Ethical Dilemmas in Healthcare: Autonomy vs. Intervention
The scenarios presented raise complex ethical questions in healthcare. The first involves a dancer refusing life-saving surgery, leading to a controversial intervention. The second explores euthanasia for a terminally ill patient. These situations challenge notions of autonomy, consent, and the right to choose in medical settings.
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Will more technological advancements cause more ethical problems? Yes No
Autonomy woman enters the emergency room with stomach pain. She undergoes a CT scan and is diagnosed with an abdominal aortic aneurysm, a weakening in the wall of the aorta which causes it to stretch and bulge (this is very similar to what led to John Ritter's death). The physicians inform her that the only way to fix the problem is surgically, and that the chances of survival are about 50/50. They also inform her that time is of the essence, and that should the aneurysm burst, she would be dead in a few short minutes. The woman is an erotic dancer; she worries that the surgery will leave a scar that will negatively affect her work; therefore, she refuses any surgical treatment. Even after much pressuring from the physicians, she adamantly refuses surgery. Feeling that the woman is not in her correct state of mind and knowing that time is of the essence, the surgeons decide to perform the procedure without consent. They anesthetize her and surgically repair the aneurysm. She survives, and sues the hospital for millions of dollars.
Do you believe that the physician's actions can be justified in any way? Is there anything else that they could have done? Is it ever right to take away someone's autonomy? (Would a court order make the physicians' decisions ethical?) What would you do if you were one of the health care workers?
Euthanasia A woman was diagnosed with motor neurone disease (the same disease that Stephen Hawking has) 5 years ago. This is a condition that destroys motor nerves, making control of movement impossible, while the mind is virtually unaffected. People with motor neurone disease normally die within 4 years of diagnosis from suffocation due to the inability of the inspiratory muscles to contract. The woman's condition has steadily declined. She is not expected to live through the month, and is worried about the pain that she will face in her final hours. She asks her doctor to give her diamorphine for pain if she begins to suffocate or choke. This will lessen her pain, but it will also hasten her death. About a week later, she falls very ill, and is having trouble breathing.
Does she have a right to make this choice, especially in view of the fact that she will be dead in a short while (say six hours)? Is this choice an extension of her autonomy? Should the money used to care for this woman be taken into account when she is being helped? Do you think that legalizing euthanasia could create conflicts of interest for the patient/ or the doctor? Will people feel that they need to end their lives earlier to save money?
There are two types of surrogacy. One type involves a surrogate mother who uses her own egg and carries the baby for someone else. The other type is a "gestational surrogacy" in which the mother has no genetic tie to the child she carries. In the case presented, a gestational surrogate is used.
A woman, after a bout with uterine cancer had a hysterectomy (surgical removal of the uterus). Before, its removal, however, she had several eggs removed for possible fertilization in the future. Now married, the woman wishes to have a child with her husband. Obviously she cannot bear the child herself, so the couple utilizes a company to find a surrogate mother for them. The husband's sperm is used to fertilize one of the wife's eggs, and is implanted in the surrogate mother. The couple pays all of the woman's pregnancy- related expenses and an extra $18,000 as compensation for her surrogacy. After all expenses are taken into account the couple pays the woman approximately $31,000 and the agency approximately $5,000. Though the surrogate passed stringent mental testing to ensure she was competent to carry another couple's child, after carrying the pregnancy to term, the surrogate says that she has become too attached to "her" child to give it up to the couple. A legal battle ensues.
http://ww.scu.edu/ethics/publications/submit ted/cirone/medical-ethics.html
Baby K, as she came to be known, was born with a severe neurological condition known as anencephaly. In affect, she was born with both cerebral hemispheres missing from her brain, which means that her greatest potential would be shy of ever producing a single, fundamental thought. Her mother, insisted that Fairfax Hospital provide Baby K whatever treatment was necessary to keep her alive as long as possible, as most anencephaly cases failed to survive for more than a few hours, days or weeks at best. Fairfax, in Falls Church, VA provided the standard treatment for Baby K s condition and obliged her mother s insistence for aggressive respiratory treatment when needed. The cause of death can commonly be linked to the fact that the single brain stem cannot support normal respiratory functioning. The hospital staff did what they could to keep Baby K and her mother as happy as possible and awaited the infant s unavoidable death.But Baby K proved to be a survivor. At sixteen months she was stable at an extended care facility that provided her constant attention and total care. The hospital was still obliged to provide the respiratory treatment needed for her survival, at her mother s continual insistence, although the physicians believed that further respiratory intervention would be futile. Eventually, Fairfax sought a ruling from the federal district court that would allow them to refuse the aggressive respiratory treatment that kept Baby K alive. Although their case was overturned in court, Fairfax appealed the decision at the U.S. Court of Appeals. Again their position that Baby K s quality of life was not sufficient to mandate the treatments she was receiving, was not supported due to the 1986 Federal Emergency Medical Treatment and Active Labor Act. This law required hospitals to provide the type of treatment that Baby K needed as long as she needed it. Although the law was not originally intended for cases like Baby K s, it was instead passed to keep private hospitals from "dumping" emergency cases without insurance to public facilities, the courts perceived that they could not support the hospitals request to deny life saving treatment to Baby K, despite the fact that she was incapable of anything more than existing in a void of nothingness.
Cultural Beliefs vs. Western Medicine You are a general practitioner and a mother comes into your office with her child who is complaining of flu-like symptoms. Upon entering the room, you ask the boy to remove his shirt and you notice a pattern of very distinct bruises on the boy's torso. You ask the mother where the bruises came from, and she tells you that they are from a procedure she performed on him known as "cao gio," which is also known as "coining." The procedure involves rubbing warm oils or gels on a person's skin with a coin or other flat metal object. The mother explains that cao gio is used to raise out bad blood, and improve circulation and healing. When you touch the boy's back with your stethoscope, he winces in pain from the bruises. You debate whether or not you should call Child Protective Services and report the mother
Should we completely discount this treatment as useless, or could there be something gained from it? When should a physician step in to stop a cultural practice? (If someone answers "when it harms the child" remind that person that there is some pain in many of our medical procedures, for example, having one's tonsils removed) Should the physician be concerned about alienating the mother and other people of her ethnicity from modern medicine? Do you think that the physician should report the mother?
Baby Owens was born at 11:30 pm to Dr. Owens and her husband, Philip at Midwestern Hospital. The proud parents didn t remain proud very long as their first meeting with the child showed that something was terribly wrong. The baby s misshapen head and aloof look in those strangely shaped eyes had all the earmarks of Down syndrome and neither Dr. Owen nor her husband were prepared to accept a baby of such shortcomings into their home, their family or their lives. They verbally announced their feelings to the staff that had taken care of Dr. Owen during the birth and any attempt to console them was futile. Their minds were made up. To add insult to injury, Baby Owens was hiding a deeper secret. She was born with a sealed patch in her small intestine, also known as duodenal atresia. Although the condition is lethal if left untreated, as the baby would not be able to eat, a relatively minor surgical intervention could correct the problem and Baby Owens would grow into a normal healthy child, at least as normal and healthy as a Down baby can be. In all honesty, the physicians had no way to determine the extent of Baby Owens mental retardation, but it made no difference to the Owens s, severe or mild, their baby would be ultimately retarded and that was one condition they just could not accept. Dr. Owens informed Dr. Ziner, her attending physician, that she and her husband would not authorize the surgery needed to save Baby Owens life. According to Dr. Owens, "It wouldn t be fair to the other children to raise them with a mongoloid. It would take all of our time, and we wouldn t be able to give David, Sean and Melinda the love and attention they need." (Munson, Intervention and Reflection 144) Despite Dr. Ziner s objections, Dr. Owens remained firm in her and her husband s decision to allow Baby Owen to die of starvation by denying her the life-saving surgery. The hospital s legal and medical representative got together to discuss their position on the matter.
What action, if any, should they take to prevent the death of an otherwise physically health child? In previous matters when a parent s religious belief conflicted with a necessary surgery on a child, the hospital had received court orders mandating the surgery, regardless of the parents wishes. But was this case different? Was the fact that the baby was mentally handicapped a spin that would allow her death? The hospital decided that they had no reason to force the parents to authorize the operation and subsequently, be forced to take home a baby that they didn t want. The official position of Midwestern Hospital was that they could not perform an operation on an infant without parental consent. Twelve days later, Baby Owens died of starvation in an isolated room away from the other patients. Although many on the staff were appalled by the hospital s position to allow the death of an otherwise healthy baby, they were not allowed to intervene in the baby s slow, lingering death. The most they were permitted was to apply drops of water her lips and throat in an attempt to ease her suffering.
