the mother’s autonomy to “coerce and compel” her into treatment, now that she is pregnant it is not only her autonomy, but also the autonomy of the unborn fetus must be taken into account (pg205).

References:

Brooner, Robert, Ph.D. “Center for Addiction and Pregnancy (CAP).” Http://www.hopkinsmedicine.org/psychiatry/bayview/medical_services/substance_abuse/center_addiction_pregnancy.html. N.p., n.d. Web.

Thomas, John E. 1926-. “Case 5.4: Protecting an “Unborn Child”” Well and Good. a Case Study Approach to Health Care Ethics. 4th ed. Peterborough, Ontario: Broadview, 2014. N. pag. Print.

Image citation:

“Mother To Unborn Daughter Quotes – Viewing Gallery.” Mother To Unborn Daughter Quotes – Viewing Gallery. N.p., n.d. Web. 30 Jan. 2015.

Background

Mental illness has always been a taboo topic avoided in social circles and ignored within family discussions given its difficulty to understand, treat, and manage. Whether it be the degrees to which an individual is afflicted with a particular set of symptoms, the fear that a disorder is hereditary, or the fact that these diseases cannot be cured but rather only managed instills fear, confusion, and hostility in both the patients and their loved ones. And unfortunately, the brain continues to be an un-mapped and untapped realm of curiosities that keeps modern science from being able to truly pinpoint how and where behavioral malfunctions occur. How then does one handle a scenario where a patient is at risk of hurting themselves but the course of treatment may be just as hurtful?

The Case of Mr. S

Having attempted on taking his life in his home, Mr. S is taken into an institution where he is to be managed until he is deemed fit to return to his domicile.However, instead of getting better and flourishing during his stay, he begins to further deteriorate and spiral into a deep depression. His behavior becomes increasingly erratic, he continues to show that he is suicidal and willing to act on said impulses, and he no longer finds meaning in life. Given that a conventional course of medications did not help his situation, Mr. S’s psychiatrist suggests electroconvulsive shock therapy to help with his worsening condition since there is evidence that such treatment has shown significant improvements in the lives of depressed patients.

Analysis

There are multiple issues with this scenario, the most pressing being the idea of quality of life the patient is to have post-treatment. Mr. S repeatedly states that he does not wish to live on and that the depression he lives with stems from guilt concerning his mother’s death, which will never leave him in peace. Given that the psychiatrist said himself that the treatment would most likely cause temporary memory loss, if the treatment is applied Mr. S will still have the memories of the issues that are causing him this grief. There is also the concern of the treatment itself being inhumane in nature. The patient’s quality of life is being violated if there are multiple measures being implemented to minimize the repercussions of this treatment. The muscle relaxants, the restraints, the anesthesia, and the oxygen administration all show how stressful this kind of procedure can be on the body.

Therefore, it begs the question: if Mr. S is conscious of his surroundings, able to explain why he feels the way he feels, and reject the same treatment that his son is likewise refusing on his behalf, wouldn’t it be a violation of autonomy to do otherwise?

In my opinion, it absolutely would be. In order to force treatment on to a person, you must be able to prove beyond a reasonable doubt that they are a threat to themselves or society. The catch here is that the person in question must also be deemed unfit to make decisions for themselves. Such accounts would fit the criteria for a “Baker Act” to take place (that is, institutionalize an individual for up to 72 hours in order to administer drugs and treatment without their consent). However, here we have a patient that is capable of expressing themselves in a logical fashion, that is aware of what is happening around him and still refuses treatment. A line must be drawn on where a person’s autonomy over their own life and the state of their life is. Especially when the advocate for a person such as Mr. S is not entirely contradicting the wishes of the patient. Successful treatment requires the cooperation between the patient and doctor. If the patient does not wish for the treatment, then in the moment they may get better but the long term results will reverse everything and perhaps even make the situation worse. From the understanding of preserving one’s autonomy over their own life, Mr.S should not be treated with a procedure that may not only hurt him but also not work and cause further harm, as well as removing his capacity to end his suffering in the manner he consciously wishes it.

Image Source:

1)  http://academicdepartments.musc.edu/psychiatry/research/bsl/ect.htm

Background

Suicide is not an easy topic of conversation for most people – and for obvious reasons. Taking one’s own life goes against everything we grow up believing is morally right. One of the most fundamental moral principles is to not kill. As we have discussed in class, this principle can be broken down into more specific domains, such as do not kill humans, and includes certain exceptions such as it may be ok to kill in self-defense. So, herein lies the problem: how do we view suicide? Is it morally wrong to kill oneself, or do we have the autonomy to do what we choose with our own life?

Simon’s Case

In this particular scenario, Simon was a clinically depressed 53-year-old who had been medicated for years. Simon reported difficulty concentrating and remembering things, and showed little interest in doing anything at all. He admitted to staff members that he was planning on killing himself. From a physician’s standpoint, their goal is to do everything they can do keep a patient alive. The psychiatrists’ suggestion was to try electroconvulsive shock therapy (ECT) as a more intense method to hopefully alleviate some of his depression. ECT would require 6 shocks over a 2-week period. While the charge of electricity induces a convulsive seizure, studies conducted with elderly depressed patients have shown that the procedure significantly reduces remission rate (Bjølseth et al., 2014).

Analysis

In many cases, such as when an individual is comatose, we value the decision the individual would have made prior to their comatose state, or based on what they had written in their living will. Similarly, some may argue that Simon should be allowed to take his own life if he so chooses in order to end his suffering. However, I argue that if Simon has treatment-resistant depression (TRD), he is not in a healthy state of mind to make a clear decision. TRD occurs when depressed patients are nonresponsive to treatment used for depression, and many alternative methods are now being utilized to treat these patients, such as ECT or brain stimulation (Souery et al., 2006). Therefore, the psychiatrists should do their job and treat him to the best of their ability, and perhaps once he is thinking rationally again he will be able to make a clearer life choice. Thomas, Waluchow and Gedge (2014) raise an important question – “Should we regret having administered the most effective known treatment for Simon’s depression or regret that the most effective treatment available proved to be inadequate?” In the non-maleficent viewpoint it is best to try all options before all else fails.

Perhaps my opinion is biased because I will one day become a psychologist. From a psychologist’s standpoint, their primary goal is to keep a patient alive and do whatever it takes to minimize suffering and help a patient recover. However even thinking about this situation from my own moral viewpoint, I think that suicide is not the solution to end suffering, and that Simon will be able to recover through means of other options that were not previously explored, and as humanbeings it is our duty to do what we can to keep Simon alive and treat his depression so that he is no longer suffering and can live a full and fulfilling life.

Resources

Bjølseth TM, Engedel K, Benth JS, Dybedal GS, Gaarden TL and Tanum L (2014). Clinical            efficacy of formula-based bifrontal versus right unilateral electroconvulsive therapy         (ECT) in the treatment of major depression among elderly patients: A pragmatic,       randomized, assessor-blinded, controlled trial. J Affect Disord. 175C:8-17.

Souery D, Papakostas GI and Trivedi MH (2006). Treatment-resistant depression. J Clin             Psychiatry. 67 Suppl 6:16-22.

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