Ethics in Health Care
There are no absolute rules and guidelines when dealing with humans in medicine (except for operating procedures and et cetera) since different variables are taken into consideration and some of which are not applicable to the other (McCormick, 1988). However, there are three basic principles that are generally accepted by society concerning religion and ethnicity with regards to health care. These are the principles autonomy, beneficence and justice (Ethical Issues, 2003).
But these principles are subject to interpretation and discretion of the health workers. The scope of these principles sometimes overlaps and makes the questions such as “What treatment ought to be done? Who should decide for the treatment to be done? And when should it be done? ” a bit complicated. The most obvious ethical dilemma stated in the given scenario is “who has the final say over whether the patients’ leg is to be amputated or not – the physician, the patients’ relatives, or the patient herself? ”
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The issue concerns three parties who obviously have their own agenda’s, reasons, or ethics that they abide to with regards to their stand on the issue. Taking all these into consideration, it is best to look at the different views of the parties concerned. And these parties are the patient, the relatives, and the physician. The person directly affected by any decision reached by the three parties is the patient. So in normal circumstances it is only logical and ethical for us to say that the patients’ decision has the greatest gravity on the issue.
Adding to that is the fact that every patient is vested with the principle of autonomy which states that “the patient has the right to refuse or choose their treatment” (Medical ethics, 2006) or the “willingness to accept the proposed treatment, if the patient is cognitively capable of doing so” (Ethical Issues, 2003, para. 2). However, our patient, Ms. Alexander is suffering from a degenerative disease which is Alzheimer’s disease. A person suffering from this ailment “have trouble remembering, speaking, learning, making judgments, and planning” (Alzheimer’s Disease, 2006, para. ) and since there is yet no cure to this disease, the patients’ condition will worsen as years pass. Now if autonomy is defined as “a person’s ability to make independent choices” (Alzheimer’s Association. 2006) if he is “cognitively capable of doing so”(Ethical Issues, 2003, para. 2) we can safely conclude that our patients right to autonomy is rendered void due to her incapacity in making sound judgment which will hinder her from making independent choices.
And this is where our question take its roots, who has the final say over whether the patients’ leg is to be amputated or not – the physician, the patients’ relatives, or the patient herself? We have ruled out the patient on reasons stated above, this leaves us with the relatives and the physician. It has been common practice in hospitals that in events where in a patient is in a comatose of left in a vegetative state, that the immediate family can make decisions regarding the welfare of the patient.
However, the condition of the patient hasn’t reached that stage yet, and since there was no immediate family (parents, husband, daughter or son) stated in the scenario, this leaves the relatives less right to make decisions for the patient. And given the fact that the death of the patient can very well leave her relatives with large amount of financial assets, their intentions can be put to question as well. In this case, they refuse to let the physician amputate the leg of Ms. Alexander and accusing the physicians’ motivation as an “experimental medication”. Such statement clearly states their doubt in the physicians’ capabilities. This dilemma can be addressed by seeking the advice from other doctors regarding the patients’ condition, which for some unknown reason, the relatives failed to do. However, just recently, a lot of hospitals have discreetly developed policies stating that doctors, and not family members or relatives, should have the final authority to make these decisions.
And if this is the case, this would be beneficial to the patient since it will cancel out the possibility of hidden agenda’s of her relatives, that is, if there truly is a hidden agenda in their refusal to amputate the leg of the patient other than their doubt on the physicians capabilities. Having cancelled out the two parties, we are left with the last one, and that is the physician. With regards to his patients’ autonomy, he has a duty to respect the choice of the patient, as well as the duty to avoid unnecessary harm to them.
This is where we find that the principles autonomy and of beneficence overlap one another. The physician has a choice as to let the patient be, not amputating her leg that is, or performing his treatment in the defense of beneficence. The later can very well serve the interest of the relatives but it will surely leave the patients ailment unattended and could later on cause complications or death. While the former is a clear manifestation of beneficence and will serve the welfare of the patient, it will also cause conflict with the interest of the relatives.
Given that both have negative implications; this is where the physician is faced to do the lesser evil. Beneficence is “the duty of health care providers to be of a benefit to the patient, as well as to take positive steps to prevent and to remove harm from the patient” (McCormick, 1988). Hence, if the physician deems it significant and utterly important to amputate the leg of Ms. Alexander, he can do so if and only if he truly believes that the patient is “compromised and cannot act in his/her own best interest at the moment” (McCormick, 1988).
His actions can be a case of justified paternalism where in he feels the need to intervene on the attempt of saving the life of the patient. Cases like these often happen on emergency cases where a physician takes medical action without the consent of the patient in an effort to save his/her life. Let’s take a cardiac arrest as an example; the physician doesn’t need to ask for the patients consent in performing cardiopulmonary resuscitation in order to save the patients life. It is with clear conscience that the physician took the necessary actions for the welfare of the patient.
If he refuses to do so, he can be charged with neglecting of duty. Now the question here is, with regards to the scenario: “Joanna Alexander, a 72 year old with Alzheimer’s Disease and diabetes has gangrene of both feet. Her physician believes that her feet need to be amputated in order to save her life. Ms. Alexander has screamed her wishes that no surgical procedures be performed at any time. Ms. Alexander’s family members side with her and are refusing consent fearing that the surgeon’s motivation for the amputation is research of a valuable post-amputation experimental medication. Ms. Alexander’s death would mean a considerable financial gain for her family members. ” To what extent can a physician exercise the principle of beneficence without undermining the patients’ right to autonomy? III. Conclusion If the physician, with absolute certainty of the patients condition and that amputation is indeed the best shot, can exercise the principle of beneficence if he has, as clearly as possible, explained the realities of the patients condition and why he deems it significant for the welfare of the patient that her leg has to be amputated to the relatives and to the patient as well.
If the physician has the slightest doubt on his assessment of the patient and his proposed treatment, he can advice the relatives to consult other medical advice from other physicians. To put things into perspective, though the two principles overlap at some points, it is up to the physician to weigh as to which principle will benefit the patient the most. In this case, beneficence will serve to the best interest of the patient given that, and I would further stress, that the physician is absolutely certain that the treatment will benefit the patient the most.