http://www.brainviews.com/abFiles/ImgPet.htm

Simon who is a widowed father of age 53 came to the hospital with mentally unstable mind. He had a severe depression to the point of attempting suicide and wasn’t willing to receive the proposed treatment (1). The dilemma is whether physicians should take Simon’s refusal as a respect for his autonomy and not give the proposed treatment of electroconvulsive shock therapy or value beneficence more and give the treatment despite Simon’s will. Specifying a little bit more, we need to focus on and explore if Simon is competent enough to be considered as autonomous and decide the matter for himself.

In Scotland, the government has introduced an interesting bill to be considered supporting physicians to assist their patients with committing suicide should they desire (2). It has complicated issues and questions involved, such as what are patients’ and physicians’ roles, is it moral to help patients to commit suicide, what is physicians’ job ultimately in helping patients, how do we redefine “helping”, how do we balance between patients’ autonomies and physicians’ need to be beneficent, etc. Applying it to Simon’s case, if we value his autonomy, he not only won’t be treated with the electroconvulsive shock therapy but also will most likely to commit suicide. As a result, doctors may be passively “assisting” Simon to commit suicide. Before we go further and look deeper into whether it is morally better for the doctors to value autonomy over beneficence, it is important to specify what constitutes autonomy and if doctors should respect Simon for his autonomy, if he has any.

According to Beauchamp and Childress, there are three components to autonomy: intentionality, understanding, and noncontrol (3). Simon has intentionality; he doesn’t want the treatment. In addition, although there are influences and resistances exerted by the physicians, Simon remains firm and “noncontrolled”. His autonomy is questionable when we consider his understanding of the situation, though. He doesn’t seem to understand his own situation nor the benefits and possible consequences of the electroconvulsive shock therapy due to the severe depression he has. This ties into assessing one’s competence. Appelbaum and Grisso presented the standards of incompetence including inability to understand one’s situation and its consequences (4). Simon may be able to express his own intentions, but whether physicians should respect his autonomy is debatable because of his current mental condition that hinders his understanding of the circumstances. I say doctors should go ahead and give him the treatment.

Now, the consequences of valuing beneficence over autonomy may be costly. Simon may suffer from permanent memory loss and possibly death in the worst case scenario, not to mention the fact that the treatment only temporarily relieves the severe depression. However, I believe physicians should consider the best solution for the patients always, and in this case, it is treating him with the electroconvulsive shock therapy. They should respect patients’ autonomy, but not when a patient is about to commit suicide because of depression or when the patient himself doesn’t really know much about his own state of mind incapable of making a reasonable decision. In fact, the consequence of valuing autonomy over beneficence is much worse, Simon with his severe depression that doesn’t seem to improve with the current medication, which might lead to his suicide. To give or not to give the treatment is the dilemma. Neither way can satisfy every party involved. Therefore, I believe physicians should make the best choice for the patient who doesn’t meet the criteria of autonomy by giving the treatment to prevent Simon from committing suicide.

References:

1. Waluchow, Wilfrid J., and Elisabeth Gedge. “3.2 Non-Consensual Electroconvulsive Shock Therapy.” Well and Good. a Case Study Approach to Health Care Ethics. By John E. 1926- Thomas. Peterborough, Ontario: Broadview, 2014. 124-31. Print.

2. Russell, Paul. “Pro-assisted Suicide Lobby Making Nonsense.” LifeSiteNews. Life Site, 28 Jan. 2015. Web. 29 Jan. 2015. <https://www.lifesitenews.com/opinion/pro-assisted-suicide-lobby-making-nonsense>.

3. Beauchamp, Tom L., and James F. Childress. “Respect for Autonomy.” Principles of Biomedical Ethics. New York, NY: Oxford UP, 2001. 101-40. Print.

4. Paul S. Appelbaum and Thomas Grisso, “Assessing Patients’ Capacities to Consent to Treatment,” New England Journal of Medicine 319 (December 22, 1988)

“The biggest thing people don’t understand is: this is not a death sentence. It’s not a suicide. It’s about rights.” – (Fox13Now)

Case Discussion:

The major moral dilemma in this case study deals with whether or not the father should receive more evasive yet more successful treatment for his severe depression even though he declined receiving Electroconvulsive Shock Therapy (ECT). The ethical issues is exacerbated when the next-of-kin, the patients’ son, has been informed of the positive as well as the negative effects of receiving ECT, however still denies the treatment for his father which could drastically improve his father’s medical condition. The psychiatrist is faced with the ethical dilemma of respect for patient autonomy versus non-maleficence. Should the psychiatrist allow the patient to revel in this very deep depression where he has attempted to commit suicide or should the psychiatrist override the wishes of the patient and administer the procedure regardless of if the patient or his next-of-kin consents? If the psychiatrist doesn’t intervene, then the father could possibly commit suicide, which goes against the ethical principle of non-maleficence; it is the duty of the psychiatrist to not harm the patient. One can argue however, is the psychiatrist really harming the patient if the patient chooses to commit suicide? The psychiatrist is also expected to respect the decisions of the patient. The patient is an adult and has made the previous decision to receive antidepressants. If the patient is able to make that choice, then he should also be able to make the choice that he does not want to undergo ECT.

(www.nevcoeducation.com)

My Response:

This is a very difficult dilemma to attack. However, if I was the psychiatrist in this position, I feel like I would have no other choice but to honor the decision of the patient and his son. Sometimes medical professionals can be selfish in their pursuits of solely wanting to make sure that a patient lives because no one wants a patient to die on their watch! If a patient dies, then the medical professional will feel like a failure. The psychiatrist should try his/her best to assure that the severely depressed patient causes no harm to himself and should just patiently wait the four to six weeks for the drugs to take effect.

Current Event:

The case discussion has brought up a very interesting point. What is the difference between this depressed patient and “the cancer patient who initially agrees to surgery but who now refuses chemotherapy? How can we acknowledge the right of patients to refuse potentially life-saving treatment in the one case but not in the other? (Thomas, 129-130)”. In a recent news report, a court case ruled that Cassandra C, a17-year old minor, would be forced into chemotherapy against her consent. The court said that Cassandra’s attorney failed to prove that she is mature enough to make her own medical decisions. If the girl was not a minor or successfully proved that she was mature enough to make a decision regarding her health then she would have been able to, under the law, refused chemotherapy. Cassandra’s mother approved of her daughters’ decision and exclaimed to news reporters that “The biggest thing people don’t understand is: this is not a death sentence. It’s not a suicide. It’s about rights.” This can be applied to the ECT case in that the patient, who is an adult, made a decision that should be respected by the medical staff. If cancer patients could ultimately have autonomy over their health decisions, then why can’t the depressed patient have that same autonomy?

Works Cited

Thomas, John and Waluchow, Wilfrid. Well and Good. Canada: Broadview Press, 1998. Print.

“Teen Forced into Chemo Treatments, Mother Supports Decision to Refuse.” Fox13nowcom. N.p., 07 Jan. 2015. Web. 29 Jan. 2015.

“Teen’s Forced Chemo May Continue, Connecticut Court Rules – CNN.com.” CNN. Cable News Network, n.d. Web. 29 Jan. 2015.

Background

In Thomas, Waluchow & Gedge’s Well and Good, case number 3.2 presents Simon, a widowed father of one child was brought to the hospital after being found unconscious in his bed next to an empty bottle of antidepressants. Simon’s guilt in regards to his absence during his mother’s death along with his thoughts of financial ruin led him to believe that living “in a state of perpetual depression was intolerable” and that he would “rather be dead than suffer like this for the rest of his life” (Thomas, Waluchow & Gedge, 124). Upon admission to the hospital, 36 hours later, Simon’s unkempt appearance and suicidal actions led his psychiatrist to propose electroconvulsive shock treatments (ECT).

Dilemma

Although there are several dilemmas presented within this case study, the two that stick out to me the most are those concerning the ethical principles of autonomy and non-maleficence. Autonomy, respect for persons, can be defined as acknowledging a person’s right to make choices, to hold views, and to take actions based on personal values and beliefs (Bishop). In this case, Simon refuses to consent to the proposed treatment, as he had no desire to live. After conferring further with Simon’s son, who refused to override his father’s expressed wishes, the psychiatrist was left to make a choice – to respect Simon’s wishes, and therefore his autonomy, or to violate his autonomy by applying to the review board in hopes of obtaining permission to treat Simon against his wishes.

On the other hand, non-maleficence, do no harm, can be defined as the obligation not to inflict harm intentionally (Bishop). In this case, the psychiatrist is forced to weigh the options – if Simon continued drug therapy, could it lead to further harming himself? If Simon underwent the ECT would the physical harm of the treatment itself be worse? Or maybe the ECT could cause death in a worse case scenario?

Reflection

Similar to the Integrity and Nurses’ Relationships with Colleagues and Employers case that we spoke about in class on Wednesday, the two main dilemmas in this case revolved around autonomy and non-maleficence. In terms of autonomy, Simon is entitled to refuse the ECT. However, according to a Disability Rights Brochure, “the doctor must also tell you that you are responsible for anything that happens to you because you refused the treatment” (Electroconvulsive Treatment). In medical ethics, as non-maleficence makes clear, a guiding maxim is “do no harm” (Bishop). How is the psychiatrist able to respect Simon’s autonomy while at the same time abiding by the principle of non-maleficence? Additionally, Simon’s plea to be left alone makes the psychiatrist’s decision even harder in the sense that Simon is not only refusing the ECT, but is also suggesting that he is not considering any other options to save/fix his life. Although there is no ideal solution, I believe the best way to move forward at this point would be to find another drug therapy option while keeping Simon under a close watch.

Works Cited

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

“Electroconvulsive Treatment (ECT).” Disability Rights California . N.p., n.d. Web. 28 Jan. 2015. <http://www.disabilityrightsca.org/pubs/539801.htm>.

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

Image Webpage:

http://www.psychiatrictimes.com/schizophrenia/possible-restriction-ect-devices-concern-grows-among-psychiatrists

To what extent should society have an interest in protecting the health and well being of the fetus? Although the cases are quite different I do see a basis for comparison between The case of Ms. G and an outside case. This case involved a pregnant Indian woman, Savita Halappanavar, who was vacationing in Ireland. She encountered significant medical distress. The only way to save her life would have been to terminate her pregnancy, which was essentially nonviable at this point. However, her doctors informed her that in Ireland, due to Catholicism, as long as there was a fetal heartbeat there could be no abortion. Now this is not entirely true, the mandate actually states that if there is significant danger to the mother’s life the pregnancy may be terminated. It is important to note that life is not equivalent to health in this case. There are variances in how medical health professionals define and danger to life and a danger to health (Berer,2013). This is a problem with specificity that is directly impacting health outcomes.  Savita Halappanavar did not survive and died of septis three days later.
There are multiple dilemmas here.   Just as in the Ms. G case other people are imposing on autonomy. Savita tried to argue with her doctors that this was not her will, and that further she was not Catholic or Irish so they should not treat her as if she was. The other side of this is that if the fetus would have been born it would have rights to autonomy as well. So should society protect those rights now?  The moral principle of non-malevolence and benevolence are also relevant. There is significant harm being done to her because doctors are refusing to terminate her pregnancy. However, with respect to the fetus some would argue there is harm being done by terminating the pregnancy. Whose well-being are we chiefly concerned with?
Ultimately the decision to protect the health and well-being of the fetus led to the untimely demise of Savita Halappanavar. Although it is easy for us to discount this as the fault of a medical and law system steeped in the Catholic faith, I have to wonder if this is the far end of the slippery slope: taking autonomy away from women with respect to their bodies. Significant harm, death, was done to her by denying her treatment that could have saved her life in a failed attempt to save her non-viable fetus. I believe that the Canadian justice system made the right decision in the case of Ms. G.  The Canadian Royal Court ruled that societies duty to promote the health of the fetus does not come at the expense of human rights (Thomas), while Savita’s doctors decided the opposite. This case made global news and has sparked legislators in Ireland to debate abortion public health policy.

Berer, Marge, Termination of pregnancy as emergency obstetric care: the interpretation    of Catholic health policy and the consequences for pregnant women,    Reproductive Health Matters , Volume 21 , Issue 41 , 9 – 17, 2013.
Thomas, John and Wilfrid Waluchow. Well and Good: A Case Study Approach to    Biomedic Ethics. 3rd ed. Broadview Press Ltd., n.d. Print.

Background

“G”, mother of three children and pregnant with a fourth, has a known substance abuse problem. Out of the three children she has already given birth to, two of them have known mental and physical deficits. A lower court had ordered “G” to be committed to a treatment facility for the duration of her pregnancy in the hopes of controlling the substance abuse issue.

The main problem stems from the fact that by commanding “G” to be placed in a facility they have denied her human rights. A higher court overturned this decision and released “G” to continue her pregnancy on her terms, even if it caused harm to the fetus. She ended up giving birth to a baby that did not show any physical or mental ailments.

Dilemma

This case study concerning an unborn child presented in Thomas, Waluchow & Gedge’s Well and Good presents a few ethical dilemmas. One specific dilemma in this case involves how far the law is allowed to go to protect an unborn human. This issue involves the moral principles autonomy and non-maleficence. Each principle has a different effect on one’s decision when regarding a solution to this problem.

Autonomy plays a part in the issue while concerning “G’s” rights. Autonomy is defined as: “Self-rule that is free from both controlling interference by others and from limitations” (Varelius, 2006). I understand this to mean that one has the inherent right to make decisions for themselves without needing to consult others. It is a basic human right. According to the case described, “G’s” autonomy was most definitely violated. However, are there situations in which autonomy should be compromised for the greater good?

Non-maleficence is a major aspect when concerning the protection of “G’s” unborn baby. Non-maleficence states that humans should “avoid needless harm or injury” (Lisa, 2011). According to the previously stated background, “G” is claimed to be a repeat offender of substance abuse. She has already procreated two “harmed” and “injured” children as a result of her addictions. She has already defied the ethical principle of non-maleficence. Should she be given the chance to inflict “harm” and “injury” on yet another child?

Reflection

There are two very big issues and neither have a simple solution. I am an advocate of human rights, but in this case I don’t think it is that simple. “G” made an autonomous and declarative decision to keep her fetus and give birth to a baby. Making that decision not only made her responsible for another life in addition to her own, but also made her accountable to provide the best possible life for her unborn baby. As human beings, “Our existence, individually and corporately, is as dependent upon mutual responsibility as it is upon rights” (Haack, 2009). It is common in our day and age where women’s rights are being strongly advocated for that other co-inhabiting issues are being subdued. “G’s” autonomy is not the only thing at stake here; it is intertwined with her duty to her unborn baby. Acting according to the principle of non-maleficence is a basic aspect of providing an acceptable quality of life for her unborn child. In addition, her autonomy was only temporarily suspended. The court only ordered her to be in a treatment program for the length of her pregnancy. Once she delivered her baby, she could make her own decision about whether she should stay in the facility or not. While it is not ideal, I believe that the best solution to the problem would have been to keep “G” in the treatment program until she gave birth.

Works Cited

Haack, Susan M. “The Rights and Responsibilities of Pregnant Women.”The Rights and Responsibilities of Pregnant Women. Trinity International University, 23 Jan. 2009. Web. 24 Jan. 2015. <https://cbhd.org/content/rights-and-responsibilities-pregnant-women-0>.

Lisa, Sher. “Non-Maleficence and Beneficence.” The EIESL Project RSS. University of British Columbia, 2011. Web. 24 Jan. 2015. <http://ethicsofisl.ubc.ca/?page_id=172>.

Varelius, Jukka. “The Value of Autonomy in Medical Ethics.” Medicine, Health Care, and Philosophy 9.3 (2006): 377–388. PMC. Web. 24 Jan. 2015.        <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780686/>

Image Sources

http://shark-tank.com/wp-content/uploads/2014/04/Fetus-2.jpg

http://www.icb-builders.com/images/Houston_County_Superior_Courthouse_Interior_Renovation.jpg

The current kidney donor shortage in relation to the number of patients suffering from renal failure creates responsibilities for transplant professionals to seek new methods to increase kidney donation.  Although this is a dire effort to help save the lives of many who rely on it, unfortunately many die as they wait for a match. According to the United Network for Organ Sharing around 31,000 potential recipients are on the waiting list for organ transplantation. Only around one third get the transplant while many others die in the interim (Nelson). There were many efforts to try to establish a financial incentive for kidney donation, especially with live donors, which in most cases, is non-maleficence for the donor. However, under the National Organ Transplant Act, it is illegal to exchange an organ for money but there have been efforts that are statistically supporting such an exchange.  That would facilitate the decrease in insurance expenses and increase in the number of living patients (Koren). The perspective of kidney donation is two-fold; with one party thinking that the financial incentive for a living kidney donor meets ethical bases if it preserves the donor’s autonomy, be non-maleficent for the donor, and help in saving lives; however, the other party views this process unethically where it decreases the sacredness of the human body by turning it into a commodity assessed by the donor’s financial need leading to unjust inducement, undue inducement, and even a decrease of altruistic donation (Allen, Peter). Therefore, the moral dilemma is: Should we allow people to donate kidneys in exchange for money or prohibit financial exchange for donation and risk the death of more patients with renal failure?

Virtue ethics is another form of approach in the analysis of medical dilemmas that don’t only depend on reason but also on the importance of emotion.  Those against the financial incentive emphasize that there will be an emotional disrespect of life in general, the human body in particular, and a loss of human connection during the donation process. Moreover, the financial incentive will intimidate the needy people into accepting risks that might be unacceptable in the absence of financial rewards leading to “undue inducement.” For instance, donors who possess certain diseases, such as coronary vascular disease or diabetes, might ignore the risks of being operated on, as they are compelled to accept for the sake of the financial reward. This will also lead to “unjust inducement” as only the poor may feel guilty if they do not sell their kidney to satisfy their family’s financial needs (Allen, Peter). This will lead donors to violate the moral principle of beneficence by increasing harm on them despite potentially relieving harm on patients. However, a discerned physician should be able to determine if donors are competent, from a health standpoint, to make such a decision. A doctor with integrity has an essential responsibility to assess the calculated risks and determine the need for transplantation that would better the quality of life for both the patient and donor.

More questions need to be answered before a decision is made on this moral dilemma. Who would incur the responsibility for the financial reward, insurance company or recipient’s family? If the insurance company is held responsible then only the insured will benefit from such a program and if the recipient’s family are to bear the cost, then only patients who come from a particular socioeconomic status will survive as there will be a decrease in altruistic donation after the introduction of financial incentives.  Therefore, patients are being discriminated based on their ability to pay or their respective insurance coverage. This dilemma appears to be more of a business negotiation as opposed to an ethical issue.

I think that, based on the aforementioned, kidney donation, under financial incentives, will encourage more donors to step forward and help in saving more lives despite the risks donors may endure throughout the procedural process. However, I disagree with the whole concept of financially benefiting from such a humanistic act of courage and altruism for the greater good of those in a terminal position. The whole concept of human relationship, the sacredness of human body, the decrease of altruistic donation and discrimination among patients, will alter the process of donation from being a moral act to being a business transaction.

Works Cited

Allen, Matthew B., and Peter P. Reese. “Financial Incentives for Living Kidney Donation: Ethics and Evidence.” Clinical Journal of the American Society of Nephrology : CJASN. American Society of Nephrology, 24 Oct. 2013. Web. 23 Jan. 2015.

Koren, Marina. “Would You Donate a Kidney for $10,000?” Www.nationaljournal.com. National Journal, 28 Oct. 2013. Web. 23 Jan. 2015.

Nelson, Edward W. “Organ Procurement and Transplantation Network.” Ethics. Health Resources and Administration Services, 20 June 1993. Web. 23 Jan. 2015.

The moral dilemma in this case revolves around the issue of autonomy. The Alzheimer residents at St. Mary’s suffer from mental impairment, as a result of their disease, and tend to experience “intermittent competency”. Dr. Selleck is proposing to conduct a clinical trial in order to test the efficacy of the drug Tetrahydroaminoacridine in dramatically decreasing the “progression rate of Alzheimer’s disease” (Thomas & Waluchow, 129). Participants in the trial would include individuals who maintain some control over their mental capacities and are in the middle stages of Alzheimer’s. To qualify for participation in the study, “formal, written consent” must be obtained from both the patient and their closest relative, and the healthcare staff at St. Mary’s must agree. If a patient is deemed “legally incompetent”, then consent from the patient is not necessary, but consent from a relative is required for participation (Thomas & Waluchow, 129). The director of St. Mary’s, Ann Wilson, objects to these patients participating in the clinical trial. She argues that the residents at St. Mary’s are elderly, institutionalized, and impaired, and should not be victimized through scientific examination (Thomas & Waluchow, 129-130). The proposed clinical trial cannot access a large enough sample size without the assistance of St. Mary’s residents. The dilemma is whether a resident at St. Mary’s Nursing Home, who meets the appropriate qualifications, should be allowed to participate in the clinical trial or precluded from participating for the reasons stated by Wilson. While objections from a healthcare staff member at St. Mary’s may prevent residents from participating in the clinical trial, I argue that Wilson is obstructing the notion of a resident’s autonomy by denying the resident and their family the opportunity to decide to engage in a trial that could be beneficial in reducing the progression of Alzheimer’s.

Beauchamp and Childress (2013) define respect for autonomy as a moral principle involving “a norm of respecting and supporting autonomous decisions” (13). Patients suffering from Alzheimer’s disease may be only intermittently competent, but withholding participation of such patients from clinical trials on grounds of autonomy prevents future progression in combating this tragic disease. The patients fulfilling the criteria for this trial still maintain some mental capacities, and denying such patients the liberty to consent to participate in the trial is not respecting the autonomy of these individuals. A close relative may grant consent for the patient if they are legally incompetent. The residents at St. Mary’s who are eligible to participate in the trial should be granted the opportunity to express autonomy and such autonomy should be supported.

The director at St. Mary’s may express her concern for the Alzheimer patient’s wellbeing, but denying them the opportunity to receive a drug that has promising effects in helping to combat the progression of their chronic disease is further reducing what little autonomy they have left. Participation in the trial is not proposed to have any negative effects on the participants and has been cleared by multiple Research Ethics Boards. Participation in the trial will either benefit participants or leave them to carry out the projected course of the disease. A drug for Alzheimer’s can only truly be tested by trials involving individuals with Alzheimer’s and with Alzheimer’s disease comes questions of competency. If the patient and a close family member consent to the trial, participation should not be denied. Preventing this clinical trial not only affects the participants in the trial, but also impedes possible advances in treatment for other individuals with Alzheimer’s.

A study was conducted by Kim et al. (2001) to determine the competency of individuals with Alzheimer’s in giving informed consent. Results of the study address the controversy in gaining consent from such individuals. More information regarding the study can be found through the following link: http://ajp.psychiatryonline.org.proxy.library.emory.edu/doi/full/10.1176/appi.ajp.158.5.712

Works Cited

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

Oxford UP, 2009. Print.

Thomas, John and Wilfrid Waluchow. Well and Good: A Case Study Approach to Biomedical

         Ethics. 3^rd ed. Broadview Press Ltd., n.d. Print.

According to Beauchamp and Childress, “An individual acts conscientiously if he or she is motivated to do what is right because it is right, has tried with due diligence to determine what is right, intends to do what is right, and exerts appropriate effort to do so” (42). Prior to reading the second chapter of the aforementioned authors’ bioethics guide, I had known conscientious as only to mean one was aware of something. For instance, a nurse informs you that giving blood might make you lightheaded. You acknowledge this fact and still consent to donating; you conscientiously gave permission to have your blood drawn. However, in the case of ethics, I am learning commonplace words, such as rules or principles, can take on new meanings. Conscientious will now be added to my ever-growing mental list of words that do not mean what they should in ethics. All jokes aside, the above definition of conscientiousness has sparked questions about how moral conscientious refusal has a space in the field of healthcare.

In the introductory chapter of Beauchamp and Childress’s book, the notions of common and particular moralities are of focus. One such particular morality is that of a professional morality. The professional morality is non-universal and dictates moral codes and standards that are particular to a certain profession (Beauchamp 6). When you become a professional, you are ascribing to the moral codes that come with that profession. Ethically speaking, as a nurse or physician it is your duty to act in the best interest of your patient regardless of your own separate moral obligations.  So how can one claim a conscientious objection to a medical procedure that aligns with the patient’s morals but not their own? In the example Beauchamp and Childress give, a nurse can conscientiously object to having any part in an abortion procedure if that decision does not follow what she thinks is right (Beauchamp 43). This refusal is fine if there are other nurses around; the nurse is not interfering with the patient’s autonomy by not allowing the procedure to take place. There is also no malevolence because there is someone to aid the patient in the procedure. However, if there was only one nurse available and she conscientiously objected thus forcing the patient away would be immoral. The nurse is no longer doing what is right; yes it may be right in their mind but as a care provider it is not right. The patient’s autonomy has been taken away for an unjust reason. One cannot both be conscientious and refusing to provide care, which is not right and contradicts the nurse’s obligation to his or her patient.

The problem with conscientious objection in healthcare lies within the definition. Several times in the definition of conscientious, the idea of what one thinks is right is used. One’s personal morality does not have room in professional morality because one’s definition of right is subjective and falls outside the particular morality.  In accepting a job in healthcare you should be conscious of the fact that you may encounter patients that will have medical views that they are entitled to that do not align with your own.

Works Cited

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

In this case, the director of the Nursing Home uses the authority of her role to take away the right of her patients to decide whether or not they choose to be part of a research study about an Alzheimer’s drug. It is of note that by making this choice, she is exercising her own autonomy while denying all her patients their own autonomy. The study itself has been deemed ethical by several review boards. Indeed, even to my own sensibilities, it appears to me that the three types of consent, from the patient, a relative, and finally from the director herself, thoroughly ensure that only voluntary, competent patients become a part of the study. A striking point made in the case discussion, “if a reasonably competent patient consents but the family member does not, does it not seriously violate the autonomy  of the patient? ” shows that even these safeguards reduce the patient’s autonomy (Thomas and Waluchow 113).  However, this reduction in the patient’s autonomy, in my opinion, is trivial compared to the complete removal of personal choice from each patient under the director’s decision to not allow the study at her institution.

After reading the case and considering the case discussion, another salient point to me was the roles of the common good versus the rights of the individual. In this case, the director is disregarding the common good (that of those who might benefit from a successful Alzheimer’s treatment) for what she considers the rights of her patients (the right to live an unbothered, peaceful life). The director is using her own individual morality to over ride a study deemed ethically sound by other institutions. Perhaps, in this case, the morality of the individual should bend to fit into the ethics of a study that could help many in society.

Another point the case discussion brought up is the role institutions have on our autonomy. In general, most people are part of institutions, such as schools and workplaces, at some point in their lives. Almost by definition, institutions must provide some types of regulation to ensure that chaos does not occur. However, social institutions that are able to provide individuals with the biggest sense of autonomy are the most successful (Reeve and Assor 111). In my opinion, if studies have shown that this is the case, then the ethical thing to do is to allow as much autonomy as is possible in social institutions. In this case, therefore, allowing patients to choose whether or not they should be a part of the study would reinforce and rebuild a perhaps lost sense of autonomy in elderly persons and therefore result in a better quality of life. In the case discussion, it is presented that patient’s seeking to find meaning in life by contributing to the study would be an unwanted outcome. However, to me, it seems like a result that further supports allowing patients to participate in the study. Indeed, many people who are fully competent and healthy participate in studies so that they can contribute to society. If contributing to society makes these patients feel more fulfilled and happy, then I argue that it is the director’s moral obligation to allow the patients and their family’s to make such a choice.

 Works Cited

Thomas, John and Waluchow, Wilfrid. Well and Good. Canada: Broadview Press, 1998. Print.

Reeve, John and Assor, Avi. Do Social Institutions Necessarily SuppressIndividuals’ Need for Autonomy? The Possibility of Schools as Autonomy-Promoting ContextsAcross the Globe, ‹http://johnmarshallreeve.org/yahoo_site_ad min1/assets/docs/Reev e_ Assor2011_Chapter.1051322.pdf>

The case, “Research Involving Alzheimer Patients,” revolves around the enrollment of elderly people with middle stages of Alzheimer’s disease as subjects for a research project that assesses the effectiveness of a new drug at treating Alzheimer’s. For patients to be added to the study, the investigators required consent from the patients themselves, consent from their closest relatives, and approval from the medical staff at St. Mary’s (Thomas, 129). If some patients were labeled as “legally incompetent,” only consent from the relatives was necessary. One dilemma related to this situation involves whether the medical staff should or should not object to the recruitment of their patients for this study.

The medical staff could argue that it is necessary to object to the recruitment process to protect the patients from being exploited. According to the National Institute of Aging, Alzheimer’s includes various symptoms that range from memory loss and confusion to the inability to perform daily tasks such as getting dressed. As they progress, these issues can lead to institutionalization and to the patients believing that they are helpless and are a burden to society. It may be true that the participants are, thus, consenting primarily because of this feeling that they are no longer able to contribute to society, so they think that by enlisting, they will be considered “valuable.” The medical staff may become concerned about the patients being exploited as research subjects due to this attitude.  Moreover, in scenarios where patients are “legally incompetent” and the relative provides the consent, the medical staff could choose to object if they are doubtful of the relative’s judgment.

There are also multiple reasons for the medical staff to not object to the researchers recruiting subjects from their facility. One reason would include them potentially intruding on the patients’ autonomy. In their book, Beauchamp and Childress define respect for autonomy as an important principle that involves respecting and supporting autonomous decisions (13). In this scenario, if the patients give their consent to participate in the study, the staff would be ignoring their autonomy by objecting. Furthermore, if a patient is ruled “legally incompetent,” but the closest relative provides consent, an objection by the staff could also be controversial. In addition, all the Research Ethics Boards endorsed this project (Thomas, 130). Additionally, it is important to consider the fact that the patients’ participation could result in treatment of their Alzheimer’s if the results from the study demonstrate the efficacy of the drug. This potential discovery would also lead to the treatment of many other individuals who have this disease. Without the involvement of these patients, Dr. Selleck argued that there might not be a sufficient sample size. Assuming this is true, the objection from the medical staff would prevent the researchers from investigating a potentially life-changing drug for all Alzheimer’s patients including those from St. Mary’s.  Ultimately, I believe that the disadvantages of an objection significantly outweigh the benefits, so Ann Wilson and her staff should not have objected to the recruitment process.

Worked Cited:

“Alzheimer’s Disease Fact Sheet.” National Institute on Aging. NIH, n.d. Web. 23 Jan. 2015.

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. N.p.: Broadview, 2014. Print.