The Case of Scott Starson - Essay Example

Case Study: The case of Scott Starson Introduction The Scott Starson case involved a patient, Starson, who had been involuntarily committed to a psychiatric hospital. This happened after he had been found “not criminally responsible” for two accounts of uttering death threats. Potentially, such commitment may have been informed by his history of psychiatric disorders and a diagnosis of bipolar disorder at the time. Following diagnosis, Starson had voluntarily undergone psychotherapy but had declined to take any medication for the condition. According to Starson, taking the medication would disrupt him from pursuing his research; being a gifted theoretical physicist, he believed that this research was the only reason he felt his life carried a meaning. In this sense, being unable to carry on with it would simply render his life “useless” and “meaningless.” However, the physician felt that Starson's refusal was informed by his inability to appreciate the value of treatment. Consequently, the physicians petitioned to have Starson's treatment decision transferred to a surrogate. Though the petition was granted, Starson would later appeal, and the petition was reversed at the Supreme Court of Canada. The Supreme Court held that a patient, in this case Starson, was not required to make a decision that is in their “best interest” as determined by the physician, and thence they are permitted to disagree with a treatment recommendation. The Court also reasoned that Starson was a competent patient capable of making his own medical decisions. This case has both legal and ethical implications; firstly, this study delves into examining the ethicalness in a physician imposing treatment, and secondly, the study also looks at physicians’ position in determining a patient’s “best interest”: whether they are entitled to make this decision on behalf of the patient and how far can they go with this. The study will also look at the concept of informed consent and the idea of competence. Argument 1 The above case represents a conflict of these two rather ethical considerations. On the one hand, the physician feels compelled to do what he believes is in the best interest of the patient. On the other hand, the patient feels that it is his right to refuse medication based on his own grounds. Under these circumstances, how far is the physician expected to go with his persistence? Most legal cases, not only in Starson’s case, often uphold the position of the patient. This is referred to as patient autonomy. The principle of patient autonomy states that competent patients have the opportunity to choose among medically indicated treatment and to refuse any unwanted treatment. Under these circumstances, the physician must respect the patient’s decision. It is necessary to understand that treatment decisions are not only based on objective medical considerations but also involve a considerable level of personal value judgments and preferences (Meier, Isaacs, and Hughes 95). Therefore, to some extent, the physician may compel a patient to take a certain medication not only because it is the right and objective medical step but also because he feels, based on his values and preferences, it is the right thing. For the latter, he is imposing his personal feelings, not professional mandate, to the patient. In these cases, a physician may be ethically driven to compel a patient to take medication because he feels it is the right thing to do. However, it is essential to note that a physician demonstrates respect for human dignity, a biomedical ethical consideration, when he acknowledges the freedom and right of the patient to make choices based on their own beliefs and values (Kluge 7). Perhaps another consideration arising from Starson’s case is the idea of sound medical treatment. Starson, for some reason, felt that the medication offered was disruptive and would interfere with his ability to complete his physics research. Indeed, physicians are ethically forbidden to administer unsound treatments. In this case, sound treatment refers to the use of medical knowledge or means to cure, prevent a medical disorder, preserve life, or relieve distressing symptoms (Meier, Isaacs, and Hughes 96). Sound medication arises from the principle of beneficence and non-maleficence. The principle of non-maleficence bars physicians from utilizing their medical knowledge to cause harm to the patient. On the other hand, the principle of beneficence requires that a physician utilize his medical knowledge and skill to improve a patient’s situation (Hope, Savulescu, and Hendrick 185). Given these principles, we must consider the physician’s standing in compelling treatment to Starson. However, the case points at no instance through which we may be forced, from an ethical standpoint, to validate Starson’s fears. Therefore, this is a case that purely brings to the fore the principle of patient autonomy. Argument 2 By law, a competent patient may refuse any treatment irrespective of the consequences (Lo 85). Throughout medical history, there have been many cases involving competent patients who would want to do away with a critical part of their treatment. In most of these cases, withdrawing the intervention measure often means outright death of the patient. An example of these instances includes a patient who wishes life support to be withdrawn. Often, this is not an easy request for doctors to handle as they feel it is their mandate to ensure sustenance of life. In these cases, courts have time and again granted the wishes of the patient (Kluge 5). The take is that by any chance a physician, given his moral standing as informed by his values and beliefs, feels burdened or unable to carry out the patient’s request, then they should transfer the patient to doctors who would comply with the patient’s wishes. Therefore, what are the conclusions drawn from these cases, and what is the extent that a physician would go to help out the patient or improve the patient’s medical situation? In answering this question, it is fundamental that one understands that any decisions that profoundly affect a patient’s wellbeing cannot be made independent of a patient’s subjective preference and values. In some cases, medication issued to the patient may be considered burdensome, invasive, and disruptive as was the case with Starson. In these cases the patient is not only concerned with the likelihood of death or life. The patient has to consider his situation and weigh his options. It is here that the decision to take medication or accept life support is reached (Hope, Savulescu, and Hendrick 185). These decisions are hinged on personal belief, values and to some extent, self-evaluation of the physicians. It is in recognition of this personal consideration that the principle of autonomy arises (Lo 86). The only exception to this arises if the patient, to some extent, is unable to follow the common or expected thought process. This ultimately influences his ability to make a sound decision regarding his/her health. In such cases, it would be ethical to take adequate steps in order to ensure the patient receives medication or whatever medical intervention that the physician deems fit. Conclusion/Recommendation If Starson was considered incapable of making a sound choice as informed by past events or the current mental state, then it would be both plausible and ethical to seek a petition to have the treatment decision transferred to a surrogate. This was not the case; therefore, it would have been ethical for the physicians, irrespective of their personal beliefs and values, to respect his decision. They should have understood that when a physician withdraws treatment on the request of a patient, they have fulfilled their obligation to offer sound treatment to the patient. Additionally, this does not in any way contravene the principles of beneficence and non-maleficence. In this case, the physician’s position in determining a patient’s “best interest” is limited by a patient’s wish to accept a physician’s directive on medication or otherwise. Following this argument, this study from an ethical perspective supports the view of the Supreme Court. Works Cited Hope, R. A., Julian Savulescu, and Judith Hendrick. Medical Ethics and Law: The Core Curriculum. Edinburgh: Churchill Livingstone/Elsevier, 2008. Print. Kluge, Eike-Henner. Readings in Biomedical Ethics: A Canadian Focus. New York: Pearson Education Canada, 2004. Print. Lo, Bernard. Resolving Ethical Dilemmas: A Guide for Clinicians. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2009. Print. Meier, Diane E., Stephen L. Isaacs, and Robert G. Hughes. Palliative Care: Transforming the Care of Serious Illness. San Francisco: Jossey-Bass, 2010. Read More