Medical Ethics of a Physician - Case Study Example

Medical Ethics Dr Green, physician The statistics, provided by the Department of Health in 2005, says that one third of all pregnancies is terminated world wide. There were approximately 185,400 patients in the UK in 2004 that had to undergo the ToP (termination of pregnancy) operation. In the same time, only 1% of UK abortions conducted in 2004 were due to grounds of a risk of severe mental or physical handicap in the child. All the other cases were dictated by one of other three reasons that can become the ground for abortion according to the 1967 Abortion Act risk to a woman's life risk to her physical or mental health risk to physical or mental health of her existing children Most operations were performed for the second reason. The operation Ms Quick demands would also be classified as performed of the second reason. Termination of pregnancy is a serious decision both for the women, and for the practitioner, who treats her. To terminate the life of the unborn fetus, serious reasons have to exist. The case of Ms Quick is quite an unusual one, as it is usually that the women, who are trying to conceive, are keener on keeping the lives of their future children regardless of their number. When I tried to find out what were the reasons for her decision to terminate two of the fetuses, Ms Quick stated that she really wants to have a child and "be a good mother" but doesn't feel capable of caring for more than one child at a time. She added that she would rather terminate the pregnancy than have triplets born. It is obvious that Ms Quick is afraid of the idea to take care of three children at a time. In addition, the decision about terminating two fetuses was made after she communicated with her husband, thus I concluded that her husband also does not like the idea of having ore than one child at a time. Ms Quick is thirty, and this is her first pregnancy. Maybe, that is why she is so nervous. The behavior of my patient is indistinctive for the woman who was under the infertility program. Usually these women are very keen on having children, and they usually don't request abortion even if the gestation is multiple. In the same time Ms Quick is ready to abort all the fetuses rather than have triplets. She is aware of the fact that abortion may make her chances to conceive again much smaller, than they are now. The patient isn't stopped by the increased risk of miscarriage of the third fetus in case the first two are terminated, and health risks like pain, bleeding, low-grade fever, hematometra, retained products of conception, uterine perforation, bowel and bladder injury etc (Clinical Management of Abortion Complications : a Practical Guide, 1994), presented by the usual abortion procedure also don't stop her. Analyzing her behavior and opinions, I would conclude that Ms Quick isn't ready to mothering at all, at least psychologically. Regardless of the decision she will make I will advise her to ask for counseling services, or visit the psychologist. In this case we have to deal with an ethical dilemma - a situation when there are two or more correct courses of action but you can't do both. The patient has the right to decide that three children is too much for her, considering the fact that she may not have enough resources to rise three children, or that she just does not want to have three children, its pro-choice approach (Baird, 2001). In the same time, all three fetuses seem to be healthy, and there are no medical indications for terminating the pregnancy or two of the fetuses. In this case using the utilitarian approach to ethics would be the wise decision. According to the definition developed by the Markkula Center for the Applied Ethics, "utilitarianism is a moral principle that holds that the morally right course of action in any situation is the one that produces the greatest balance of benefits over harms for everyone affected". In this case the ends - the lives of the children, and the physical and mental condition of their mother are of greater importance than the means. In this case the utilitarian approach should be used in order to minimize harm in this situation. As every ethical dilemma, this situation has lots of alternatives of development. Of course, the physician can agree to the patient's request, and selectively terminate the gestation of two of the triplets, or terminate the pregnancy through a standard method of abortion. He also has the option of refusing to terminate the pregnancy with transfer of care to a physician who is willing to do so. But this list of alternatives isn't exhaustive. Before making any decision concerning termination of pregnancy, the physician can advice his patient to visit a fertility counselor, and/or the psychologist. There is no information about the well-being of the family in the case, thus we cannot conclude, where the decision of the patient is grounded on material or psychological reasons. In case the reasons are psychological, the specialist may help her to deal with fear and emotion about her future motherhood. Another option the physician should suggest her is giving birth for all the children, and giving two of them for adoption. There are many families in Britain, which want to have a child, but can't give birth to it. They would be happy to adopt one or two healthy kids. This decision would be optimal for the health of the patient, as there would by no operation performed over her, and thus the risk of miscarriage would be minimal From the ethical point of view, it would allow the doctor to keep all the three lives of the unborn kids. In addition, the patient would not be exposed to the risks that abortion delivers to the reproductive health of the women. If she would accept this alternative, the physician should make sure that she visits the counselor and/or psychologist during all the term of the pregnancy. The patient may change her decision concerning the children, and leave all of them to herself, or stick to the previous decision, but, in any case she would need qualified professional help in dealing with her emotion, fears etc. As a physician, who treats Ms.Quick, I would advice her on the option of keeping all the three fetuses, and considering the option of adoption for the two of the three kids, in case she is sure her family is unable to deal with three kids. I will advice her to visit the fertility counselor and/or the psychologist to help her make the final decision. In case she would decide to terminate the pregnancy, or selectively terminate the gestation of two of the triplets, I would refuse to terminate the pregnancy with transfer of care to a physician who is willing to do so. References 1. Department of Health Abortion statistics, England and Wales: 2004 2. EMIS. Termination of Pregnancy (ToP), 2005. Available from http://www.patient.co.uk/showdoc/40000047/ [cited 11 January 2007] 3. Baird, R., 2001. The Ethics of Abortion: Pro-Life Vs. Pro-Choice. Prometheus Books. 4. Velasquez, M. Andre, C. Shanks, T. Meyer, M., 1989. Calculating Consequences: The Utilitarian Approach to Ethics. Markkula Center for the Applied Ethics. Issues in Ethics V2 N1 5. WHO - OMS.,1994. Clinical Management of Abortion Complications : A Practical Guide. Geneva: World Health Organization Medical Ethics 2. Fertility counselor Ms Quick, the client that came to me for the advice concerning her pregnancy is facing a difficult situation. She has to make a very important decision, and she has little time to make a choice. The ultrasound diagnostics has revealed that she has three fetuses when the term of pregnancy was nine weeks. The Abortion Act allows termination of pregnancy if the term is less than 24 weeks, but, as the British Medical Association states, the sooner the abortion is made, the better it is for the women's physical and psychological well-being. The situation is that Ms Quick, a thirty-year-old woman, who has been treated from infertility by clomiphene citrate. She was aware that this drug increased the incidence of multiple births. When the client conceived she was happy, but when the ultrasound diagnostics revealed she had three fetuses growing inside her, she decided she didn't want to give birth to triplets. The client motivates her decision saying she would not be able "to be a good mother" for more than one child. The client's husband supports this opinion. Thus she requested her physician to terminate the gestation of two of three fetuses, even being aware that this procedure seriously increases the risk of miscarriage. Moreover, the patient states she would rather terminate pregnancy than give birth to triplets. Dr. Green, her physician, doesn't approve her decision, and he is thinking about transferring her to the other doctor in case she would make a final decision about terminating the pregnancy or selectively terminate the gestation of two of the triplets. After talking with the patient I found out that the woman is scared by the possibility to have three children instead of one kid she always dreamed about. She wants to be a good mother very much, for her maternity is a very serious task. She is pregnant for the first time, and has never had an opportunity to take care of the newborn kid. She feels that raising a child takes lots of time, effort and resources. In her opinion three children is too much for her family, she isn't sure they would be able to give them decent upbringing and education. She has always planned to have one, maximum two kids, and three, all the more so, at a time, is too much for her. The type of the problem we have her is Ethical Dilemma - a situation when there is more than one right course of action, but we can't follow both of them (Darwal et al, 1997). The patient has the right to choose not to give birth to more children than she wants, and she has the legal right to terminate her pregnancy before twenty-four weeks term. Nevertheless, the fetuses also have the right to live. Dr Green has the right to refuse to terminate pregnancy, if this is unethical from his viewpoint, and recommend the patient to turn to other doctor who would be willing to terminate the pregnancy. To solve this problem we could use the cost-benefit approach, under which the costs and benefits of taking versus not taking a particular action are balanced (Darwal et al, 1997). In case the patient would decide to selectively terminate the gestation of two of the triplets, the risk of miscarriage is becoming greater. In the same time, the patient gets the chance to have the child she dreams about, and be delivered of the problems connected to raising three children. Nevertheless, for those, who support the pro-life abortion position this decision would be unethical, and the patient may suffer from moral problems and public condemnation (Baird, 2001). In addition, even the selective termination of two fetuses would create other health risks except for miscarriage. The decision to terminate the pregnancy rather than giving birth to triplets would result in having no problems with the newborn kid Ms Quick is so afraid of. It would give her time to think over her position concerning maternity, and to decide whether she needs children at all. In the same time, it is likely that the client will end up having no possibility to have a child at all, considering the fact that abortion increases the risk of infertility greatly (McNamee et al, 1993), and the fact that she was treated for infertility when she conceived. Another option exists in this situation, which is giving birth to all the three children, and given two of them for adoption. The diagnostics shows the fetuses are healthy, thus there should not be many problems finding new families to the newborns. It would allow saving the lives of the unborn kids, without creating the risks for the life and health of their mother, and increase the chances that she would have a healthy child she dreamed about. Also a variant exists that during pregnancy the client would change her mind considering the number of kids she is ready to raise, and this situation would be solved by itself. In the same time, the risks exist that this decision would lead to psychological problems for the patient, to the problems with her husband and family. In addition, public opinion is disapproving to women, who give the kids up for adoption, especially when those women are married, as Stephen Fitzpatrick, who researches the question of adoption, noted in his article Choice (2005). For Ms Quick the fetuses are something abstract, she does not see them as live children, which is proved by the fact that she is ready to get rid of two of them for her convenience. But newborn kids cannot be an abstraction. They cry, and want to eat, and you may touch them. Giving her kids up for adoption may be traumatic for the patient. She may decide not togive them up under the pressure of the society, her family, or because of her own reasons, but she could still be unhappy, feeling that she doesn't want to raise three children, that she is unable to do it. Both the client and the kids would suffer in this situation, together with her family. Nevertheless, as I, as a fertility counselor, hold to the pro-life position, giving birth to the triplets and than giving them for adoption is the best choice in my opinion. Of course it may cause numerous problems to the client, and to the kids, but this children would still be given the chance to live, their lives would be saved. That is why I would advice my client to keep the pregnancy, considering the option of giving the kids for adoption, and leaving herself the time to decide about her course of actions after giving birth to her kids. References 1. Baird, R., 2001. The Ethics of Abortion: Pro-Life Vs. Pro-Choice. Amherst: Prometheus Books. 2. British Medical Association., 2005. Abortion time limits: A briefing paper from the BMA May 2005 3. Darwall, S. Gibbard, A. Railton, S. eds., 1997. Moral Discourse and Practice: Some Philosophical Approaches. Oxford: Oxford University Press Inc. 4. Fitzpatrick, S., 2005. Choice. Available from http://www.uktrackers.co.uk/006_choice_200509.pdf. [cited 13 January 2007] 5. Frank P, McNamee R, Hannaford PC, Kay Cr, Hirsch S. 1993. The effect of induced abortion on subsequent fertility. British Journal of Obstetrics and Gynaecology. June;100(6):575-80. Read More