The Principles of Beneficence and Nonmaleficence - Assignment Example

R.Preeti 22/8/2007 Medical Ethics Medical Indications - The Principles of Beneficence and Nonmaleficence. The patient inquestion from the case study given, has been diagnosed with Cancer of the Cervix and w as reportedly, in the advanced fourth stage. It was the first hospitalisation for the woman and she had had a severe attack in the lower quadrant, in the same are, the last December. She has severe pain and a mass formed, in the area and had come to the hospital for a check up and medication. The fact that she has been diagnosed with Cancer, that is in the advanced stages, guarantees that she would not live for long and that she is bound to die soon, maximum within very few years. Therefore, the probabilities of restoring the earlier condition of health and her chances of survival range between a meagre 0% to 20%. The treatment that could be offered to her are radiation and chemotherapy, which are not the solutions or cures for the disease, but only means of perhaps, extending the life cycle of the patient. Therefore, the goals of the treatment are not concerned with reversal of the health conditions, but for the preservation of life to the maximum extent possible. In totality, the patient cannot really escape the fact that her life is going to end shortly, may be within the next few years. Medication is a method of prolonging her life, to a certain extent and not complete restoration, in her case. 2. Patient References - The Principle of Respect for Autonomy. The patient is evidently, well informed and capable in terms of mobility and mental conditions. She is completely competent, because of the facts that she had worked in the medical field previously and also since she had noticed the mass and the severe pain and had taken the initiative to approach a professional, rather than perhaps subsiding it. The patient confesses that she suspects she is a victim of cancer and therefore, asks the medical student to tell her the truth. She is also aware of the fact that the doctors might, after all, not inform her about the disease and diagnosis, in case it is cancer. The patient has not yet been informed about the disease and she is yet to receive the confirmation of her apprehension that she has cancer. The very fact that the patient quite willingly and readily agreed to undergo the surgery, without posing a problem conveys that the patient was cooperative and trusted her doctors. However, on the whole, we see that the patient's desire to be informed and share the knowledge of the doctors, regarding her condition is in all probability not met with. Therefore, one can draw the conclusion that the ethics and laws governing medicine has not been met with. Had the patient been an ignorant and non-cooperative person, the best alternative could be giving treatment and keeping the patient in the dark. But since the patient is from a medical background herself and is well aware fo the situation, it is most ethical to inform her about it and give treatment with mutual cooperation. 3. Quality of Life - The Principles of Beneficence and Normaleficence and Respect for Autonomy. The prospects of returning back to the normal way of life depends on the patient's perspective view of what the 'normal way of life' is. If it is more of a mental or psychological framework and the patient is strong enough to endure the fact that she would not live for long, she can try and enjoy her short span of life, to the fullest. If the patient undergoes physical treatment and that is an important aspect of returning back to normal life, then she would perhaps face problems. In the case provided, the patient is a well-informed lady who seems strong enough to take in the fact and also extend her cooperation for the treatment. Therefore, in all probability, she would find it hard to accept the fact initially and then, she would aim at making the most of the short time she has. The treatment would render her weak, both mentally and physically. Firstly, she would have to lose a lot of her stamina and energy. The chemotherapy could render her thoroughly exhausted. Hair loss and darkening of skin and nails are some of the common results. In addition to this, she could be rendered infertile. Psychologically, she would definitely feel drained and even depressed. Any individual facing the fact that her life would end in a few days or months or years would certainly feel pangs of hatred, anger and depression. In the society, she would be given a sympathetic look or even a curious one. However, it would take time for people to accept her as the same person. Medicine is a field wherein biases do not find place in the doctor's treatment modalities. She is a patient first and then a woman or other distinctive character. Therefore, biases should not find a place in this noble profession and she must not be meted out to any, even if she is a patient. The patient's future condition is death and this might provoke many to empathise and say it is totally undesirable to carry on with life. However, she must learn to accept the fact and enjoy every precious moment left to the fullest. This is the only way of living a fulfilled life. Treatment can be forgone in her case, since the therapies would only drain her even more. The End result would perhaps extend her life by a few months. Of course, it is an individual choice. She should know when she can carry on with the treatment and when to put a full stop to the same, if it gets too tedious. Therefore, she could choose the paths that have opened up in front of her---fight and live for a few more days or enjoy those days or give up completely! 4. Contextual Features - The Principles of Loyalty and Fairness The case study does not present any family background details of the patient and therefore, one can only assume that the family would be heart-broken. However, on analysing the fact that she came in alone and the surgery was performed with her consent and interest, her family would have either been supportive or her treatment measures or they do not bother. Either way, the treatment wouldn't have been affected. A major difference of opinion exists between the providers---the medical student and the chief resident doctor. The former feels that the truth must be shared with the patient, while the latter asserts that 'ignorance is bliss'. As far as the portrayal of the case study is concerned, there are no problems with issues like financial difficulties or class/race distinctions or even confidentiality matters from the side fo the patient. The conflict of confidentiality exists between the providers! 5. Moral Issues. The Ethical Problem as reflected in the case study deals with whether the patient must be allowed room and share knowledge about her disease, which is the advanced stage of the cancer of the cervix, or should she be allowed to enjoy the last years of her life without any hardships or psychological effects. I know for sure that the patient would not live for long and that she is in an advanced stage of cancer. However, I do not possess information on whether she is a strong person psychologically and temperamentally to take in this fact and whether she should be allowed some information on the condition of her health or not, on this basis. In the case of letting her know what is in store for her, she would try to obtain treatment and this would surely increase her desire to live longer and happier. It would also put a great amount fo strain on her financial condition, as treatment for an advanced stage of cancer is quite expensive. In addition to this, the physical effects the treatment would produce would perhaps keep her in the public eye or draw curious glances and comments, which would wound her internally. Psychologically, she would obviously be very depressed with not only the condition of her health, but the economic and social possibilities as well. The first alternative could be that the medical student could go on and tell her about her disease. In the best case scenario, she would obviously be hurt but she would put up a brave front and fight her way through. In the worst case scenario, she would get into depression or may even try to end her life which is anyway going to end in a few years. On informing her, the patient should be given the liberty to choose if she would life to continue with the treatment or not. This act makes me a more frank and open person, who would like to state things as they are and would not wish to keep anything under wraps. The second alternative would be adhering to the advice of the chief resident, which means she should not be informed about the disease. In the best case scenario, she would trust us immensely and enjoy life as she has always been doing. In the worst case scenario, she would grow suspicious about our constant treatment or concern and might stop trusting us with her life. In this case the decision whether one must give her the treatment or not rests with the doctor and not with the patient. This act makes me a more humane person, with immense control over my emotions and dealing with the issue subjectively and objectively, at the same time. The second alternative would generate the greatest amount fo benefit for the greatest number of people, since the patient and her family would be unaware about it and live a normal life. The 'principle' of the alternative should not transform into a universal law, since there should be no hidden facts and important facts at that, in a profession like medicine. The safest course of action would be contacting the family members and asking them for a proper solution---whether it is safe enough to inform the patient or is it alright to keep it under cover. In any case, they would be involved in taking care of the patient, which they might otherwise, not feel to be very significant! This decision would surely relieve me of the burden of deciding a person's life---treatment or no treatment. It would also call for more care and concern from the family members of the patient, as she certainly requires immense amount of care and concern coming from them! References Case Study provided Definitions provided Read More