Medical Ethics PHIL 148 @ Binghamton University, Sum 11

8Jun/1151

Patient-Professional Relationship Case Study (Care Ethics)

This is a very interesting case. The issue at hand is whether or not Dr. Wilson should perform a hysterectomy on Carmen Diaz, in addition to the Diagnostic Laparoscopy which was the initial procedure. This issue arose when Dr. Wilson discovered, during the laparoscopy, that Carmen had several large tumors about her uterus. Although the tumors were benign, they tend to be painful, and were most likely to blame for the near crippling pain that Carmen experienced for the past three months. Upon signing a consent form for the diagnostic laparoscopy, Carmen granted Dr. Wilson the right "to do what is medically necessary and advisable if unexpected circumstances arise during the surgery." The question is whether this hysterectomy, which will consist of removal of Carmen's uterus, is medically necessary.

Taking stance on the ethics of care, I feel as if it is necessary for Dr. Wilson to perform the hysterectomy. Care ethics, as the name implies, focuses on caring for others, by showing empathy for them as well as showing concern for their needs and interests.  Rather than putting emphasis on universal moral standards, as do ethical theories of consequentialism and deontology, care ethics places an emphasis on the importance of relationships, and the responsibilities that arise out of such.

When Carmen signed the consent form and gave Dr. Wilson the right to do whatever was medically necessary, she (Carmen) made way for their relationship to take form of the friendship model. The friendship model is right in tune with care ethics, contending that in a medical setting, the physician assumes the interests of the patient, while the patient puts his/her trust in the physician. In this situation, Dr. Wilson would be assuming the interests of Carmen since Carmen trusted her so much as to give her such significant rights. With the knowledge that Carmen has large tumors that are painful, Dr. Wilson would be acting in the best interest of Carmen by performing the hysterectomy and removing the tumors. This would rid Carmen of a terrible pain that has restricted her physical activity and worsened the quality of her life. Dr. Wilson would also be acting in the best interest of Carmen by performing the surgery now, and not allowing Dr. Wang to awaken Carmen and plan the hysterectomy for a future date. If the surgery is put off, Carmen would still have to deal with the crippling pelvic pain until her rescheduled surgery. Dr Wilson would also be acting in the best interest of Carmen in terms of Carmen's psychological health. If the surgery is put off until a later date, Carmen has to carry two burdens; the burden of pain that the tumors are causing her, and the burden of fear and anxiety that she would soon have to undergo a serious surgical procedure, and she would soon have her uterus removed.

In assessing Carmen's needs, I believe we can all agree that Carmen needs for her pain to cease as soon as possible. The terrible pain she experienced impaired her ability to work and to do routine daily chores, thus making life that much more difficult. Since the ethics of care are normative, Dr. Wilson is able to assess those needs and determine whether or not she is taking the right action. However, it does seem tough to try and balance the right and wrong of this procedure; is it right to rid Carmen of her pain, or is it wrong to perform a procedure as drastic as removing a uterus without notifying Carmen first?

Care ethics hints at a gender difference in reasoning. Thanks to Carol Gilligan, it is understood that females are more inclined to protect the interests of everyone involved, whereas men are more inclined to sacrifice one's interests. It can be argued that while Dr. Wilson was trying to protect Carmen's interests by performing the hysterectomy, Dr. Wang (who is a male) was sacrificing Carmen's interests by planning to awaken her and delay the hysterectomy. What are your opinions on that matter?

Another interesting question is whether empathy is a competent approach to determining right and wrong actions in the medical field. Empathy consists of attempting to recognize one's feelings and trying to share in those feelings, without actually being in the same situation. In this case, Dr. Wilson couldn't be aware of Carmen's feelings because Carmen was anesthetized. Could Dr. Wilson adequately share in Carmen's feelings of learning that she no longer has a uterus and therefore no longer has a functioning reproductive system? Surely Dr. Wilson doesn't know the pain of waking up to the news that you won't be able to reproduce. If Dr. Wilson were to perform the surgery, what do you expect Carmen's reaction to be? Will she be happy that the pain is gone, or sad that she can't have children, or both? Will she understand that Dr. Wilson was acting in her best interest?

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