Medical Ethics PHIL 148 @ Binghamton University, Sum 11

1Jul/1131

‘Yes’ opposing legalized abortion imposes a moral obligation to adopt

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Debate Question:

Does opposing legalized abortion impose a moral obligation to adopt, if one has the resources, on those who oppose?

Position Post:

The opposition of legalized abortion imposes a moral obligation to adopt for those who are both opposed and have the resources to support an adopted child.  Upon first reading this position you may think that it is on the extreme side and though this may be true, this position is both an ethically logical and morally relevant stance that warrants attention. The main source of dispute in this debate question is over who is to take responsibility for children once they are born to parents who are incapable of and/or unwilling to raise them. Those morally opposed to abortion are obligated to answer this call for responsibility and adopt an ‘unwanted’ child. This is due to their expressed interest in the child’s life and well being prior to their physical birth. If one wishes to take away a woman’s right to decide if she will become a parent, then it logically follows that they must also be willing to take on the responsibility of caring for the resulting child, given that the biological mother is still unwilling or unable to care for her child at time of birth.

One who is opposed to abortion inherently believes that a woman who does not wish to carry her child to term does not have a right to abort her fetus because that fetus’s right to personhood overrides her right to bodily control. There will always be a certain number of infants born to unfit and unwilling mothers who will be put up for adoption. Adoption is a frequently proposed alternative to abortion by abortion opponents. By putting the child up for adoption, the biological mother relinquishes her legal responsibilities for that child; we are left with the question of who will now take on the responsibility of raising this child? While there are individuals unable conceive who will adopt and those who wish to adopt out of a sense of social responsibility, this number is insufficient in meeting the demand for adoptive parents. There are literally thousands of children available for adoption through foster care and over 40% of the 127,500 adoptions that occurred in the United States were done through foster care. (The Administration for Children & Families) Each year about 3.6% of all children in foster care “age out” without ever being adopted (Children Aid Society), clearly indicating that there is a greater number of children who need to be adopted than people willing to adopt.  Those opposed to abortion have a moral responsibility to close this gap in supply and demand. Who better than those who were so extremely interested in seeing that mothers do not terminate their unwanted pregnancies and respect the “right to life” of their potential children. It is only logical that those who took such a personal interest in the rights of a fetus would take up the responsibility of seeing to the success of the child’s future and continued well-being as the child grows. The failure to adopt a child would prove an opponent of abortion’s stance to be only a shallow expression of a fleeting moral interest, a hypocrisy characterized by the refusal to take an active responsibility for the very life that they believed so sincerely had a right to be brought into the world.

This stance can be well supported by the arguments that Hornstra’s  presents in her paper, “A Realistic Approach to Maternal Fetal Conflict.” She states that, “Society claims an interest in the developing fetus, but no responsibility.” Although Hornstra is specifically speaking about society’s attempt to regulate the actions of pregnant mothers, this argument also applies to my claim that by opposing a woman’s right to an abortion, one has a moral responsibility to adopt a child.  In order to justifiably take an “interest” in another person’s private matters, one must also take a “responsibility” for them.

If an opponent of abortion dusts off their hands right after an infant takes its first breath, and immediately thinks “mission accomplished,” the opponent is acting rather naively. It is fair to say that the simplest part of one’s life is being born; the true hardships and trials begin as children grow older and face the world. These hardships and trials are compounded for children who are never adopted; in contrast to their peers, youth who age out of foster care are less likely to “have completed high school or earned a GED, more likely to suffer from mental health problems, be involved in or be victims of crime and be socially isolated.”  As adults these youth are more likely than their age peers to be unemployed or homeless and living in poverty” (Joint Center for Political and Economic Studies Health Policy Institute). A utilitarian would agree that if those opposed to abortion accepted their moral duty to adopt more frequently, it would be better for society as a whole. Fewer children would wind up aging out of foster care, and instead would be more likely to be raised and nurtured in a stable environment that will likely result in them becoming a more productive member of society.

In Marquis’s paper “Why abortion is immoral,” he states “what primarily makes killing wrong is neither its effect on the murderer nor its effect on the victims friends and relatives, but its effect on the victim.” It seems fair to say that this statement implies that what primarily makes bringing a child into the world “right” is neither its effect on the parents or the child’s friends and relatives, but its effect on the child. If abortion is immoral as Marquis posits, it seems that a mechanism must be in place to ensure that a child is better off existing than not existing at all. Since an abortion opponent’s primary goal is to see that pregnancies are not terminated, they have a moral responsibility to make sure that the effect of being born (aka having a life) on an unwanted child is more positive than nonexistence. There is no better way to practically accomplish this than through adoption.

According to virtue ethics, character is displayed through both actions and intentions. The actions that one performs are linked to the successful consequences of these actions. People must also have good intentions while performing actions and act on the good intentions that they have. It is not enough for someone who is opposed to abortion to simply believe that abortion is wrong and say that adoption is a better option. For their intentions to be morally relevant, they must reflect their good intentions towards unwanted children outwardly and take action by adopting, assuring first-hand that the child will have a safe and secure existence.  Thus, the successful upbringing of an adopted child would outwardly demonstrate the abortion opponent’s good intentions toward unwanted children.  Although they may not be able to adopt more than one child, the positive consequences that result from their decision to adopt one child demonstrate a high degree of morality and reflect their intentions for all children Additionally, virtue ethics places emphasis on the “naturalness” of one’s behavior. After taking a specific interest in a child prior to its birth, the abortion opponent refusing to adopt a child seems unnatural as it is quite contradictory to suddenly stop caring about someone’s future immediately after arguing that it had an independent right to that same future.

(1) The Administration for Children and Families http://www.acf.hhs.gov/programs/cb/stats_research/afcars/trends.htm

(2) The Children's Aid Society http://www.childrensaidsociety.org/issues/aging-out-foster-care

(3) Joint Center for Political and Economic Studies Health Policy Institute http://www.blackadministrators.org/pdf/Aging_Out_of_the_Foster_Care_SystemFINAL.pdf

 

Filed under: Abortion, Debates 31 Comments
24Jun/1111

Morality of limiting resources

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It is moral for government/private hospital to provide limited resources on a first come first serve basis. Resources are anything that can help an individual get better, but in terms of limited resources I believe these are the crucial and less available things that patients need to continue their lives. For instance receiving any form of organ/ performing any type of surgery.  Think about a little girl who needs a heart transplant and then is placed on a waiting list for a year. Finally her name was at the top of the list and a suitable match was found, but then the heart was given to someone else; how would that child feel knowing that heart was suppose to be given to her and not someone else. I do believe that having the system of first come first serve is effective and orderly.

Deontology views moral life in terms of duties, obligations and what is the right thing to do. To be moral one has to perform actions that are required by moral law and thus this action has a good intention and is done for the sake of duty.  It also emphasizes the quote “Do unto others as you’d have done unto you.” Ross sates that an action is right not because it bring about good consequences but because it is an act that fulfill duties. When these government/private hospitals are limiting resource they are simply doing their duty which is to take care of their patients and provide them with the necessary equipments/ resources that they need to get better. So if there aren’t enough resources for every patient these hospitals are still performing the task/ duty of being an institution that provides health care to its patients. In addition for Ross one has a prima facie to what is right, for example the hospitals have a prima facie duty to provide resources but they also have a prima facie duty to be fair. Knowing that their maybe circumstances when everyone may not get the resources they need, giving health care resources in an orderly is better because at least there are people who are getting the help they need and it is done fairly.

Virtue of ethics is the moral character of an individual; the feeling one gets to help another person. It states that we do what is good in a way to see what is good. Indeed the hospitals are helping their patients; they are giving their patients the resources that they need, acting from the goodness in their hearts. Utilitarianism deals with the maximum happiness; it raises the questions of how much and what kind of happiness each person receives. Mill believes utilitarianism to create the overall good of a certain situation, thus in this situation limited resources can be seen as an overall goodness since people are receiving whatever treatment they need. I believe act-utilitarianism is best linked to this situation; the hospital is faced with this tough decision and has a choice to make so they decide limiting resources on a first come first serve basis is best. Act utilitarianism states that when faced with a decision between A or B we have to consider the consequences of each of the actions and then see which one will create more pleasure/ happiness. In addition justice is giving an individual what he/she deserves; including having one’s right respected and to be treated fairly. We do live in a society where people prefer fairness in any form of area. First come first serve see to it that each patient is treated fairly and for this is believes it is the best solution.

24Jun/118

It is Immoral

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It is immoral for hospitals or the government to limit resources on a first come first serve basis. By treating citizens in need on a first come first serve basis, the government or the hospital is disregarding their moral responsibility as structures for care in the eyes of many ethical perspectives. I believe resources should be used based on severity of the injury, illness, or situation. For instance it is fair to say that a person dying from gunshot wound is more severe than a laceration on someone’s leg. Both procedures require sutures and anesthesia. These resources should be used to sustain a life, over a leg and many ethical thinkers would agree.

Egalitarians would also disagree that treating patients on a first come, first serve basis would be just because this system of equality of treatment based on time denies certain patients a bare minimum of care. We can define the bare minimum of care for a gunshot wound victim to be; care to close up the wound. If we were following the unjust system and there are no more sutures left to close the wound then this system denies the patient of the bare minimum. In fact it is possible that care of any sort can be denied, if the resources are unavailable, to patients and therefore it is unjust. If we based the system solely on severity the bare minimum care could be met easily. Wounds that are in dyer need of stitches would get them and those that would be able to heal with a band-aid or bandage wouldn’t use stitches. Secondly, Egalitarians would find this system of treatment immoral because it is excluding and unfair to a portion of people. Egalitarians find that moral acts are ones done that keep the treatment equal for all. If only the first few people can be treated because they limit the resources for them solely, than the people who come into the hospital later cannot receive any treatment.  Egalitarians would agree that severity would be the best way to use resources because treatment for the injury would be based on a scale that treated everyone the same for the same severity of injury. For instance somebody with a gunshot wound at 9 am would receive the same treatment as some one who came into the hospital at 9 pm. If these two patients had been treated based on a first come first serve basis it is possible that the second victim would receive improper/or no treatment because all of the resources had been used up prior by lower level severity cases and therefore those two victims would not be treated equally even though they should be because they have the same injury. If they were treated on the terms of severity it is highly likely that the second injured patient would be able to receive the same proper medical care. Using severity to spread the resources equally proportional to the level of severity, just like it is known that taxing on a proportional scale would satisfy an egalitarian. One is treated the same as the other in proportion.  By treating patients based on severity level you are standardizing a basic minimum as well. You are saying that the lowest level severity patients will use the least amount of resources, which gives the bare minimum, and then scale the amount of resources to be used accordingly. This provides equality throughout the levels of severity and throughout the system. For instance, the gun shot wound patient at 9 pm would receive the same treatment as someone at 9 am using the same resources, including patient care, and doctoral attention. Someone who fell off of their bicycle would receive the same amount of attention but on smaller scale, 3 doctors do not need to diagnose how to fix a simple laceration on someone’s leg, but 3 doctors may need to figure out how to remove the bullet, close the incision, and the fastest safest way to go about it. So it’s all equally relative to the problem.

Utilitarians would also find it immoral to serve patients on a first come first serve basis. Utilitarians wish to maximize overall utility for the largest amount of people, therefore they would find this system immoral because it would not be satisfying this point. First, this system would not provide care for those who would need it after a certain time because the resources would be used before they could be applied to the later patients. Therefore these patients would not find happiness or satisfaction, or relief from pain. If the gunshot wound victim comes in at 9 pm and cannot receive treatment because there are no resources to treat him, he will be in severe pain and possibly handicapping his future. In a utilitarian view, the act of not providing care to this patient is immoral. Providing at least the minimal amount of care to anyone in need is seen as more justifiable than treating a few patients thoroughly. For instance, providing the gunshot wound victim with no care because he was admitted to late and the resources have all been used up is immoral. The resources should have been saved to treat such severe cases and spared on the cases that unnecessarily use the resources. For a utilitarian we can maximize resources this way as well. Providing the resources to patients in an organized manner based on severity would allow necessary resources to only be used in such cases in which they are desperately needed. For example using a bandage on a cut instead of stitches, we are able to save the stitches for someone with a gunshot wound, this maximizes utility of the resources. Also, the doctors are unable to provide the care for the patients who come later and are therefore unsatisfied. These doctors wish to fulfill their Hippocratic oath to do whatever they can to treat as many people as they can. By distributing the resources by severity you are allowing more patients to be served and more doctors feeling fulfilled. If we measure utility in satisfaction, then the first come first serve system is immoral because it creates more dissatisfaction than satisfaction.

The system first come first serve would be an unjust, immoral system. It would lead to more deaths, dissatisfaction and unhappiness. Patients in need of life-sustaining treatment would be unable to receive it because of limited resources.  Patients and doctors would be dissatisfied with their level of treatment for patients that come when resources have run out.  Unhappiness would plague the system because everyday more and more unhappy people would remain that way without being treated properly. Utilitarians and Egalitarians agree that a basic minimum to provide resources must be provided for the system to be morally right and if it were based on time this minimum could not be provided for all in need. Therefore, severity is seen as the fairest way to organize and distribute resources because it creates this minimum for everyone.

 

 

24Jun/1110

Debate: Health Care & Justice (Yes)

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Question: Is it moral for the government or individual hospitals to provide limited resources on a first come, first serve basis?

Yes, I believe it is moral for the government or individual hospitals to provide limited resources on a first come, first serve basis.  Well first off, I feel that it is necessary to define what exactly "limited resources" are.    I believe limited resources include measures and procedures that utilize more than the usual time and money.  For example, a heart transplant is something I would refer to as a limited resource.  Besides measures and procedures, a limited resource can be an organ as well; some examples would the heart and the kidney.  A limited resource can also be a vaccination of some sort in order to prevent the flu.  Keeping this in mind,  I believe that the government or hospitals are morally sound in providing these limited resources on a first come, first serve basis, because the people that they are given to actually need them.  If a patient is next on the waiting list for a heart transplant and a heart is found, then that patient deserves to undergo the operation and obtain his/her new heart.  If only 1,000 vaccinations for the bird flu are available, then the first 1,000 to show up at the doctor's office are entitled to receive them.  Some may argue that what if another individual who needed it more comes later and finds that they are not available.  They would say it is wrong to give the vaccinations to the last 100 people who were healthier, and instead, the vaccinations should have been saved for dire cases.  This may have some truth; however, what guarantee do we have that the last 100 people wouldn't have contracted the flu if they hadn't been vaccinated.  What if the last 100 lives had just been saved from the vaccination?  How do the government and hospitals decipher whether the treatment or procedure should go to the patient who presently really needs it or the future patient who may really really need it?  Both institutions are comprised of only human beings that are just trying to fulfill their daily obligations in their occupations.  These people are not gifted with the ability to foresee future patients and then use that future knowledge to withhold treatment for patients in the present who don't necessarily need it as much as the future patients do.

Let's take a look at ethical perspectives.  Kantian deontology states that people have duties whether they be perfect duties or imperfect duties.  The hospital's perfect duty is look after its  patients.  In this case, the hospital's perfect duty is to administer the limited resources to those that need it in the first come, first serve basis.  By doing so, the hospital's actions are considered to be moral.  The hospital also has an imperfect duty to think about future patients who the limited resources might benefit more than the present patients; however, by transgressing this imperfect duty, morality is still sustained.  Virtue ethics values the character of the individual.  When a physician is administering limited resources to patients on a first come, first serve basis, he is displaying virtue ethics.  The physician is caring for the patient by doing all in his/her power to restore him/her back to health and so is morally carrying out his job.  He/she knows that the patient is need of the limited resource.  The patient is next to receive whatever treatment or procedure that he/she is entitled, and so the physician administers the limited resource to that particular patient to the best of his/her ability.   By this, the physician has the right actions coupled along with the right intentions which is a mantra that is preached in virtue ethics.  Care ethics tells us that the health care professionals need to administer to both the psychological and physical needs of a patient.  In this case, the psychological needs are dependent on the physical needs of the patient.  The physical needs of the patient is dependent on the limited resource that that patient is entitled to in order progress towards a healthier being.  By providing these limited resources to patients on a first come, first serve basis, the physician is carrying out an important stipulation in care ethics.  Utilitarianism states that resources should not be wasted and should be used efficiently.  These limited resources are going to individuals who need them in order to carry on with their lives and won't be wasted.  By holding onto these resources and saving them for future patients rather than administering them to present patients who need them and are entitled to them now, there is actually a high chance of the resources going to waste which is frowned upon in utilitarianism.

The best analogy I can think of is a queue for the restrooms in a restaurant.  Sometimes, the line is long and is filled with people who need to use the bathroom for various purposes.  Yes, some people may need to do more important things than others; however, there is a line that has been established and needs to be respected.  Everybody needs to wait their turn on line so that some sort of order is maintained.  Let's say there's no queue to the restroom, should an individual think twice about using it if they have to?  Should that individual think that their purpose in the restroom is not as important as someone else's future purpose might be, so they should wait for the next individual to use the restroom under that assumption?  Absolutely not.  If that happened, then the individual would be standing outside the restroom all day and would never go in.  Nothing would be accomplished.

 

 

24Jun/1114

Debate post: Is it moral?

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Question: Is it moral for the government or individual hospitals to provide limited resources on a first come, first serve basis?

 

I don't think it's moral for neither the government nor individual hospitals to provide limited resources on a first come, first serve basis. I think that "first come, first serve" makes the implication that these resources are wants that are to be consumed by the people who are first in line to receive them. Rather, these resources are needs, and there are many people out there who need them. Take, for example, a situation in which there is a special medication that treats the flu in 24 hours, but is limited to 1,000 doses. The flu ranges in severity, as it can be insignificant to some and fatal to others. Some people may want the medication in order to be rid of the flu sooner so that they can finally get out of the house and enjoy the sun. Others may need the medication in order to live another day, as their immune systems are very weak (perhaps they're infants or the elderly) and they are at risk of dying. 2,200 people (600 whose lives are in danger) were seen by various doctors in one day, and 2,200 requests for the medication (all with date, time,  and severity included) were reviewed. Would it seem right for the hospital/government entity (again, this is only an example) to distribute the medication to the 1,000 patients whose times were soonest?

 

Take a second to consider the kinds of things that are distributed on a first come, first serve basis. A store would sell it's stock of 1,000 iPods to the first 1,000 customers in line. A person selling 50 video games would sell to the first 50 people willing to buy. Should medical resources be on the same level as these things? These are superficial wants, and health care is a need, as it is crucial in living a healthy life. Taking somewhat of a utilitarian perspective, giving these limited medical resources to the first people "in line" wouldn't be a right approach, as there would be people who don't necessarily need the resources as much as others, but receive it anyway. That would surely shorthand many people who would need the resource more than others, and have grim results as opposed to distributing the resources on a needs basis. Even if that needs basis doesn't help everyone with a need (perhaps there are more needy than there are resources), it is a better approach than just handing the resources out to whoever was first to put their hand out.

 

Where does one's autonomy come into play? It can be argued that the people who are first "in line" for something have a right to it, and I would agree. I would also agree that in some situations, people can have a greater right to something than another. For example, someone who is suffering from a disease has a greater right to specific treatments than someone who thinks they might be at risk of that disease. This should be the norm for all medical resources, including those who are limited. With respect to autonomy, needs should be of greater importance than wants. Please, share your thoughts on how you feel autonomy affects this situation, if at all.

 

Equality is another thing to be considered in this situation. Surely, working on a needs basis does not allow for equality, as some people are given priority over others. However, the only way to achieve equality in this situation would be to give the resources to all, and that is impossible as the resources are limited. Also, not everyone is on equal standing in terms of health, as some are worse off than others. In situations such as this one, it only makes sense that there is inequality, as there are people who truly need the resources and people who don't really need it.

 

 

18Jun/1115

Euthanasia Debate

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Question: If one terminal cancer patient refuses necessary life-sustaining treatment and another terminal cancer patient purposefully takes a fatal dose of necessary painkillers for managing the pain of the cancer, are these two circumstances of death morally different?

Position: Morally speaking, there is no difference between refusing life-sustaining treatment and taking a fatal dose of painkillers. The patients who make one of these two choices have decided that they want to die. Yes different methods are being used but the final outcome will be the same, and both patients have the knowledge and understanding of the outcome of their decision. Is it immoral for a patient to choose the way in which they die? This is a part of their autonomy. As long as the doctor is not the one who administers the fatal dose of painkillers and it is the patient who takes the dose on their own accord, it remains within moral boundaries.

The key point in this case is that both patients are terminally ill, meaning they will eventually die. The patient who chooses to actively ingest the fatal dose of painkillers merely chooses to die sooner and feeling no pain, while the other patient chooses to die naturally. As a healthy person watching from the sidelines it is easy to dictate what we think is wrong or right in this delicate situation. However we cannot place ourselves in their position. Suffering from a terminal condition may make a person readjust their idea of what is wrong or right in terms of euthanasia. According Hwang we currently have a cultural antipathy towards active euthanasia, or suicide as he calls it, is largely because of Western Christian influence. He goes on to say that quality of life is important and that the decision to end ones life because of intolerable conditions can be a sane and dignified option that is the thoughtul result of reasoned judgemnt (Hwang, paragraph 5).

Since these patients are terminally ill, continuing to live would be a burden on medical resources and the medical staff. Continuing their treatment would only delay their death and perhaps prolong their suffering and even the suffering of their loved ones who are taking care of them. In fact, Hardwig would suggest that it is not onlymoral for them to choose one of the cited options of euthanization but that it is an obligation. They have a duty to die. Therefore, there is no moral difference in choosing passive or active euthanization. Both result in the same outcome and both are a direct and autonomous decision of the patient.

17Jun/1127

Euthanasia Debate

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Question: If one terminal cancer patient refuses necessary life-sustaining treatment and another terminal cancer patient purposefully takes a fatal dose of necessary painkillers for managing the pain of the cancer, are these two circumstances of death morally different?

Position:

There is a moral difference between refusing treatment and taking a lethal dose of medication. Both situations are voluntary euthanasia; the major distinction is that the first is classified as passive euthanasia while the second is active euthanasia. The moral distinction according to Callahan would be that active euthanasia is killing while passive euthanasia is letting the person die. Although the end result is the same they are morally different. In one case you are adding something to cause death while in the other you are removing something to let the person die however they would in nature. In active euthanasia you are doing something to cause the death of the person while in passive euthanasia you are letting something happen, that isn’t your fault, which will result in the person’s death. While it can be agreed upon that killing another person is wrong, it can be said that letting a person die when there is no possible chance of cure or treatment is never wrong.

In the case of active euthanasia another person’s involvement to some degree is required. Unless the person steals the drugs used to end their life they had to get them from someone, usually a doctor. This request for the drugs to end their life would be a demand of treatment which the doctor does not have to respect or follow. This also has the possibility of creating a moral conflict for the doctor which would be morally wrong for the patient to do. This agrees with care ethics which would disregard the autonomy of the patient in exchange for caring for the patient and the interpersonal relationship with their health care professionals especially doctors. Refusal of treatment has the possibility to involve no one, although comfort measures are often taken which would involve health care professionals. The doctor also has an obligation to respect the wishes and autonomy of the patient who is informed and understands the implications of their refusal.

There is also the controversial argument that in some cases active euthanasia may actually be the more merciful option. In some cases comfort measures are not sufficient enough and do not provide the necessary relief from pain that would make passive euthanasia bearable. In these cases it can be argued that it is morally wrong to let that person suffer through the process of passive euthanasia. While passive euthanasia can take days, weeks, months, or years, active euthanasia provides immediate relief from suffering. This of course depends on the euthanasia being voluntary and the patient being well informed of all their options and competent to know what is right for them removed from any outside pressures.

10Jun/1139

Patient-Professional Relationship Debate

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Debate Question: If a young deaf child (5-years-old) expresses a desire for a cochlear implant (which has a chance of allowing her to hear), but the deaf mother of the child decides not to let her go through with the procedure, would it be morally wrong for the doctor to get a court order to allow him to perform the surgery?

Position Post:

To deny service to those in need while one is knowingly capable of providing aide is morally wrong. Doctors, before they received their license as medical professional recited an oath in which they pledged to uphold the priorities of their patient’s care above all else in their practicing field. These individuals promised to care for their patients to the upmost of their ability and in stating so the doctor presented in this case must submit to these orders. Now I understand that this particular case may break/destroy or even contradict some relationship principles but one must understand that when dealing with the sick, patients care stand above all. Proposing to receive a court order before the surgical procedure may even contradict a national law, but on ethical and moral grounds such rules fail to apply, as will be explained.

Let’s take a look at why this act of seeking a court order is morally correct based on the theories of certain philosophical principles, with the first being care ethics. Defined by the mere principles of virtue ethics in the placement of patient care at upmost priority, care ethics embodies the importance of empathy and sensitivity in the field of medicine. Proposing to get a court order against the wishes of the mother exemplifies this definition.  Note that the physician going against the mothers wishes is sure to break relationship ties between him/her and the parent. But disregarding this fact and continuing to declare one anyway demonstrates clear empathy for it takes true compassion and willpower to be able to commit such an act. It would also morally correct because not only does it embrace the principles of care and virtue ethics but also it satisfied the needs of the patient in having received an implant and a chance at a normal life.

Another ethical standpoint that stands in support of this moral action is utilitarianism. Derived into two forms (act utilitarianism and rule utilitarianism), utilitarianism states that an act or action must be only be performed when it is in good standing with the general body at hand. Meaning that the good (the pros) must outweigh the bad (the cons) in terms of its effect on the people in question. The people in question in this case would be the doctor, the parent and the child. Should the physician be granted the opportunity to possibly restore the child’s hearing both the child and the parent will benefit; and not to mention the physician as well. How this affects the child is obvious; he or she will be granted a chance at a normal life and will also be able to hear again. The parent will benefit in the sense that she is also deaf and will have a personal translator should she ever need one. In the end the physician will be content knowing that he/she upheld his/her promise of the Hippocratic oath and that both parties were satisfied with the procedure. In terms of rule-utilitarianism, the physician will be conforming to a set of rules (the Hippocratic Oath) that leads to the greatest good for everyone.

A counterargument that may be proposed against this moral action of seeking a court order may be that of a national law. Within the United States, children are said to be lawfully under the care and supervision of their parents until their legal age of adulthood at 18 years old. This means that the child may not receive treatment without direct consent from the mother.  From a legal perspective this may suggest that seeking a court order stands in clear violation of this law. I, however, propose that such violation does not exist. Courts pass judgments on “broken laws” so if they were to issue permission to the doctor then technically no law will “broken”  and it would be legally okay for the surgeon  perform the surgery.  Regardless of a legal aspect, the act of seeking a court order should not be denied anyway because it would be morally incorrect to do so.  To disregard the need of court consent is to disregard the practice of optimal care and to do that according to the theories of care and virtue ethics it is morally wrong.

Yes, it’s immoral to go against the wishes of the mother concerning the child but one must not neglect the needs of the child either. So what happens when you take both wants into consideration? Which side does one choose? Does one uphold the morals of the mother or that of the child? I say that of the child because of the many reasons presented above. At the end of the day, the child is the patient and not the mother. The needs and feelings of the patient are what should be considered and not that of the mother; even if she does have a say in the care of her child. Every mother should want the best for their child. If the mother fails to acknowledge this, the doctor should not and should therefore do everything humanely and morally possible to provide the optimal care.

10Jun/1111

Debate 1 Sammy Ahmed

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Question: If a young deaf child (5-years-old) expresses a desire for a cochlear implant (which has a chance of allowing her to hear), but the deaf mother of the child decides not to let her go through with the procedure, would it be morally wrong for the doctor to get a court order to allow him to perform the surgery?

 

Yes I believe it is morally wrong for the doctor to obtain a court order to allow him to perform the surgery because as a physician he/she is overstepping their boundaries in the patient-professional relationship.  The doctor would not be allowing for the patient to reserve their own autonomy.   A major issue here is whether or not the child will be able to live a normal life without his sense of hearing.  It is obvious that the child’s mother’s stance is that yes the child will be able to using herself as the example.  Though the life may be more difficult for the child it is indeed possible.  A deontologist may have a problem with the Doctor’s actions because one could argue that the doctor only wants the procedure done for his end (money).  This would infer of course that the mother’s money is all the doctor is concerned with and would give him justification to deem the procedure necessary.  The presence of the deaf mother leads to the belief that the procedure is not necessary and the child can still live a normal life like its mother is.  I also think it is significant to point out that most other parents would want this procedure done for their child because what parent would know fully allow their child to live with a disadvantage or disability.  The mother strongly believes that her child will be able to function properly and live a normal life.  The child’s state is not life threatening and thus the procedure is not entirely necessary.  The child would still be able to make most of life’s important decisions except for those obviously pertaining to sound such as what radio station the child prefers.  After all, Ludwig Van Beethoven eventually lost his hearing and he is revered as one of the most talented musicians of all time.   Furthermore, the doctor is disregarding the mother’s role as a parent.  The mother should have final say about whether or not the cochlear implant should be performed.  She may not believe the implant is appropriate for a number of reasons.  One mentioned before was that the mother does not believe the sense of hearing is necessary to live a happy successful life as she has.  Another reason for denying the cochlear implant it perhaps the mother does not have the necessary resources to make the procedure happen.   A cochlear implant may be a very expensive procedure and it may not be worth the parent’s time and effort to restore the child’s hearing.  I understand this sounds unethical on the parent’s behalf, allowing their child to “suffer”, but I believe it is up to the parent, not the doctor or the courts, to make this decision.  I don’t believe anybody else has the authority to tell a parent how to raise their child or make decisions for the parent.  The court order would force the mother to allow the doctor to perform the cochlear implant.  Unless of course the parent is deemed unqualified to raise their own children such is the case with drug addicts.  In this case however, the mother is only described as deaf so I am making the inference that she is fully capable of raising her child.

3Jun/119

Sample Debate

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Below is a Position Post for a Debate Day.  It earned a 3.  Please write a Response Post critiquing this position.  Even without having read on this particular topic (you'll have a chance next week).  Use the ethical theories and concepts you have learned this week to talk about the issues raised by this post.  As a guide, here are some questions from the Learning Packet:

  • What is your position?
  • Do you think your position is clear to others?  Are you sure?
  • Is your argument clear to others?  Hint: Be explicit; spell everything out.
  • What details do you think are ethically relevant in the debate?
  • What do the other Group Leaders think is ethically relevant?
  • What facts support your side of the debate?
  • How can these facts be combined with ethical arguments to support your position?
  • Do these facts contradict or support one another?
  • Can these facts be used to draw other conclusions?
  • What ethical perspective are you arguing from?
  • What ethical perspective are the other Group Leaders arguing from?
  • What side of the debate do you favor intuitively?
  • What side do you find most convincing independent of your intuitions?

Debate Question: Should Doctor's Ever Lie to Their Patients?

Position Post: Despite popular belief, doctors should be able to lie and withhold information from their patients. When looking at the issue broadly, one may immediately think that the truth always prevails and that one should have control over their own body, but when different scenarios are examined, it is clear that in certain types of cases, withholding information is the most moral option. There are two ethical perspectives which would support withholding information. Utilitarianism says that the moral thing to do is what is best outcome for the well being of the most amount of people. It is not the motive of the person that matters, so the fact that a doctor is lying is not morally relevant. The doctor is producing the best possible outcome, and out of all parties involved, is best fit to analyze all options and choose what is best for the patient and the community. In the example provided in the Thomasma article, the author describes a situation in which a mildly retarded woman has ambiguous genitalia.  Disclosing the truth can only ruin this woman's life. There is no possible positive outcome from disclosing the truth; her condition is not life threatening; knowledge of her condition could not improve the quality of her life. It could only damage her feelings and self worth, and the relationships with those around her. In this case, utilitarianism would suggest that withholding the information is the moral thing to do.

Care ethics could also be used to argue for the right to lie and withhold information. According to Beauchamp, care ethics stresses that individual attachments are what is morally relevant. He says that without the basic level of care, there would be no human race. Plus, the ability to put another before one's self is an important point in care ethics. In lying to a patient, a doctor is really putting the patient's well being before his own. A doctor can very well be sued by a patient who finds out that a doctor lied about their condition or withheld information. The doctor didn't lie to be mean; he wasn't lying for any personal gain because he was putting his own career at risk because he believed that lying would really be better for the patient's well being.  Doing such an act is selfless and is putting the patient before his own career and legal standing in the medical field. Plus, the relationship between the doctor and patient can sometimes become really close, and a patient may choose that they wouldn't want to know something. A doctor and a patient they have been treating for a long time establish a high level of trust, which lets the doctor in on how a patient might react.

Sometimes, offering a patient full disclosure is a death sentence, even if their condition isn't necessarily a death sentence. Patients are often stressed with their medical issues and can't make objective decisions or handle new information that must make them reexamine their life. As a person who is not sick, I know there are situations in which I would not want to know the full details of a hypothetical condition if I faced it. In the case Thomasma described in which a dying victim of a car accident asked about their other family members who were already dead, lying is most definitely the moral thing to do. The man may very well die himself in the next few hours, plus even if he has a chance to get better, devastating news like that will only make him further deteriorate and not get better. It is only cruel to tell him such news that his entire family is dead. Sometimes, motivation is what is needed to improve a patient's condition, and such can only be provided through false information. Putting positive thoughts into a child's head who has cancer sometimes helps them progress more quickly, which is not done by giving the child every detail and statistic of their condition. This concept can be applied to adults and might speed their recovery if some of their autonomy were taken away.

Thomasa also stresses that although truth is essential for healing an illness, it may not be as important for curing a disease. Illness and disease are two separate entities which must be treated differently, and most of the time when truth is withheld, it is only temporary. When doctor's take a Hippocratic oath, they swear to do what is good for their patients and treat them to the best of their ability. In reality this sometimes involves actions like lying or withholding information. The idea of necessary paternalism deems it necessary for doctors to sometimes act to protect patients from harm.