Background: One of the biggest issues that I see in our society is the unwillingness of the populace to engage with their beliefs that they hold so dear. The issue of physician assisted suicide is one of the most under discussed and consequently least understood issues of our time. The Society’s inability to separate from its dogmatic beliefs leads to a very myopic discussion about the ethics of physician assisted suicide. This problem has very harsh consequences on patients that are suffering from incurable and often very painful diseases. The case of Sue Rodriguez is such and I find it rather troublesome that the court decided against her wishes. Sue suffered from amyotrophic lateral sclerosis (ALS), a decease that leaves its victim unable to speak, walk, and ultimately kills by paralyzing the respiratory system (Thomas).

Moral Issues: The case presents several moral issues regarding the issue of physician assisted suicide. Arguments against it as listed in Well and Good book are:

• Pain can always be managed through strong analgesics.
• It will result in diminished efforts to improve end of life care for other patients.
• It is a form of killing and inconsistent with physician’s duty to never harm.
• Slippery slope to involuntary euthanasia.

Discussion: One of the greatest advocates of physician assisted suicide, Dr. Kevorkian often said that it is absolutely inhumane for an advanced society to not allow its members who are suffering from incurable and painful diseases to not end their lives. The biggest and the foremost argument in favor of it would be respect for patient autonomy. Choosing what happens to one’s life is very fundamental to being autonomous and the government should not have any say in that regard. Another not so straightforward argument would be the principle of non-maleficence. While aiding to someone’s death is clearly contrary to the principle, I would argue that intentionally forcing patients to suffer though extreme pain, especially when they do not have any potential to get better clearly violates the principle of non-beneficence. Of all the arguments against physician assisted suicide mentioned above, I would like to focus more on the last one as it presents quite unusual challenge when it comes to public policy. The issue is that it will blur the line between right to die and the expectation to die. Opponents argue that if society legalized the act of assisted suicide, it will gradually become an expectation for terminal patients to go through with the option of committing suicide. This claim does have some legitimate merits to it and should be carefully studied and discussed. However, a study from Netherlands, where physician assisted suicide is legal, showed that for the past few years there has been a decrease in the number of people opting for physician assisted suicide, partly because of the change in approach by the Dutch doctors in pain management strategy (Van). A system that adequately addresses this issue must be set in place for carrying out the practice of physician assisted suicide. I encourage you guys to have these conversations with people around you and spread awareness regarding this issue so that we address it and do justice to all the helpless patients throughout the country.

Work cited:

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well and Good: A Case Study Approach to Health Care Ethics. Peterborough, Ontario: Broadview, 2014. 214-22. Print.

Van Der Heide, Agnes. “End-of-Life Practices in the Netherlands under the Euthanasia Act.” ProQuest. N.p., 10 May 2007. Web. 18 Feb. 2017.

In this particular case, Robert Latimer deliberately killed his 12-year-old daughter to relieve her from her pain and suffering. At birth, Tracy Latimer was diagnosed with severe cerebral palsy, which left her physically and mentally disabled. It is imperative to consider both the nature of her illness and the effectiveness of her ongoing treatments to reach an ethical conclusion. Additionally, one must analyze the role of nonmaleficence, which is the principal that obliges us to impose no harm to others (Beauchamp & Childress 2001).

Outsiders have a duty to respect and support an individual’s personal healthcare decisions, as autonomy is a well-regarded moral principal. However, Tracy Latimer lacks the ability to express her thoughts and wishes due to the nature of her illness. Therefore, her father has assumed the sole role of a surrogate decision maker, which allows him to make health care decisions on his daughter’s behalf. As a surrogate, Robert needs to balance the best interests of his daughter with the competing interest to maximize benefits and minimize harms (Harrison 2004).

Throughout her lifetime, Tracy has undergone numerous surgeries to correct musculoskeletal and orthopedic problems (Thomas 2104). Despite Tracy’s inability to speak, there is well-documented evidence that the radical corrective treatments caused her severe pain. As there is no treatment to cure cerebral palsy, the surgeries merely attempted to alleviate the patient’s long-term suffering. In my opinion, the surrogate is merely tasked with choosing the lesser of two evils, as there is no decision available that will diminish the patient’s pain. Essentially, the surrogate could choose to continue surgery or withdraw surgery—however, neither of these options relieve Tracy’s pain and suffering. Therefore, Robert sought out an alternative and illegal course of action, known as active non-voluntary euthanasia.

Although there is no ideal course of action, it’s imperative to consider the duration and nature of the patient’s suffering. There is no denying that all children—regardless of physical or mental disability—have a claim to respect, protection, and medical treatment that serves their best interests (Harrison 2004). Often times, the patient’s best interest is to survive. However, it can be difficult to see how continued existence constitutes as a benefit for patients who will spend their lives in a chronic state of suffering and pain (Manninen 2006). It is fair to assume that Robert attempted to act in good faith, as he believed a continued existence for his daughter would be filled with suffering and pain.

In my opinion, Robert Latimer’s actions were understandable yet highly unethical, as he violated the principal of nonmaleficence. The father imposed intentional harm on his daughter without fully understanding her quality of life and suffering. In fact, no one will be able to fully respect Tracy’s autonomy, as she cannot express her own desires. However, Robert should have consulted additional family members and physicians before conducting non-voluntary euthanasia.

Essentially, I believe that Robert’s case sets a dangerous precedent for the future. Mentally disabled children are a highly vulnerable population and deserve additional consideration—physicians and surrogates cannot make judgments regarding a patient’s quality of life and existence, as they can merely claim that they are acting within the patient’s best interest.

WORKS CITED

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

Harrison, Christine. “Treatment decisions regarding infants, children and adolescents.” Paediatrics & Child Health. Pulsus Group Inc, Feb. 2004. 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. N.p.: Broadview, 2014. Print.

“Rex Murphy on Robert Latimer.” YouTube, uploaded by Stubby3492, 1 March 2008, https://www.youtube.com/watch?v=ZruMTCnq39k.

This case raises two issues:

1. Did the mother make a morally incorrect decision by not moving to the tertiary care hospital like her family doctor recommended, which would likely improve the outcome of the daughter once she was born?
2. Is it morally acceptable to withhold treatment from the baby when there’s a high chance that she won’t survive anyway, and even if she does that she will have severe mental disabilities?

In this case, the first issue can only be examined retrospectively. Many people might side with one of the residents who said that it was unfair to the baby that it had to suffer more because the mother didn’t take the doctor’s advice and go to the other hospital. While it likely would’ve been very beneficial for the mother to move to the tertiary care facility, I don’t think the mother purposefully harmed her baby. First of all, she was in a very vulnerable and uncertain state. She was unsure of when the birth would occur, and how it would go. She also suffered two other miscarriages in the past. Therefore it’s understandable that she wanted the support of her husband and her parents, which she could have by staying in the community hospital. It also appears that the her doctor failed to properly inform her about the importance of moving to the other care facility. He only mentioned it to her in a “brief conversation.” With regard to the information elements of the informed consent model, which includes “disclosure,” “recommendation,” and “understanding” (of the disclosure and recommendation of the plan), the doctor does not give adequate time to ensure that the mother fully understands the information (Beauchamp 124). If the doctor had a prolonged conversation where he discussed his concerns and the benefits of the tertiary care facility more thoroughly, then the mother would have been more likely to move to the other facility, but if she still hadn’t, then there would be more grounds to accuse her of purposeful wrongdoing.

Both the parents of the girl and the healthcare professionals are divided over the second issue. The mother wants to give the daughter every chance to live, the father is concerned about the daughter’s quality of life if she survives and the toll it will take on their marriage, the resident doesn’t think that living a severely cognitively impaired life would be worth it and describes how much it will cost the family to treat her later in life, and the pediatrician does not want to suspend treatment since she is not braindead, and is hopeful about the fact that the girl has a chance of surviving with little or no cognitive impairment. The father and resident seem to be most concerned with the resources, time, and money it will take to care for the girl. The pediatrician is clearly framing the possible outcomes by mentioning her chances of survival and life without disability, and hardly acknowledges the possibility of death or a severe mental disability. The mother is clearly emotionally attached to the daughter, especially since all of her other children died. While there is a degree of bias in everyone’s decision, I don’t think that suspending treatment is the right course of action, especially considering that the daughter might not die, and her condition would be even worse if she lived.

Citation:

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2013. Print.

It is rare to hear the words “compassionate” and “homicide” in the same phrase. However, in the case of Tracy Latimer, a so-called “compassionate homicide” ended her young life. In 1994, Tracy’s father, Robert, murdered Tracy to relieve her from her life of suffering due to severe cerebral palsy. Three years later, he was issued a constitutional exemption from the typical penalty for second-degree murder, reducing his sentence from life in prison to a mere two years. This court ruling is controversial, leaving us with important questions about the implications of excusing Robert Latimer’s “mercy killing” of his 12-year old daughter (Thomas, 2014).

While Robert’s actions cannot be undone, this case begs us to ask: was it morally right to kill Tracy with the intention of freeing her from pain? In order to answer this question, we must understand the facts of the case. First, Latimer believed killing Tracy was the right thing to do, arguing that her quality of life was so poor that death itself was a better alternative. It is clear that Robert’s actions were in good faith. Described by the judge as a “loving and protective parent”, Robert had his daughter’s best interests at heart. Or, at least, what he thought were his daughter’s best interests.

As discussed in the case, there is a general consensus that he had good intentions; however, his intentions do not make this action morally right. In fact, killing Tracy was an extreme example of surrogate decision-making gone wrong. Because of Tracy’s disability, she was unable to express her wishes, giving the decision-making role to her parents. However, how is Robert positive that this is what Tracy would have wanted if she does not have the capability to express it?

This uncertainty is at the heart of why Robert’s actions were morally unjust. Just because Tracy lacks what most of us could not imagine living without (the ability to talk, walk, and feed herself) does not mean her value as a person is any less than someone without a disability. Furthermore, Robert can not be sure that her quality of life is diminished, either. How do we know she did not enjoy life in her own way? In fact, the very definition of “quality of life” as defined by the WHO is the “individual’s perception of their position in life”, not the perception of someone else (WHO, 1997). Therefore, it is not Robert’s place to decide when her life should be over, as he cannot possibly know for sure that this is what she wants.

Robert is not alone in this viewpoint. It is not uncommon for the able-bodied to perceive their own quality of life as higher than that of a disabled person. For example, a survey of emergency medical professionals found that only 17% believed their quality of life would be average after a severe spinal cord injury, compared to 86% of actual survivors (Senelick, 2013). In this case, we have to remember that these types of pessimistic attitudes are personal opinions and do not justify Robert’s actions.

The implications of Robert’s sentence in this case extend far beyond the life of his family. Advocates of those with disabilities worry this type of treatment will lead us down a slippery slope where treating people with disabilities as “less than” the able-bodied is justified. As Pat Danforth of the City Council of Canadians with Disabilities states, “We’re telling every senior citizen, every quadriplegic, anyone injured in a car accident that their life is of diminished value” (Thomas, 2014).

Some may argue that Tracy’s quality of life was indeed diminished by the extreme pain she experienced. There is debate on whether her pain was continuous or situational. However, Robert’s actions are still unwarranted for a few logistical reasons as well. First, this is not an act of assisted-suicide, but one of non-voluntary euthanasia. Choosing to kill Tracy in the back of his truck is an active decision, making him accountable for his actions. However, if Tracy were to be arrested during a surgical procedure and her parents opted to file a DNR order then this passive act of non-intervention would be better justified. It may seem like the two are similar; however, it is more a question of the immediate harms to Tracy herself. In this case, Tracy was not in any mortal danger the day her father killed her. Second, Robert did this act alone without consulting his wife or medical professionals about alternative options. As Arianna states in her blog post, he completely bypasses his wife’s say in this life-changing decision. If he were in this situation again, he could discuss his concerns and find a more humane and less rudimentary way to rid his child of her pain. However, it should not have been up to him.

In conclusion, Robert Latimer’s actions were morally wrong even though his intentions were in good faith as he violated the principle of autonomy and nonmaleficence. If other cases like this arise in the future, keep these words in mind: “There is great danger if we allow ourselves to view the disabled as people whose lives are not worth living” (Senelick, 2013).

REFERENCES

WHO. (1997). Measuring Quality of Life. WHOQOL, pp. 1. http://www.who.int/mental_health/media/68.pdf

Senelick, R. (2013). Reconciling Life and Quadriplegia. The Atlantic. https://www.theatlantic.com/health/archive/2013/12/reconciling-life-and-quadriplegia/281821/

CBC News. (2010). ‘Compassionate homicide’: The law and Robert Latimer. CBC News. http://www.cbc.ca/news/canada/compassionate-homicide-the-law-and-robert-latimer-1.972561

Thomas, J. (2014). Well and Good. Broadview Press, 4th edition.

In Chapter 6 of Well and Good, the authors present two very intriguing cases regarding end-of-life issues and whether to allow patients to die. In the first case, Carole suffers from cardiorespiratory arrests and is incompetent to decide whether the physicians may take her off life support. Her son cites religious issues, in the form of a curse that has been put on him that will wreak havoc should he fail to return his mother to Jamaica before death, as his main argument to keep her on life support. The doctor should go ahead with the do not resuscitate order for several reasons. The first is that the son does not have the means, and is not in a situation to obtain the means, to travel from Canada to Jamaica in a reasonable amount of time, as he is unemployed and bankrupt. To allow the son enough time to get enough money to get to Jamaica would needlessly extend his mother’s suffering and divert precious medical resources away from others that need them. The doctors not only have an obligation to Carole, but also to all the other patients in the hospital. Carole’s prospects for recovery are nonexistent, as there is no hope for repairing her breathing muscles and she would die in minutes if taken off the respirator. While Carole may or may not be in pain, she is unaware of her surroundings and is not leading a fulfilling life in the hospital. Unless the son can get the money in a reasonable time frame and Carole’s treatment resources are not taking resources from other patients, the doctors have an obligation to the other patients to take her off the respirator.

The case that I thought was more interesting was the second one, in which 26-year-old John suffers from “the elephant man’s disease” and wishes to be euthanized. John is also on a respirator, and would most likely die very quickly if taken off it.  He is competent and not subject to any form of manipulation, and has decided that he wants to be euthanized. I would allow it.

The issue of death with dignity is an issue that arises from the debate between autonomy and the common moral belief of “do not kill.” Many people bring valid reasons to the “against” side of this debate, such as Dr. Aaron Kheriaty of UC Irvine. Dr. Kheriaty argues that people that wish for death are often doing so under the influence of severe, yet treatable, psychological issues such as chronic depression. He also argues that these patients feel that they are an undue to their caregivers and families. Finally, he makes the point that, in our society, people that do not have the resources to secure proper care to give them a comfortable hospice process may see euthanasia as their only option. See Dr. Kheriaty’s remarks here: https://www.youtube.com/watch?v=WGzXGOsNNt8.

While there are valid points against death with dignity, one cannot deny the moral inconsistencies it invokes. As Dr. Allan Saxe says in his TED talk (link: https://www.youtube.com/watch?v=B7ehf6CmG4Y), many states allow capital punishment, which is definitely non-consensual. So, why should they not allow consensual physician-assisted suicide that affects no other people whatsoever? The arguments against death with dignity would be stronger if those enforcing policies against it were morally consistent. However, they are not. A morally inconsistent authority does not have the right to impose inconsistent morals upon others, and the autonomy of a patient such as John, who is suffering greatly and is perfectly competent to decide for himself, must not be violated. As long as John is ruled to be psychologically healthy by a psychiatrist, he should be allowed to die.

Case 6.2: Sue Rodriguez: “Please Help Me to Die”

Introduction

Physician-assisted suicide is one of various types of end-of-life decisions debated in bioethics and legal circles. In this case, Sue Rodriguez has ALS. Once she began to experience deterioration of her abilities, she entertained the possibility of suicide and petitioned the courts for an order “which would allow a medical practitioner to set up technological means by which she might […] end her life.” After the Supreme Court of Canada issued its ruling, she took her own life with the assistance of an unidentified physician. In 2012, Gloria Taylor suffered from the same disease that affected Sue and brought the issue to the forefront of the Canadian public once again (Thomas, Waluchow, & Gedge 214).

The Question / Discussion

Like many of those we have discussed in class, this case presents a question about the morality of the choice of a physician to assist suicide, not directly about the legal issue; setting aside the legal question, which regards social policies and actions of the political community as a whole, if you or I were a physician, would it ever be morally right for us to choose to assist someone to commit suicide? (Lee 213).

Intentional Killing vs. Accepting Death as a Side Effect

Contemporary Debates in Bioethics presents two perspectives: “Physician-Assisted Suicide is Ethical,” and “Physician-Assisted Suicide is Not Ethical.” It is important to understand that we do not always have to take all measures possible to preserve someone’s life, our own included. It can be morally right to forgo life-sustaining treatment, foreseeing that this will result in dying more quickly than one otherwise would. There is a crucial distinction between intentionally killing and choosing to forgo treatment, foreseeing (but not intending) the death or hastening of death, that will occur as a side effect. Sometimes not doing something can be chosen as a means of bringing about some end. So, it is possible to choose an omission as a way of bringing about someone’s death. In choosing to assist Sue with suicide, the physician diminished his respect for the intrinsic good of human life (Lee 215).

Hence, I agree with Patrick Lee in arguing that physician-assisted suicide is not ethical. It would have been acceptable for the physician to withhold treatment and allow Sue to die (passive euthanasia), but that it was not acceptable for him to assist her in committing suicide (active euthanasia).

In the Media Today / Discussion

This case brought to mind two films that many may have seen: You’re Not You and Me Before You.

You’re Not You is a drama centered on a classical pianist named Kate who, like Sue, has been diagnosed with ALS. When Kate is in the advanced stages of ALS, she is shown sitting upright in her wheelchair and speaking in a labored fashion. The film is valuable in showing the way in which patients in this condition are unable to sit upright because the muscles in their backs are no longer receiving signals from the brain; the same is true of the muscles in the throat and jaw, making speech impossible. Kate says, “I’m going to die. I don’t want to be here.” Do you think that if misery is placing an undue burden on her existence, she may ask for assistance in ending her life? Trailer:

In Me Before You, the lead character is disabled (paralyzed) and chooses to end his life, leaving the newfound love of his life instructions to “live boldly” and encouraging her to live well. I feel that this romanticizes a death wish and promotes suicide as an act of love. What message do you think this sends, and how does his predicament relate to Sue’s case? Should medical aid in dying be considered differently for people with disabilities (Will) than people with terminal illnesses (Sue)? Trailer:

Works Cited

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2013. Print.

Lachs, John. “Physician-Assisted Suicide is Ethical.” Contemporary Debates in Bioethics. Chichester, West Sussex: John Wiley & Sons, Inc., 2014. Print.

Lee, Patrick. “Physician-Assisted Suicide is Not Ethical.” Contemporary Debates in Bioethics. Chichester, West Sussex: John Wiley & Sons, Inc., 2014. Print.

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. “Case 6.2: Sue Rodriguez: ‘Please Help Me to Die.'” Well and good: a case study approach to health care ethics. Peterborough, Ontario: Broadview Press, 2014. Print.

In case 5.1, a 22-year-old mother goes into premature labor and delivers a baby in need of “aggressive resuscitation” (Thomas, et al. 186).  With rapid deterioration after only the first 12 hours of life, the baby has a poor chance of survival and high risks of suffering from cognitive disabilities even if she does make it.  Someone must now decide whether or not to withdraw the use of the ventilator, but with the parents in somewhat of a disagreement, who gets the final say and what might affect that decision?

There are many dilemmas at play here and I recognize that the principle of nonmaleficence plays an important role in this case as do the distinctions and rules governing nontreatment addressed by Beauchamp and Childress, but in this discussion I want to focus on the interactions between the parents and the health care professionals.  I find the resident’s statement – “I certainly wouldn’t like to grow up as a cognitively disabled, visually impaired child” – to be completely inappropriate and unprofessional (Thomas, et al. 187).  Respecting a patient’s autonomy or even a surrogate’s decision in this case, means letting a patient or surrogate choose.  These difficult evaluations require us to analyze our values.  Physicians should not recommend values, but rather, provide the facts relevant to the situation.  While others may argue that you seek out your health care professional for advice in times of need, I believe that the resident should not reflect his personal beliefs and values about the meaning of life or limitations of the cognitively disabled, especially since he has no personal experience as a disabled person.  A review of ethical issues involving premature births even agrees by stating that “physicians should be careful to separate their personal views…from current medical, legal, and moral standards of care for such children” (Baer & Nelson, 2007).  Premature birth and the decisions to treat or not treat that accompany it contain this messy gray area.

In a journal discussion by Rebecca C. Thilo, she examines ethical issues in relation to the distribution of emergency contraception.  In one section, she addresses the attitudes and beliefs of nurses who provide emergency contraception to adolescents, who express personal disapproval of such methods and choices.  She explains how “it is ethically unacceptable for health care professionals to penalize patients for their actions” (Thilo, 2012).  Despite the difference in topic, the social judgment the resident expresses can affect and bias the parent’s decision as does a nurse’s critical and disapproving lecture on the uses of emergency contraception.  In both situations, the nurse and resident should not be expressing their personal beliefs or values in order to respect and maintain patient autonomy.  It is the responsibility of the health care professional to present the facts of the treatments and different options available to the patient without immediate personal input.  The resident should not provide personal input, but simply explain the important facts clearly so that the parents make an informed and autonomous decision without influence or judgement from the healthcare professionals around them.

Works Cited:

Thomas, John E, et al. “Case 5.1: Should Treatment Be Withheld from Patients with Severe Cognitive Disabilities?” Well and Good: Case Studies in Biomedical Ethics, Broadview P, 1987.

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2013. Print.

Baer, Gerri, and Robert Nelson. “A Review of Ethical Issues Involved in Premature Birth.” Rev. of Institute of Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy Outcomes. (2007): n. pag. NCBI. Web.

 
Thilo, Rebecca. “Barriers and Biases: Ethical Considerations for Providing Emergency Contraception to Adolescents in the Emergency Department.” Virtual Mentor 14.2 (2012): 121-25. AMA Journal of Ethics. Web

Dilemma:

Stephen Dawson is a severely mentally disabled seven-year-old who was born prematurely in Canada. Ever since he was two he has been rapidly declining in health and currently he needs 10 hours of daily care to live. He cannot eat, take medicine, or do any of his basic needs by himself. Currently he is in need of a critical surgery in which a shunt has to be placed in Stephen’s brain in order to drain out excess cerebro-spinal fluid. Initial Stephen’s parents consented to the surgery but the next day they decided against it. They believe Stephen’s life is painful and unhappy and that the boy deserves to die in peace. Immediately after this decision, the superintendent of family and child services decided to get involved in order to assume custody of Stephen. They filed a petition for temporary custody, which was ultimately granted. How was this decision made? Was it right for the parents to lose autonomy over their own child? Who should have the authority to make the decision over those not competent to make healthcare decisions themselves?

Discussion:

This situation has a range of issues to be considered. For one the quality of the life of the child is an important aspect of this case. In testimonies by the parents, it is stated that Stephen has to be forced to eat, chew, and take medication. This child also has a severe seizure disorder as well as being blind and largely unresponsive to the world around him. Stephen’s family spends an average of 10 hours taking care of him a day along with having two other children around the same age. It is evident that Stephen’s quality of life is largely compromised and has been reduced to him having little to no control over his life. Secondly I think of the distinction between extraordinary and ordinary in terms of the surgery that is needed. Is this surgery largely unneeded and only a temporary Band-Aid to Stephen’s many mental disabilities or a life saving treatment that is going to ameliorate Stephen’s quality of life? Is this an extraordinary intervention or an ordinary treatment along with many of Stephen’s other medical aids? As decided by the judge, the surgery is largely extraordinary and is stated by Judge Bryne would “constitute cruel and unusual treatment of Stephen” (Thomas et al., 2014).
Using this information and the ethical concerns discussed above, I would agree with the parents in deciding that the surgery is not necessary and Stephen should be allowed to live out the rest of his life peacefully. I also think that it should be the parents’ decision to make. While it is true that the doctors and medical staff understand the technicalities of Stephen’s condition and the intricacies of the surgery, they still shouldn’t have autonomy over Stephen. The clinical stuff should be able to consult the parents on the decision as well as give them advice but they shouldn’t have autonomy to decide the fate of another person’s child.
The decision to withhold treatment for a child should be a deeply thought out and acknowledged from all angles. The staff at the foster home in which Stephen spent some time, Sunny Hill, felt as though he experienced happiness to the environment around him. The professionals at this center found Stephen to be, “a happy little fellow despite his handicaps” (Thomas et al., 2014). This shows that maybe Stephen needed to be in a more stimulating environment in order to show more of a response or improvement. This picture is different from the one depicted by Stephen’s parents. I think it is important for his parents to consider this narrative and thoroughly understand the risks and benefits of the surgery. If in the end they were to decide that withholding treatment is what is best for their son, then I think that decision should be respected.

Works Cited:

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well and good: a case study approach to health care ethics. Peterborough, Ontario: Broadview Press, 2014. Print.

Case 6.1: Two Different Requests to Be Left to Die: John versus John

In Case 6.1a and 6.1b the two cases are compared and contrasted on multiple levels. What stands out to me the most is John’s case of “sanctity”. John is a man of 26 years of age who suffers from the elephant man’s disease, also known as Proteus Syndrome. John is captive on the respirator and urges his conscious decision to end his life and disconnect from the respirator. Many questions arise from paying respect to John’s decision. Should the doctors and his family respect his “sanctity” and allow him to die by his own choice or should others take over and exert control over his life?

John is fully alert, conscious, and in control of his mental faculties and clearly he wants to die. What stood out to me was what the elephant man’s disease was and how it could cause someone to consciously want to die. John has been suffering from this syndrome for 20 years and has gone over 100 operations as a result of uncontrollable tumor growth.

Proteus syndrome is results in abnormal growth of bones and blood vessels, as well as benign tumors on the body’s nerves. This syndrome results in a whole facial disfiguration, as well as physical disfigurement (DermNet). The case is mirrored by the “Real Elephant Man”, an Englishman named John Merrick, who the disease is named after. Merrick was supposedly a “circus performer” due to his physical appearance. However, Merrick had an indomitable spirit in which he utilized his freakish physical appearance and became a popular icon. He was in fact one of Queen Victoria’s favorite performers at that time. In a sense John Merrick’s attitude towards his syndrome is very dissimilar to the John in this case study. In a bigger sense, are two scenarios comparable in bioethics due to similar diseases and symptoms?

According to the physicians, John would most likely live for many years if John continued on life support. However, the question of whether or not John’s autonomy should be respected arises. Is allowing for a patient to live for a few more years morally correct even though the patient wants to die right now? John’s family members were initially very opposed to John’s autonomous decision to end his life. However, after extensive counselling, they accepted his decision. Therefore, the role of the counselor is also very impactful on the family’s perception of the scenario. Could John also be counseled and therefore have a change in his autonomous decision to die?

Now a question arises of how much of an impact can external factors have on one’s decision making, especially in the case of choosing to end one’s own life. For John Merrick, there was popular support in his actions and he was notoriously a figure/icon to many people around him.

Merrick obtained many supporting visits from many different people when he was hospitalized.

In this scenario I would choose to encourage as much positive support for John (from case study) as possible and encourage counseling and social support.

Works Cited

Ngan, Vanessa. “DermNet New Zealand.” Proteus Syndrome | DermNet New Zealand. N.p., n.d. Web. 9 Feb. 2017.

Sheward, David. “The ‘Real’ Elephant Man: A Look at the Life of Joseph Merrick.” Biography.com. A&E Networks Television, 15 Dec. 2014. Web. 10 Feb. 2017.

Thomas, John E., and Wilfrid J. Waluchow. Well and Good: Case Studies in Biomedical Ethics. Peterborough: Broadview, 1987. Print.

In the case 6.3, a young girl with severe cerebral palsy, Tracy, is killed by her father, Robert, due to her perpetual suffering from her condition. When arrested and charged with second-degree murder, Mr. Latimer argued that he committed the act to put his daughter out of her constant misery. However, the courts did not initially agree with Mr. Latimer and sentenced him to life in prison. Later on, after appeals and reevaluation of the case, Robert Latimer was seen to not have committed a heinous crime, rather, an unconventional way of caring for his child. Thus is sentencing was reduced. The strongest backlash came from groups supporting the rights of disabled persons, as they argued that Tracy’s rights were not being respected. In that the issue arises: were Tracy’s rights infringed upon although she has no official way to provide consent and was enduring pain for most of her life?

Although Mr. Latimer committed the act with good intent, I believe that he was wrong in killing Tracy due to lack of ethical justification. First off, Mr. Latimer took it upon himself to end his daughter’s life without any formal consent from her or medical professional support. Even though Tracy was not able to give her consent due to her cerebral palsy. In this, Mr. Latimer in essence committed a non-voluntary euthanasia, which is illegal. Also, not only did he lack the direct consent of Tracy, but also her mother as well as her doctors. Since Tracy is minor, her mother is also an autonomous figure for her and needs to provide her consent on major decisions made for Tracy. Also, there is no impending medical need for Tracy to lose her life. None of her doctors proposed a mercy killing as a way to end Tracy’s suffering. Rather, they stuck to the moral codes of ethics and practiced non-malfeasance by recommending surgeries that could help her daily life. According to the text, Tracy’s pain was perpetual however not necessarily constant. Although she experienced suffering in the past and will most likely face it in the future, she death was not warranted due to her consistently conscious state. Her life was not directly at risk at the time of her death.  As Beauchamp distinguishes, there is a difference between “allowing to die” and killing. While allowing to die in this case were to be if Tracy experienced a sever compilation in her condition that threatened her life. If her parents placed a DNR on her, then Tracy would be dying by natural causes consistent with her parents being her autonomous figures.

Another issues brought about in this case is risking the “slippery-slope” where we must define a justified killing if the patient is not consenting. If the patient is able to consent, than euthanasia or “mercy killings” can be a more dignified way for people with terminal, painful conditions to pass. However, the issue arises when the patient is not consenting, albeit the patient is a child or is cognitively unavailable. Who is it then that can make these decisions? Must a medical professional also consent for the procedure?  And where is the line drawn to distinguish if euthanasia or mercy killings are even  justified for each situation?

Of all those questions, I feel that the one that would provide the greatest slippery-slope is the last. Theoretically, we could grant consent to the patient’s next of kin, spouse, or caretaker. However, how can we make sure that the assisted deaths would be done with pure intent? Although a person may be facing imminent death while also painfully suffering, how do we know the consenting person in the situation isn’t doing it for greedy purposes that would diminish the purity of ending the patient’s suffering? This would be the hardest to criteria to gauge since everything can seem circumstantial and coincidental.  For example, a successful woman who is battling brain cancer who had slipped into a coma after months of excruciating pain. If her son was the one granted to be the consensual being as well as happens to be the sole heir to her fortunes, how can it be determined if he is trying to put his mother out of her misery or simply trying to cash in his inheritance early?

References:

“BBC – Ethics – Euthanasia: Voluntary and Involuntary Euthanasia.” BBC News. BBC, n.d. Web.

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2013. 176-79. Print.

Kishore, Lalit. “Mercy Killing: Pros and Cons.” Merinews. N.p., n.d. Web.

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.