Ethics: Bioethics - Case Study Example

Case Study, Ethics- Bioethics Part A Q1: Paternalism vs. Autonomy - Dax Cowart Should Dax’s physician administer treatment even after his wish to reject treatment and die? The primary issues related to Dax’s case of dilemma include; informed consent, health care decision making capacity and autonomy and the right to reject treatment. In the case of Dax’s request to refuse treatment and die, there are a number of stakeholders involved and their position in Dax’s case. Mr. Dax: Is a patient that had been in a propane gas explosion that left him handicapped and physically disfigured with two-thirds of his body suffering from severe burns. The patient had refused treatment and presented his wish of dying, especially due to the uncontrollable pain and lack of medication to subside the pain he was going through. Mr. White: The second stakeholder who was the physician that attended to Dax during his seven years of hospitalization. Mr. White administered treatment against his patients consent, violating his right to autonomy, but at the same time sustaining is quality of life. Dax’s mother (Mrs. Cowart): The third stakeholder who was his next of kin who signed his consent forms to burn therapy and the lone parent after his father’s death in the same explosion that left him blind and crippled. Dax mother was worried about his son’s wishes to die and hopelessness in life and presented his son’s concerns of selling pencils in on a street corner. Autonomy is the act of self-determining of the choices we make in life. Every patient has a right to make informed choices concerning his/her health condition, treatment of refusal of the same. More often than not, a patient’s autonomy can be violated by the medical practitioners when, their wishes to reject treatment are dismissed, by actual force to treatment or when through threats explicit and implicit nature. Moral theories argue that people have inherent worth, rather than instrumental worth. Therefore, such persons have uniquely qualified to make their own decision that they see best and violate such rights is to treat someone as less than a human being (Munson, 2007). Dax made his choice to reject treatment because he found it the best option for his situation, considering that he would remain disabled all his life not forgetting the pain he went through. With the support of John Stuart Mill principle of liberty, respect for autonomy should involve free and independent thinking as long as no harm is caused to others (Mill, 1963). This emphasizes that a patient just like Dax had the right to refuse treatment and no one is rightful enough influenced his decisions to receive treatment whatsoever. In health care, Self-determination is a core principle which is shifting from a paternalistic approach to a client based approach (Schwartz, 2011). This means that a patient, such as Dax has an active responsibility and role for his own well being, being aware of the consequences that might follow. The only instance that Dax’s right to autonomy should have been violated is if he was not in his right state of mind and was mentally ill or was of underage, eighteen years and below (Burr &Kurtz, nd)). According to bioethics principle of beneficence and non-maleficence, a patient has a right to have balanced benefits to treatment against involved risks while at the same time avoiding causing harm. What the principle of non-maleficence implies is that if the risks involved in treatment overrides the benefits then, treatment should not be administered. On the other hand, beneficence which is a principle that Dax physician practiced is failing to respect a patient’s right of autonomy for his own good and the good of others. Being a physician that Mr. White was in Dax case, the best decision that a medical practitioner would have done is to act is a beneficial manner. As much as his right to autonomy was dismissed, the treatment and therapy, he underwent through was for his own good and that of his mother and friends. The treatment helped to decrease the pain he was going through and cure the recurring infection on his burns. Therefore, as much as he wished to die was objected by his physician, his quality of life was sustained. Part B Q2: Confidentiality, Disclosure and Livid Lovebirds Was Dr. Friendly justified in breaching his professional responsibility by asking Lancelot to talk to his parents first and was being ethically right to disclose the hospice talk between him and the patient’s son? The most appropriate primary issue in this case is confidentiality and breach of professional responsibility. Mr. Lovebird: first primary stakeholder is a sixty-five and over patient battling with stage five lung cancer and metastasis in his colon. He underwent through two surgeries and chemotherapy with several rounds of radiation. Dr. Friendly: a family friend of the Lovebirds, an oncologist by profession and the family care physician. He was approached by the lovebirds about Mr. Lovebird’s situation and he suggested that the patient would give experimental treatment a try. Lancelot: is the Lovebirds only son who is objecting to the experimental treatment and suggests of a hospice treatment. They conflict with Dr. Friendly when the physician discloses their ‘hospice talk with his Lancelot’s parents. Family care givers such as Dr. Friendly, play an important role in increasing health care and quality of life, especially to patients with acute and chronic illnesses. However, there is a great challenge that physicians face in balancing between ethical standards and the relationship between their patients and family members. Hospice and palliative care cater for the effects of illnesses for both patients and members of their family. However, bioethics emphasize on the importance of respecting a patient’s autonomy and confidentiality, but the need for a family-centered approach is increasing in demand. Additionally, bioethics emphasize on the importance of proper communication. This means that the patient and the family member’s decisions for treatment and care giving should not conflict in any way (Mitnick, Leffler and Hood, 2010). Dr. Friendly breached his in professional responsibility when he asked the family’s son to talk to the parents on his behalf and the end result brought conflict in the family. According to opinion on the patient - physician relationship, 1992principles of medical ethics state that patients have the right to confidentiality and all communication should be kept between the physician and the patient. The only exception to this right of confidentiality is if the patient gives consent that information can be revealed or when such information is needed lawfully. Additionally, ‘principles of medical ethics,’ 2001, emphasizes on the importance of professionalism that a physician should uphold with honesty and competence while dealing with patients. If, Dr. Friendly was a professional oncologist, he should have approached the Lovebirds and explain his alternative in hospice treatment presented as a concern by their son. This is because he has all the necessary information needed by the patient to settle for a reasoned decision. This brings us to a conclusion that Dr. Friendly was unethical and violated the right to confidentiality with his patients that is the Lovebirds and their son since he was the family caregiver. More to that, there was no professionalism and competence in his actions to first discourage Mr. Lovebird to undergo through treatment as well as asking their Lancelot to medically talk his parents into his own opinion of hospice treatment. As a medical practitioner, confidentiality and professionalism are the first step to gaining trust of the patients. Without the two elements true professionalism is not demonstrated in the medical field. Q3: Morally Wrong or Ethically Challenging? The case of legalizing voluntary death of terminally ill patients will threaten some important safeguards if such law is passed in Nirvana. One of the safeguard at risk is promoting the right for mentally ill patients that are not diagnosed with the illness because they are mentally unstable to reasonably make the decisions to end life before time. The second safeguard threatened by legalization of euthanasia is vulnerability due to poverty, disability and lack of finances for proper health care. The third safeguard at risk is that of other alternatives that does not include ending one’s life, such as hospice care and pain control. Some of the stakeholders that might be affected if the right to PAS include but not limited to: The public: These are the majority who suffer from terminal illnesses or have a family member that have a terminal illness. However, such people may not advocate for PAS for their terminally ill family member. The vulnerable/marginalized groups: These include poor people, persons living with disabilities among others. PAS might be an alternative to the harsh reality of disability and poverty and such person can make decisions that are not well informed or as an alternative to lack of finances to cater for their medical care. “Oregon revised statute” chapter 127, 1997 states that any residence in Oregon by birth, or lease of property, of an adult age precisely, 18 years and is suffering from a terminal illness has a right to request for death with dignity. This is not without the attending physician and consulting physical’s approval of the terminal illness with less than six month’s due to a patient’s death. The patient can undergo counseling incase, of depression related illnesses after which they wish to PAS is granted. A sensitive matter unattended by the statute under chapter 127 is that a PAS patient can choose to inform the family or not. This is not morally right because the family members will suffer a loss they did not expect and some might be depressed with the decision to end life without their consent. Family members are also not allowed to be witnesses in the PAS request papers because they might influence the patient to other non-suicidal alternatives. Furthermore, “annual reports,” 2012 state patients who choose to end their life in a dignified manner can later choose to not take the medications and still die from other causes. This means that PAS to such patients was not necessary after all. If the PAS law is passed in Nirvana, many people will suffer from death that could have been prevented by proper managed physical symptoms. “The New York State Task Force on Life and the Law,” 1997 illustrates that physicians may end up granting a patient’s request to assisted suicide even before all available alternatives to relieve pain are exhausted. Additionally, patients might make uninformed decisions that are irreversible due to lack of proper counseling on life sustaining treatment and other alternatives such as hospice care. Assisted suicide might have incentives that are much cheaper and better than the palliative care among other alternatives. This will lure many terminally ill patients to take the PAS alternative but, by their full consent but by the influence of incentives. Every physician, especially those dealing with end of life, should give quality information on care alternatives in case PAS law should be passed in Nirvana. Principles of bioethics state that every patient has a right to better health care and decisions such as refusing treatment and in this case assisted suicide, should not be influenced by threats of any sort. Additionally, it is a patient’s right to make informed decisions with the assistance of a physician who can present better alternatives of less risk. Q4: The Emily Dilemma – Abortion Should Emily be granted the wish in rejecting abortion even the medication she is taking it will cause harm to herself and her baby? The primary issues in Emily’s case are those of religious morals in abortion and medical ethics in aborting or keeping a pregnancy at risk of deformity. Emily: 20 years old and pregnant and suffering from bipolar disorder and Schizophrenia disease and is undergoing treatment which might cause deformation in her growing baby. Emily lives with her parents, who think abortion is the best choice for her, but Emily thinks otherwise. Dr. Heady: Emily’s practicing physician who is in a dilemma of whether to consider Emily’s request of keeping her baby despite the medical risks involved or to carry out the abortion for Emily’s good and that of the unborn baby. According to the film “conception to birth” 2011, a child’s life beings at conception and ends at death, and before a child is delivered it undergoes through important stages of growth and development. This stage starts when a sperm fuses with a mature egg and an embryo is formed. A human body consists of millions of bonds that fold, and unfolds where necessary to bring forth a fully developed baby. If every part of child development from eye formation to limb formation, then what happens when one such stage is skipped? The obvious answer is that a deformed baby such as Emily’s is likely to be born. Some countries around the world have legalized abortion and have given a mother the right to decide on abortion or not. As for the case of Emily she was firm catholic who did not want to abort her baby despite the medical risks involved. According to the law in “Roe vs. Wade”, 1973court ruling on abortion, a mother who is of an adult age, eighteen years and over has the right to choose abortion in case of financial constraints, medical risk. This is something that Emily’s parent should have understood because she is twenty years already and can choose to keep or abort her baby. As a practicing physician in Emily’s case, one should let her understand the medical risks involved in bringing a deformed baby to term, especially because her partner wants a ruling against any responsibilities after the baby is born. In the film “What Happens to Women Denied Abortions?” 2012, is that chance that women who are denied abortion are domestically abused are higher than those who aborted. This is because of the pressure that comes with the finances and preparedness of a new family. This comes to a conclusion that Emily is an adult who is capable of choosing what is right and wrong for her unborn child. The practicing doctor does not have a right to force Emily on procuring an abortion without her consent. However, if the pregnancy is life threatening to the mother, then, the doctor can ethically procure the abortion. Additionally, the physician has an obligation to provide information on the risks of bringing a deformed baby to term. This might help Emily change her opinion on abortion and undergo through it successfully. References Alzheimer Europe. Ethics - Definitions and approaches. The four common bioethical Principles Respect for autonomy. (n.d.). Respect for autonomy. Retrieved August 15, 2014, from http://www.alzheimereurope.org/Ethics/Definitions-and-approaches/The-four-common-bioethical-principles/Respect-for-autonomy Annual Reports. (n.d.). Annual Reports. Retrieved August 15, 2014, from https://public.health.oregon.gov/providerpartnerresources/evaluationresearch/deathwithdignityact/pages/ar-index.aspx Arras, J. (1997). Physician-assisted suicide: a tragic view. The Journal of Contemporary Health Law and Policy, 13(2), 361-389. (28) Burr, R., &Kurtz, P. (nd).Chapter 11: Ethics and health. A handbook. Boston: J Ones and Bartlett publishers, 248-279. Dax Cowart 2002 1. (n.d.). YouTube. Retrieved August 15, 2014, from: https://www.youtube.com/watch?v=lSsu6HkguV8 Iadarola, J. (Performer) (2012, November 25). Study: What happens to women denied abortions? The Young Turks.[Audio podcast].Retrieved from http://www.youtube.com/watch?v=dWBjQ7P9SSs. Mill, J. S. (1963). On liberty. Raleigh, N.C.: Alex Catalogue. Mitnick, S., Leffler, C., & Hood, V. (2010). Family caregivers, patients and physicians: ethical guidance to optimize relationships. Journal of General Internal Medicine, 25(3), 255-260. Munson, R. (2012). Intervention and reflection: basic issues in bioethics (9th ed.). Boston, MA: Wadsworth, Cengage Learning. Opinion 10.01 - Fundamental Elements of the Patient-Physician Relationship.(n.d.).Opinion 10.01 - Fundamental Elements of the Patient-Physician Relationship. Retrieved August 15, 2014, from http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion1001.page Oregon Revised Statute. (n.d.).Oregon Revised Statute. Retrieved August 13, 2014, from http://public.health.oregon.gov/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Pages/ors.aspx Schwartz, P. H. (2011). Questioning the Quantitative Imperative: Decision Aids, Prevention, and the Ethics of Disclosure. The Hastings Center Report, (2), 30.doi:10.2307/41059016 Tsiaras, A. (2011). Alexander Tsiaras: Conception to birth -- visualized. YouTube. Retrieved August 15, 2014, from https://www.youtube.com/watch?v=fKyljukBE70 Read More