In the case of the Nuu chah nulth Nation and Arthritis Research (case 9.1), the primary dilemma revolves around the use of blood samples for other, unspecified research. Dr. Richard Ward came to the Nuu chah nulth Council to receive permission to take blood samples in hopes to “ discover a genetic predisposition to [rheumatoid arthritis] and … help in the search for a cure or at least direct people testing positive to physiotherapy” (W & G 289). His results for discovering a link to arthritis were lacking; however, he was able to publish a groundbreaking paper on the genetic distinctiveness of the Nuu chah nulth Nation. During Dr. Richard’s rise to fame, he neglected his original agreement with the Nuu chah nulth Nation and has let the blood sample circulate through the research community.

The issue at hand is the vagueness of the consent that the Nuu chah nulth Nation signed. Due to this vagueness, the Nation was exploited for their genetic information, receiving neither the promised information nor help regarding Arthritis in their community. Although Dr. Richard Ward forgot to contact the tribe after a year, he technically fell within the constraints of his proposed research –“to conduct a Health Canada sponsored study” (W & G 289). A small loop hole, due to the vagueness in the description of his study, allowed him to branch away from solely doing Arthritis Research. This action should not condone but it prevented; however, I argue that the blame falls on both sides. The consent should have been more specific, and at the time there should not be blind trust in the researcher. This act of blind trust is still prevalent in research today. This became painfully obvious after looking at my own research.

Doing research myself, I never put much thought into the mandatory consent form given out at the beginning of each experiment. For the most part, it is routine and a box on my checklist to ensure the lab does not get sued. I never realized it was also to protect the rights of the subject and the data collected from them. The most frightening part is the fact that most participants in my research do not read the consent but rather agree to my verbal synopsis of it. There is a blind trust towards scientists. People assume the best from them and offer little hesitation when agreeing to someone in a “white lab coat”, especially when the incentive is high.

My final thought after reading this paper is the iconic line from the Hippocratic Oath: “to abstain from doing harm”. I agree that Dr. Richard Ward preformed unsanctioned experiments due to vagueness; however, would the reaction from the Nuu chah nulth Nation be different if the research helped them instead of hindering them? I find it interesting that the reaction of the tribe would have probably been different if Dr. Richard Ward found something prevalent to the Nation’s health, but also unrelated to Arthritis. If no harm were done to the Nuu chah nulth Nation, would there be such large backlash towards the additional experiments?

Citations

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. “Case 9.1 The Nuu chah nulth Nation and Arthritis Research” Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. Peterborough, Ontario: Broadview, 2014. 289-192. Print.

Waterson, Bill. “Calivn and Hobbes”, http://1.bp.blogspot.com/-Cmn9aQ8ZpPE/U3fKHC9-3uI/AAAAAAAAGlU/v0jCsff3dEQ/s1600/Research.jpg.

In 1981, researcher Dr. Richard Ward consulted the Nuu chah nulth nation, a group of Aboriginal people living on the west coast of North America, about conducting a study on the increased rate of rheumatoid arthritis experienced by these people. Not only was no such study ever conducted, but Ward used the 30mL of blood conducted from 883 Nuu chah nulth as the basis for his groundbreaking research on the genetic distinctiveness of the Nuu chah nulth. The obvious moral question is should Aboriginal communities have the right to dictate what type of research is performed on their data and materials?

As I read this case, not only was I alarmed by the lack of informed consent involved in Ward’s research, but the complete disregard for the Nuu chah nulth people. While genetic research is hot and flashy, studies show that such research can be damaging to the group, resulting in the questioning of group membership, and the abandonment of the value of culture and oral history (W & G 290). As a result of such controversial studies, researchers such as Dr. Judy Putt propose necessary ethical guidelines that must be followed when conducting research with Aboriginal groups. She writes, “safeguarding participant privacy, which may require special measures with the sharing of research with community organizations…should be negotiated with participants, partners, and/or collaborators” (Putt). She goes on to list values that should be considered when conducting research with Aboriginal peoples such as honesty and integrity, appropriate acknowledgements of the role of others, and responsible communication of results. Due to the fact that none of these values were honored in the present study, I would argue that Ward’s complete disregard of the Nuu chah nulth nation was unethical.

This case reminded me Dr. Peter Provonost’s work in evaluating the infection-control of ICUs in 67 Michigan hospitals. Provonost’s research was halted by the Office for Human Research Protections on the grounds that Provonost was conducting his research without the informed consent of the ICU’s patients. After much review, the OHRP permitted the continuation of the study based on the belief that the work was being used solely for clinical purposes and not medical research or experimentation (B. 157-158). Given that Ward’s work does qualify as medical research, the informed consent of the Nuu chah nulth people seems requisite.

When conducting research, especially research with a unique cultural group, not only is it important to uphold the value of informed consent but respect for the customs of the cultural group, neither of which occurred in the present case.

Beauchamp, Tom L., and James F. Childress. “Respect for Autonomy.” Principles of Biomedical Ethics. 7th ed. New York: Oxford UP, 1994. 125-31. Print.

Putt, Judy. Conducting Research with Indigenous People and Communities. Sydney: Indigenous

Justice Clearinghouse, 2013. Indigenousjustice.gov.au. Indigenous Justice Clearinghouse, 2013. Web. 25 Feb. 2017.

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. “Case 10.3 Should Patients Be Informed of Remote Risks of Procedures?” Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. Peterborough, Ontario: Broadview, 2014. 300-02. Print.

In class today, we had a discussion about the case with the murder of the young girl by her father. That lead us into the discussion of whether or not the death of the young girl, and cases similar to it should be classified as a killing or as a case of letting someone die. The class presented interesting distinctions between the two groups, but I personally think that a killing can be intentional or unintentional, but when one makes a decision to let someone die, it is intentional, because there is a choice that is made over the person’s life.

When discussing the Case 6.2, about the woman from Canada who wanted to die once her condition deteriorated, one issue that came up with the case was whether or not a physician assisted suicide is a form of killing. It was an issue because a physician has the duty to never cause harm to a patient. From our discussion in class, it can be concluded as an intentional killing, but I would also add the phrase morally justified intentional killing, because the patient had a desire to die, the doctor as the physician has the duty to not cause harm, and in the case of the patient, causing harm would the psychological and physical deterioration that the patient will experience if she lives with her condition.

When looking at these cases of assisted suicide, it is important to look at the choices made, the intention of the person/patient, the expected outcome, and the justification of the case, keeping in mind that each case is relative.

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

Communication is a key component of research. If there is not sufficient communication between both the researcher and the subject, then one party may misinterpret an action or statement from the other party. Let’s look at the case of the Nuuh chah nulth Nation to gain a better understanding of the issue. In 1981, a researcher named Dr. Ward conducted research and collected blood samples on the Nuuh chah nulth to examine if there was a genetic predisposition between the Nuuh chah nulth nation and rheumatoid arthritis. After research was conducted, no genetic predisposition was found. However, Dr. Ward continued to use the blood samples and data he previously collected to further his research on the history of First Nations. The Nuuh chah nulth were outraged and devised a council that would work to gather all of the data that was misused. Although it was years before the blood samples were returned to the council, the damage had already been done.

One of the main issues I would like to focus on is that the patients were not informed. After the Nuuh chah nulth openly allowed the researcher to enter their community and conduct research, they were exploited and not informed of the results as they were promised. The blood samples were then distributed throughout the scientific community for a variety of studies unrelated to arthritis, such as HIV/AIDS. These results humiliated the Nuuh chah nulth and left them in the dark about their lab results.

The problem with not informing the Nuuh chah nulth about the intent to use their blood samples for other purposes is that it destroys trust between the researcher and the research subject. The Nuuh chah nulth complied with the researcher and gave blood samples, because they hoped the information would allow them to learn more about their genetic history. However, when the researcher decided to change his mind on divulging information to the subject, and instead used the samples for other purposes, the trust between the subject and the researcher is damaged. Furthermore, when the Nuuh chah nulth obtained their blood samples back, they never received an apology from any of the parties involved. Because of this, the Nuuh chah nulth are less likely to allow another researcher to study their community.

As it turns out, there have also been other cases where patient information is misused or their privacy has been invaded. In 2016, it was discovered that some private health insurers may have gained access to patient information, such as which dentists they visited and how much they charged for a specific procedure. This could allow insurance companies to tailor their prices to make them more competitive. Although this is legal under HICAPS, the clause for the use of confidential information between private insurers and dentists, some policy workers are working to revise this legislation. In a more extreme case, a woman in Hawaii was able to access the medical records of another woman and reveal confidential information, such as the fact she was diagnosed with AIDS. Although the woman was charged and sentenced to a year in prison, one has to question the extent to which our medical information is available to the general public.

These are interesting questions to be addressed in health policy. Although I personally believe that information on patients should be used at their discretion, this is not always the viewpoint of physicians, researchers, or private insurers. By always confirming with the patient on whether their results are safe to be used, researchers can be limited in the scope of what they want to accomplish. This may deny them grant funding, prestige, or even higher incomes. However, if the patient’s privacy is not respected, then there may not be data to collect, and research would be halted altogether. Let me know what you think down below.

Citation:

Amaguin, Roman. “Hospital Employee’s Misuse of Personal Health Information: A Wake Up Call for Hawaii Employers.” Hg.org. N.p., n.d. Web. 24 Feb. 2017.

Bailey, Michael. “Private Health Funds Accused by Dentists of Misusing Patient Data for Commercial Gain.” Financial Review. N.p., 25 July 2016. Web. 24 Feb. 2017.

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

Colorado, one of the first states to legalize marijuana back in 2012, approved a bill last year to legalize assisted death (“Colorado”). This came as a shock to many people not in support of assisted death, but, recently, more and more people have begun to support the idea of a doctor prescribing medication that will result in the death of his patient. As a quick background on information, doctors can’t just prescribe anyone these lethal drugs: the United States has set guideline for who is eligible to receive them. Patients must be terminally ill, have to be able to take the drug on their own, and, dealing with competency, must “have the mental capacity to know what they are doing and what the consequences are,” as well as make “two verbal requests, 15 days apart, and one written request with two witnesses” (Jaret). Additionally, more than one doctor must verify that the patient fits all these criteria. This ensures that the patient is competent to make the decision to end his or her life and also that the patient is not being coerced by a third party.

Assisted suicide should be a viable option for patients like Suzie Rodriguez. One of the Canadian Judicial System’s reasoning behind denying Ms. Rodriguez’s plea to have assisted suicide was that assisted suicide would “deprecate” human life (Thomas 215). I think it’s the opposite—people who have reached the end of their life and don’t want to die in an undignified and painful way should be allowed to do have assisted suicide in order to make their life as fulfilling as possible. Based on the principle of autonomy, patients should have the right to decide to die. Death is a major event in someone’s life, and if they aren’t able to carry out their final wish of how they want to die, then a medical professional should help them. I still believe, however, that doctors that don’t feel that same way should be able to refuse to ‘treat’ the patient. If I was a doctor in this position, I wouldn’t be able to carry out assisted suicide because of my own personal religious beliefs. Similar to the policy on abortion, doctors in this position should be allowed to maintain their own sanctity of life and refer the patient to a doctor willing to help them.

Many people argue that rather than suicide, modern medicine should enable patients to manage their pain instead of ending their lives. But what if in order to properly manage the pain, the medicine must be extremely strong and will affect the patient’s cognitive abilities and ability to have a satisfying, pleasurable, stimulating life? This starts to creep into the realm of deciding someone’s quality of life. I agree with previous readings that we shouldn’t judge the value of someone’s life based on our own perception of their quality of life, but I think that if a person thinks his or her own quality of life is below worth it, and they are terminal with no hope of change, then they should be allowed to have PAS.

Another argument against PAS is that it can result in a ‘slippery slope’ where involuntary patients or patients that are coerced are killed against their will. However, I disagree that PAS will lead to a slippery slope. As seen in the beginning of this blog, countries have already passed bills to regulate PAS so that only a very specific population of terminally ill, consenting, competent, and non-coerced people can participate in PAS. By instating bills like this, we prevent the possibility of a slippery slope developing. Weighing all of these factors, PAS should be legalized.

Works Cited

“Colorado.” Death with Dignity, www.deathwithdignity.org/states/colorado/.

Accessed 23 Feb. 2016.

Jaret, Peter. “Is Physician-Assisted Suicide Ethical?” University of California

Berkeley Wellness, Remedy Health Media, 26 Apr. 2016,

www.berkeleywellness.com/healthy-community/health-care-policy/article/

physician-assisted-suicide-ethical. Accessed 23 Feb. 2017.

Thomas, John, et al. Well and Good: A Case Study Approach to Health Care Ethics.

4th ed., Broadview Press, 2014.

Informed consent and disclosure are two very important aspects of conversation in bioethics. Beauchamp and Childress discuss how informed consent has been put in place to “protect autonomous choice, to avoid manipulation, and to respect persons’ rights” ( Beauchamp and Childress, 121). With informed consent, patients and subjects must authorize and gave permission to researchers and physicians for a specific task, whether for research or a medical procedure. In order for patients and subjects to consent, they must be competent enough to understand the information and be in the right frame of mind to make a decision. Along with informed consent is disclosure. Beauchamp and Childress explain the obligation of researchers and physicians to disclose necessary information to their patients and subjects. Patients and subjects have every right to know all the information that pertains to them, especially when the outcomes may negatively impact them. Informed consent and disclosure are essential in research. Researchers must provide subjects with every single detail of the research. Taking that statement into consideration, consider the following the case. Dr. Richard Ward is a researcher who wanted to conduct research on the Nuu chah nulth, an aboriginal group suffering from arthritis. He approached the council and asked to perform an experiment to help understand the  genetics behind arthritis. The council gave him permission. Dr. Ward goes on to collect blood from the people and begins his research. Dr. Ward failed to disclose information about another research he is conducting on the history of First Nations by looking at their DNA. The blood samples show no genetic link to arthritis, so he continues with his other research. Dr. Ward does not share any of this information with the Nuu chah nulth.  Dr. Ward shared the blood samples of the aboriginal people with other researchers, and published a paper on the results of his second research, creating unwanted attention to the Nuu chah nulth community. (Thomas et al., 289). This case raises many issues in terms of informed consent and disclosure.

The first issue is that Dr. Ward intentionally withheld information from the council and from the subjects. He intentionally did not speak to the council about his second research and failed to report that he found no link to arthritis. His choice violates the basis of informed consent. Dr. Ward manipulated and abused the rights of the people. The fact that Dr. Ward chose not to disclose information about his other research brings into question about whether he  truly wanted to conduct research to understand the genetics of arthritis or if it was a cover up for his second research.

In addition, Dr. Ward’s failure to disclose information violates the trust of the subjects and the council. Research is a field that requires trust, considering it demands interacting with strangers. Subjects trust that the researchers are being honest about what they are doing and that the research is in their best interest. The council and the people trusted that Dr. Ward was going to discover important information about the disease that was hurting them and find ways to treat the disease. They trusted this man, this stranger, with sensitive information about their community in hope that he would provide answers, but that was not the case.

Informed consent and disclosure must play a role in patient/subject-physician/researchers relationships to ensure that patients and subjects are protected.

Works Cited:

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York: Oxford UP, 2009. Print.

Thomas, J. E., Waluchow, W. J., & Gedge, E. (2014). Well and good: a case study approach to health care ethics (4th ed.). Peterborough, Ontario: Broadview Press.

Moral Dilemma:

In the case “The Nuu chah nulth Nation and Arthritis Research”, Dr. Ward and his research team collected blood samples from the nation of Nuu chah nulth, a group of aboriginal people with the permission of the nation’s Council. The case presents a moral dilemma regarding the way in which Dr. Ward conducted his research. The question is brought up, “Should Dr. Ward and his team apologize for their actions?”

Analysis:

Informed consent in research is important, especially amongst a large group of participants. Dr. Ward received an overall consent for the arthritis testing, but he did not seek consent for anything else. The Council agreed to the research, with the hope that Dr. Ward would discover a genetic predisposition and help search for a cure.

In the case for Dr. Ward and his research team, the nation understood that he was already working on the general area of the evolutionary history of First Nations by studying their DNA. From this, it seems like the individuals were competent, so they could understand the risks of giving blood for research. Also, Dr. Ward continued to run tests on the samples after the first failure of tests. This demonstrates his dedication to the research.

However, Dr. Ward and his research team fell short in disclosing information about the results with the nation. Dr. Ward promise, but failed, to notify them on the progress of his research within the year. After gaining world recognition, he allowed other researchers to use the samples in studies unrelated to arthritis, without the consent of the nation. Although the team returned their samples after outrage among the nation and other researchers, the team has yet to apologize for misusing the blood samples.

This case deals with the major moral principle of nonmalefience: “one ought not to inflict evil or harm”. We can specify this to “not harming or exploiting the research participants’ rights”. In the “Consent of Adult Experimentation” case, we learned about the dangers of medical research from the Nazi experiments. One of the dangers is violating the participants’ rights in research. The community has a right to dictate what type of research is performed on their blood samples and the right to understand the consequences of the type of research. For example, there is a possibility of sharing identifying information through the blood samples. The research team violated the community’s autonomy when they withheld information on the type of research being done with their samples. Overall the research should be based on the consideration of the rights of the patients, like the consideration used in the case of “Research Involving Alzheimer’s Patients. The director of the patients focused on behalf of the patients rather than herself.

Another moral principle is “one ought to do or promote good”. Specifically, one should promote good with righteous intentions. It seems as if Dr. Ward got distracted in the midst of his own research on evolutionary genetics, rather than working on the Arthritis case for the Nuu chah nulth nation. The growing popularity about his work may have facilitated this distraction. He failed to help the nation efficiently and to do right by them to the best of his ability. He also failed to protect the individual privacy and confidentiality of his participants by allowing other researches to use the samples.

It is important to consider the understanding of the nation, in its entirety. Most likely, they lack similar communication system, so the information may be manipulated between the research team and the population. They may also lack the same resources or knowledge to understand all medical and genetic terms of arthritis. An example of this situation is experimentation on prisoners. In his article, Reiter says that unhealthy prisoners are more likely to desperate wanting for any type of medical care. This can lead them to taking desperate measures they may not otherwise take. Like prisoners, the individuals of the nation may have a compromised ability to understand the potential consequences of the research.

Overall, I believe Dr. Ward and his research team should apologize for exploiting the samples of the participants and violating their right to know what research is conducted on their data.

Citations

Broady, Baruch, and Tristram Engelhardt. “Consent of Adults to Experimentation.” (n.d.): n. pag. Web.

Reiter, Keramet. “Experimentation On Prisoners: Persistent Dilemmas In Rights And Regulations.” California Law Review 97.2 (2009): 501-566. Academic Search Complete. Web. 20 Feb. 2017.

Thomas, John E, et al. “Case 3.1: Research Involving Alzheimer’s Patients.” Well and Good: A Case Study Approach to Health Care. 4th ed. Canada: Broadview, 2014. 289-92. Print.

Thomas, John E, et al. “Case 9.1. The Nuu Chah Nulth Nation and Arthritis Research.” Well and Good: A Case Study Approach to Health Care. 4th ed. Canada: Broadview, 2014. 289-92. Print.

Physician-assisted suicide is controversial in the medical world due to the conflicting ethical principles of autonomy, beneficence and nonmaleficence that could be argued both for and against such a procedure. This form of voluntary euthanasia has caught media attention after the District of Columbia passed its Death with Dignity Act as of February 20, 2017, marking it the sixth jurisdiction in the United States to have a policy allowing physician assisted suicide. According to this new act, certain individuals with terminally ill diagnoses can “voluntarily and legally request and receive a prescription medication from their physician to hasten their death in a peaceful, humane, and dignified manner” (“District of Columbia Current Status”). It appears as if this act prioritizes patient autonomy and respecting the wishes of the terminally ill individual; however autonomy in this case is at odds with the duty of the physician to do no harm and help the individual. Or is it?

In the case of Sue Rodriguez, a woman suffering from ALS, she petitioned to the court to legalize physician-assisted suicide so that she could end her life in a humane way when she was no longer able to enjoy it. Rodriguez was aware of the specifics of the condition and knew that by the time her life was too painful and miserable to tolerate, she would be physically incapable to end her life. All she wanted was to try as best she could to enjoy the life she had before the disease fully took over and made life unbearable, at which point she wanted to have the option to have access to “’technological means by which she might, by her own hand, at the time of her choosing, end her life’” (Thomas, Waluchow, Gedge, 214). When it comes to life-ending issues, it is important first to assess the competency of the individual. Although suffering from ALS, Rodriguez appears to be a mentally competent individual who is fully capable of making her own decisions regarding the course of her life and consequently death. If the patient is competent, which she appears to be, is that enough to override the physician’s duty to protect the patient’s life at all costs?

With respect to this scenario, I believe that patient autonomy should trump the duty of the physician to “do no harm” and keep the patient alive regardless of her wishes. The truth of the matter is, physicians and Supreme Court Justices who are making these decisions do not know what it is like living with the unbearable pain and life restrictions that individuals suffering with ALS or other terminal diseases face every single day, and if that is the case who are they to decide if such an individual should live or die? I do not believe that every terminally ill person should opt for assisted suicide; however I do believe that they should all have a choice. In class we discussed the shift from Sanctimonious Life (SL) to Quality of Life (QL) with regards to end of life issues and deciding when it is acceptable to withhold or withdraw treatment. I believe that the shift to focusing on quality of life is a huge stepping stone in medical practice because it allows the patient to have a choice; a choice to end their life in a peaceful way rather than endure unbearable suffering when they no longer wish to live.

On that note, is it possible that by not allowing the patient to peacefully end her life, the physician is acting against the principles of nonmaleficence and beneficence? If a patient is suffering, a physician’s job is to ease their pain; therefore if the state of living is the cause of unwavering suffering, is it the duty of the physician to end the pain and subsequently end the patient’s life? As I said earlier, I am not advocating that all those who, on a daily basis, suffer extreme amounts of pain should end their life, but I can also follow the argument that for some such individuals, being able to end their life with dignity by the hand of a doctor would fall in support of the principles of beneficence and nonmaleficence.

Ultimately I believe that physician-assisted suicide should be an option to certain individuals with terminal conditions that cause excessive amounts of pain and suffering with no hope of recovery. If the patient is deemed competent enough to make the decision, patient autonomy should overshadow the idea that physicians must prolong the life of a patient at all costs. Those who are opposed to physician-assisted suicide argue “individuals can always find the means to kill themselves without a Doctor’s assistance” (220). While this argument is technically true, I believe that as a society we should not force suffering, terminally ill individuals to take matters into their own hands and end their lives in less humane ways. Whether physician-assisted suicide is legal or not, it will happen and some individuals may choose to commit suicide themselves, cutting their life shorter than they would if they knew that they could engage in a dignified, assisted suicide later.

Citations:

“District of Columbia Current Status.” Death With Dignity. Death With Dignity, n.d. Web. 23 Feb. 2017.

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

Here we consider two very different yet similar cases. Carole Jones is an elderly woman living in Edmonton, Canada where she’s suffered several cardiorespiratory arrests causing paralysis of her breathing muscles. The physicians have stated there is no possibility of restoring those muscles and she’s been in the ICU for several weeks in a semi-conscious state. Her son wants his mother to return to her homeland Jamaica before dying as their religious beliefs suggest her soul will be condemned if not on native soil. On the other hand, John is a 26 year-old man with “the elephant man’s disease” where non-malignant tumors attach themselves to the body’s nerves. He’s undergone over 100 surgeries in his life to remove tumors that lead to total deafness and partial blindness, almost complete paralysis, and total impairment of the breathing muscles. He is fully alert and conscious, deeming him competent and able to make rational choices. Both Carole and John are dependent on their respirators to prolong their lives, however Carole (and her Son) wants to remain on the respirator until she returns to her home while John is requesting that he be disconnected.

The first thing to consider in either case is whether or not anyone has the right to take someone off of life support or neglect to resuscitate him or her. If a patient has a pre-planned do not resuscitate (DNR) before experiencing whatever trauma brought them into the care of the physician, I say honor their longstanding request. In a case like Carole’s, and accepting the sanctity principle, I do not believe the physician has the right to override the son’s request and issue a DNR because that clearly goes against rules of patient autonomy. Although John’s situation may require a more morally daunting task for a physician, it’s a more reasonable circumstance because of his clear competent state and lengthy medical history that gives a detailed description of his quality of life. It does put the physician in a precarious situation because they have to directly intervene in order to fulfill the patient’s wishes in being disconnected from the respirator and end his life, no matter what the quality.

Either suggested situation ends in the ultimate death of the patient based on approval from a medical professional. But are we really dealing with the same decision in both cases? I say we are looking at two morally unique events because one is passive while the other requires direct action. Subscribing to Becker’s suggestion, issuing a DNR doesn’t cause death; it merely allows nature to take its course (Thomas, 213). It also should be noted that in practice, resuscitations aren’t as successful as we make them out to be, as only about 20 percent of older patients make it out of the hospital after suffering cardiac arrest (Graham, 1). Disconnecting the respirator is an intervention that should be approached with caution even when deemed appropriate because the decision made is irreversible and both parties are responsible for the an almost guaranteed death where as the physician cannot be held accountable for a DNR if previously arranged.

Braddock, James, “Do Not Resuscitate (DNAR) Orders” University of Washington School of Medicine

https://depts.washington.edu/bioethx/topics/dnr.html

Graham, Judith, “New Data to Consider in D.N.R. Decisions” The New York Times

Thomas, John, Well and Good

The practice of mercy killings has been a prevalent norm throughout the course of human history. However, in recent times, we have seen a spark in the moral debate relating to this issue. Case 6.3 highlights the rift in beliefs relating to euthanasia. There are 3 recognized forms of euthanasia:  voluntary, non-voluntary, and involuntary (BBC 2014). Voluntary euthanasia is performed with the explicit consent of the person wishing to end their life. Non-voluntary euthanasia occurs when someone is unable to give consent. Involuntary euthanasia concerns cases where someone wants to live but is killed regardless. For instance, “A soldier has their stomach blown open by a shell burst. They are in great pain and screaming in agony. They beg the army doctor to save their life. The doctor knows that they will die in ten minutes whatever happens. As he has no painkilling drugs with him he decides to spare the soldier further pain and shoots them dead.” (BBC 2014) The morality of these cases is usually taken on an individual case basis, and the ethical concerns are raised based on distinct opinions.

Case 6.3 in Well and Good describes the circumstances of Robert Latimer, who murdered his 12- year old daughter in 1993. Robert’s daughter Tracy suffered from numerous and intense disabilities, leading to incredible pain and torment. Not wanting to watch his daughter suffer any longer without the prospect of a cure or helpful treatment, Robert decided to end her life by exposing her to carbon monoxide. This case concerns the enactment of non-voluntary euthanasia through what could be considered a “mercy killing”. Robert’s daughter died a peaceful death, juxtaposing her tempestuous life. Another ethical issue comes to play with the concept of autonomy. Tracy could not voice her opinion because of her mental disability. Therefore, this case brings forth the question: is it morally justified to peacefully end someone’s life without their consent?

The ethical concerns with euthanasia arise from the Hippocratic oath. Physicians are not meant to harm patients and should not intentionally lead them towards death. However, what if death is in the best interest of the patient? For instance, almost 5,000 cases of euthanasia performed in the Netherlands in 1991 lacked patient consent. This contrasts many views held in the United States regarding assisted suicide. Some argue that assisted suicide is a sympathetic way to allow patients to die with dignity, others deem it as unacceptable as murder in the first degree. In the case of Tracy Latimer, could it be argued that her life was filled with more pain than happiness? Thus, her death was a merciful escape from further misery. Or was her death unwarranted? I believe Tracy’s father chose to end her suffering with good intentions, regardless of the circumstances which he went about it. I do not believe his actions were malicious in nature or he meant to cause Tracy any harm. It is more difficult to say whether he should have killed her, but his actions speak to the desperation he must have felt watching his daughter live with constant pain.

When reading about the morality of euthanasia, certain ideas are frequently shared, like the comparison between the legality of non-voluntary euthanasia, abortion, and the withdrawal of life support. These situations will most certainly involve the death of someone who would be unable to consent. For example, in the United States, it is perfectly legal to abort a child due to the development of a disability in-utero. Moreover, it is not only legal but incredibly common to terminate life supporting technology for patients in long-term comas. Many consider these humane choices; a life is ended to prevent future suffering and discomfort. After reading about this topic, I hold the belief that euthanasia is beneficial to patients who would otherwise be in distress, including those with severe mental incapacities. I would love to hear other points of views in the comments. Are Robert’s actions any different to terminating the life support for a comatose patient? How can we compare these distinct circumstances?

Other example of a euthanasia case:

https://www.youtube.com/watch?v=MAHey2LjA6c

References:

“Background about Euthanasia in The Netherlands.” Patients Rights Council. N.p., 2013. Web. 17 Feb. 2017.

“BBC – Ethics – Euthanasia: Voluntary and Involuntary Euthanasia.” BBC News. BBC, 2014. Web. 17 Feb. 2017.

Cook, Michael. “Why Not Non-voluntary Euthanasia for Psychiatric Patients?” BioEdge. N.p., 17 Oct. 2015. Web. 17 Feb. 2017.

Manninen, B. A. “A Case for Justified Non‐voluntary Active Euthanasia: Exploring the Ethics of the Groningen Protocol.” Journal of Medical Ethics. BMJ Group, Nov. 2006. Web. 17 Feb. 2017.

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