About Case Studies in Biomedical Ethics, Essay Example

Case 14: When a Pregnant Woman Endangers Her Fetus

The logic for the court order sought by the physician Doctor L. against the pregnant woman Janet M. is that the latter is endangering the life of the fetus according to her reckless behavior. The reasoning behind the doctor’s response is thus that he is essentially attempting to protect the fetus. The justification for the actions of the doctor opens the primary ethical question of the autonomy of individuals and whether the fetus has a right to be protected, or in other words, if the fetus has the same rights as any other individual in society. The case thus recapitulates the question of the autonomy of Janet L. and the autonomy of the unborn fetus. This is what Ridley terms “the status of the fetus” (Ridley 113) and the question as Ridley phrases it is “the kind of human life the fetus has.” (Ridley 113)

By pursuing a legal injunction, the doctor is essentially stating that the human fetus has the same “kind of human life” that Janet L. possesses. Moreover, this “human life” is threatened by Janet’s behavior. The doctor thus sought to utilize the legal system to protect the status of the fetus. In this regard, there is a legal dimension to the doctor’s decision. Depending on where the court injunction is being sought, the court will have its own views regarding the status of the fetus. Accordingly, the courts will decide if the doctor’s case is legally justified. From an ethical perspective, however, we return to the difficult problematic of the status of the fetus. According to the debates, we have to understand the doctor’s decision as a largely personal decision concerning the fetus. In essence, his action is indicative of his own ethical choice. The counter-argument in favour of Julie’s position could thus emphasize two points: that Julie’s own rights are more significant than those of the fetus; or that the fetus does not have the same status as Julie. The justification for the doctor’s response can only be evaluated according to choosing between one of two radically opposed ethical perspectives, and is thus arbitrary. In this regard, the legal injunction is justified because the doctor appealed to a legal body and not an ethical argument to justify his position.

Case 16: Maternal Rights, Fetal Harms

The key aspect to the case may be identified as the danger of the particular medical condition the unborn child has. The two methods proposed by the medical doctor are in no way certain to succeed and each possesses its own danger. While statistically the physician may argue for a certain approach, this argument from statistics in no way ensures a successful procedure. The physician could only note the various options available to the mother, since the physician has no way of guaranteeing the results of the procedure. His recommendations will need to be informed and professional, but must also make the patient aware of the dangers of the procedure and of the gravity of cephalosentesis.

As Carson Strong notes, that this case is a case of cephalosentesis make the situation more problematic: “Cephalocentesis is ethically problematic for various reasons.” (Crigger 73) Accordingly, the later date of the fetus suggests, in Strong’s view, that its health must be considered, however, the danger nevertheless remains extant for both the mother and for the fetus.

Considering the difficulty of the case and its potential dangers to both the mother and the fetus, a court order appears to be too rash a decision. The decision for a court order should only be pursued when the doctor can assure some reasonable probability of success, but in this situation such assurances are decisively lacking.  Accordingly, the physician must above all consider the autonomy and safety of the mother. While the counter-argument would emphasize the safety of the fetus, this safety is in no way guaranteed by any of the medical procedures. The option of a court injunction for surgery is in this sense unnecessary insofar as neither of the options presented in the case study suggest that a medical procedure would resolve the situation.

Case 17: When a Mentally Ill Woman Refuses Abortion

The central ethical problematic of Case 17 involves the autonomy of a mentally ill person and their ability to make informed decisions. In the case, Ann wishes to have the child because, from her own personal ethical perspective, she does not believe in abortion. The mother, who has legal custody over Anna, fears an increased worsening of Anna’s mental state according to not being able to care of the child.

Who would be the primary victim if Anna would in fact deliver the child? According to the circumstances presented, the mother believes that Anna would be the victim. Nevertheless, what would be the possible mental repercussions to Anna if she were forced to have an abortion that she did not believe in? By transgressing her own ethical principles and having an abortion, the damage to her psychological condition could be drastically worse than that of being separated from the child. As Mahowald phrases this argument: “The possibility that Ann’s sense of “wrongness” about abortion might impose an added psychological burden.” (Crigger 79)

The question of the likelihood of Anna caring or not caring for the child is essentially inconsequential to the case, according to how it is framed. The argument for abortion is to protect Anna’s mental state, while Anna herself indicates that this is against her ethical principles. Insofar as Anna is suffering from schizophrenia, this does not remove her right to make decisions; moreover, the only person she would be endangering by having the child would be herself.

The abortion therefore should not be performed, as the arguments of the mother are not strong enough. The mother is speculating on the possible repercussions to Anna’s psyche, while Anna makes clear her own wishes. The decision for the abortion should be left to Anna, as by having the abortion the psychological damage accrued could be far more severe and an already ill person’s condition could become even worse.

Case 20: Does “Doing Everything” Include CPR?

Two primary questions are at stake in Case 20: the issue of communication between patients and their families and doctors; and secondly, medical personnel respecting the wishes of patients and/or their families. These two issues essentially recall two entirely different ethical paradigms. In the first question, it is a question of dialogue between two parties. In the second question, it is a question of who has authority in the hospital setting.

The coding process specified in the hospital is crucial to how patients are cared for. In this regard, there is no reason for the details of the coding process to be withheld from patients as there is no argument that the disclosure of coding processes would inhibit the functioning of the hospital and the ability of the medical staff to perform their duties, Speculating on the anxiety that a knowledge of the coding process would produce for the patients’ family is exactly that: speculative. Furthermore, the coding process, as essential to the hospital experience, should be communicated to patients just as any medical procedure would be explained: this is an ethical imperative granted to the patient and their families’ about the right to know of any medical procedure being undertaken.

The second issue involves the question of the authority of the doctor versus the authority of the family. The doctor’s logic for not performing CPR is that, in his professional opinion, it would be inconsequential. In the family’s opinion, this is an example of the doctor “not doing enough”. Ronald Carson abstracts this difference as “a conflict of values” (Crigger 93), wherein there is a difference between what the doctor feels is necessary and what the family feels is necessary. In this regard, it is crucial to protect the physician’s autonomy to avoid this conflict. If the family is allowed to influence the doctor’s work this can set a dangerous precedent of families having authority over medical procedures, which they are not qualified to do. This can potentially compromise the doctor’s ability to perform effective treatment, as he/she would have to refer to the family’s wishes, rather than medical practice. In essence, medical practice itself must attempt to remain value-free to prevent what Morgan calls this “conflict of values.”

Case 22: Nurturing A Defective Newborn

The central feature of the case is whether possible emotional attachment between parents and a newborn will affect future avenues of medical treatment. In essence, hospital personnel are forced to make a reading of possible emotional states of parents.

According to what medical personnel are qualified to do, the issue of emotional attachment would appear to be outside of their expertise and the nature of their very work. If the parents’ emotional attachment would affect the medical staff’s ability to perform their duties, the argument for withholding the parents from seeing their child could be justified. However, this is a speculative decision based on an abstract concept of emotional attachment. Moreover, if the child is thought to die in any case, the prohibition of relation will not affect this fact.

In his discussion of the case, Pauli emphasizes (Crigger 102) that the wishes of the parents should be considered foremost. Pauli sees no negative health consequences that would be engendered by continuing the relationship between the family. In essence, this situation is outside of the parameters of the authority of the doctor and the latter must therefore cede to the parents’ wishes.

Not letting the parents see their child because of some trauma that further emotional attachment would produce for the parents should also not influence the decision. It is likely that such an emotional attachment already has existed and there is no medical authority to control this relationship. The medical community has no means by which to measure “emotional attachment.” According to the sensitivity of the case, the utmost ethical emphasis should be placed on the feelings of the parents. Any prohibition of allowing the parents to see their child would aggravate an already tragic situation, without any clear medical benefits to the health of the child arising from such a prohibition.

Case 26: “If I Have AIDS, Let Me Die Now!”

The central ethical question of the case is whether the medical establishment can interfere in the autonomy of the patient. The logic for Mr. Davidson’s decision to stop with the treatment for his illness is that it would reduce his “quality of life.” The difficulty for the doctors the patient’s decision creates is twofold: firstly, whether opposing Mr. Davidson’s decision would be a violation of the patient’s wishes; and secondly, whether Mr. Davidson fully understood the nature of his treatment and the consequence of his decision. As Ridley summarizes the issues in the case, it can be considered as an example of whether a “patient’s request for euthanasia should be honored.” (Ridley 175)

The psychiatric evaluation that deemed Mr. Davidson to be mentally competent is relevant, insofar as it demonstrates the patient’s self-understanding of his medical condition. From a psychiatric perspective, his decision therefore is viewed as a rational autonomous decision, made from considering issues surrounding the quality of his own personal life. While the counter-argument would state that Mr. Davidson made the wrong decision, from the psychiatric perspective there is no evidence of this. By opposing the patient’s wishes, the doctors would essentially be arbitrarily deciding that the patient is unable to make decisions concerning his own life.

Furthermore, if the doctors feel that Mr. Davidson’s complaints regarding treatment are overblown or irrelevant, this is a direct violation of his autonomy. The patient is not speculating as to what treatment may entail and found it physically difficult: “He admitted that he was feeling pain, fear, loss of control, extreme discomfort on the respirator” (Crigger 119), among other complaints.  Accordingly, the informed decision of Mr. Davidson should be respected to the extent that it is the product of a rational, reflective, competent individual. Furthermore, the medical authority does not have the right to proclaim what entails “quality of life” for any given patient without violating the latter’s autonomy, according to the subjectivity of this concept.

Works Cited

Ridley, Aaron. Beginning Bioethics: A Text with Integrated Readings. New York: St Martin’s Press, 1998.

Crigger, Bette-Jane. Cases in Bioethics: Selections from the Hastings Center Report. New York: St.Martin’s Press, 1998.