Medical Ethics PHIL 148 @ Binghamton University, Sum 11

8Jun/1143

Case Study: Patient-Professional Relationships (Utilitarianism)

The major conflict in this case revolves around whether or not it would be proper and ethical for Dr. Wilson to perform a laparoscopic hysterectomy on Carmen, after it was discovered through a diagnostic procedure that she had several benign, but painful uterine tumors.  Although Carmen signed a consent form that gave Dr. Wilson the rights to do what is “medically necessary and advisable”—the anesthesiologist, Dr. Wang has doubts about whether Carmen has given proper consent for the hysterectomy and if it is in fact medically indicated.

As a quick recap, utilitarianism seeks to create the “greatest possible good (or happiness) for the most amount of people.” Happiness or the “maximization of utility” is primarily defined in two different ways: Bentham believed it to be pleasure and the absence of pain, Another way to analyze utilitarianism, is to understand how closely it is tied to the idea of “opportunity cost,” a concept developed by Jon Stewart Mill which refers to the value of whatever one had to give up in order to pursue another course of action.  Typically, a utilitarian will want to pursue the course of action with the lowest opportunity cost, thus making the most efficient use of resources.

Under utilitarianism, it seems that Dr. Wilson’s intention to perform the laparoscopic hysterectomy would not only be the reasonable course of action, but the preferable one as well.   In terms of resources, Dr. Wilson conserves both time and energy by performing the laparoscopic hysterectomy while she already has Carmen in surgery and anesthetized. I believe doing the hysterectomy during the laparoscopy is the option that has the lowest opportunity cost.   By getting rid of the ailment in this one procedure, Dr. Wilson allows both her and Dr. Wang to have a greater amount of time in the future to help other patients that need care, since the will not have to put the surgery off for another appointment.  Utilitarianism is concerned with the “good of everyone,” thus only having one procedure will benefit those in need of medical care (which Carmen’s second procedure might have prevented). Additionally, there is a certain amount of risk for a patient each time they go under anesthesia, by consolidating the diagnostic and treatment surgery, this risk is compounded.  According to Bentham, pleasure is defined as an absence of pain, by only having one immediate surgery, Dr. Wilson is preventing Carmen from experiencing the pelvic pain that has so limited her daily life for the past few months. Also, by only having one surgical procedure—Carmen is saved the pain of a second procedure. Because Carmen will have had the procedure already completed, she will be able to return to work sooner and not have to miss yet another day to treat the tumors.  Dr. Wilson's decision to perform the laparoscopic hysterectomy makes the best use of medical resources and prevents Carmen from experiencing any more of the pain that had severely impacted her daily life, and thus would likely be supported by the utilitarian perspective.

Utilitarianism is a form of consequentialism, and as a consequence of this surgery, Carmen will most likely be relieved of the pain that has been so heavily impacting her life—the main goal of her.  The other consequences are hard to determine and require a fair amount of speculation; I find this to be a weakness of the utilitarian perspective and it was hard to determine specific consequences for certain without more information. For example, what if Carmen, upon being informed of the hysterectomy, becomes deeply depressed at the idea that she will be unable to have children and though physically well, is unable to continue.  Despite the infinite variety of consequences, I still believe that under utilitarianism, Dr. Wilson's intention to perform the hysterectomy is the best course of action and the utility is maximized to a degree where it seems to outweigh the possible negative consequences.

  • How do the goals of utilitarianism in this example compare with the ethical perspective that you are looking at? Even if the goals are different- did anyone come to a similar conclusion?

Utilitarian perspective aside, this case is something I struggled with. Personally, I found it hard to put my feelings aside in order to argue the utilitarian perspective.   From a patient perspective, I just can’t help but to think how I would feel emotionally, waking up from a surgery that was supposed to be diagnostic to find that my uterus had been removed. Here are some questions that I started to think about while I was analyzing the case study that I think would be very interesting to explore.

  • How does the solution offered by the utilitarian perspective compare to the “restoration of autonomy” that Ackerman argues is the goal of medicine? Are there any perspectives that you feel offer a better solution?
  • Though Carmen’s physical problems have been solved, how would the solution offered by the utilitarian perspective impact her personal identity?
  • After Carmen was told that it would be a diagnostic procedure, was Dr. Wilson overstepping her bounds and deceiving Carmen in wanting to perform the hysterectomy—or was she just doing what she thought was “medically advisable and necessary?”  What implications might this have for Dr. Wilsons future relationship with Carmen?
  • If you could, using the different patient-professional models we read about this week, how would you revise either Dr. Wang's or Dr. Wilsons' approach? Would this revision change the outcome according to your philosophical perspective?

 

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