Ethical Problems in Society and Medicine
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Ethical Problems in Society and Medicine
Ethics in a general view deals with the dynamics of behaviour based on whether it is wrong or right. Ethics apply to all the disciplines in life as regards to the manner of conduct considered ethical or non-ethical. Bioethics is a discipline encompassing ethics that stem from the advancement in the medical and biological fields. The ethics are usually controversial in nature as they are dilemmas arising from interrelationships between different fields such as law, biomedical technology, political science and life sciences. Bioethics addresses various issues that question the morals of the medical field and practices.
Discussion
In analysis of the Jane Smith’s case study, several bioethical issues arise. They issues include Confidentiality, Abortion, medical malpractices, organ donation and neonatal euthanasia.
Confidentiality
On finding out about her pregnancy, Jane Smith reaches out to the family doctor, Dr. Amanda Goodling, to confide in her about her predicament. The doctor later on informs her parents, who are dismayed by the news and ask the doctor to refer them to a clinic that can perform the abortion with minimal exposure. This clearly points out a breach in terms of patient-doctor confidentiality. The doctor had promised to maintain information concerning her pregnancy discrete and incase of disclosure it should have required consent from Jane Smith.
Confidentiality is fundamentally important in the development of a patient-doctor relationship. A medical practitioner is only allowed to disclose the information if the patient expresses a desire to inflict harm to themselves or others, when the information is required by the law, or in a case where an underage patient wants to terminate a pregnancy. Ironically, the disclosure of Jane’s pregnancy by the doctor brought about the issue of abortion. The parents demanded her to terminate the pregnancy so that she could move on with her life. They went to an extent of requesting the doctor to refer a clinic where Jane could procure an abortion. This clearly shows that only reason why the doctor informed her parents was to maintain a good relationship with them. It was not out of a moral obligation, as Jane did not indicate any desire to procure an abortion. This was an absolute breach of confidentiality on the doctor’s part.
In a philosophical aspect, the breach of confidence by the doctor was morally wrong (Harris, 2001). The doctor was tasked with the responsibility of upholding confidentiality of her patient as long as she did not contemplate on terminating the pregnancy. The decision to breach confidentiality was betrayal and disrespect to her Jane’s privacy. From a legal standpoint, the doctor denied Jane the rights to confidentiality as mandated by the statutory and common law. Jane had the right to take legal measures against the doctor after the information about her pregnancy was disclosed to her parents.
Abortion
After the realization that Bobby had been cheating on her, Jane moved back to her parent’s house and gave in to the pressure to abort the pregnancy that had advanced to the second trimester, at 22 weeks. Prior to returning home, she had run away because of her parents demand and due to the fact that her boyfriend was against the idea of terminating the pregnancy. She went home to get support in raising the child, as she was unable to raise a child alone. She was involved in an accident on her way to an appointment with a clinic, which has consented on carrying out the procedure.
The major ethical issues that are present in this scenario are termination of pregnancy at later stages, consent by a medical facility to procure an abortion to an underage teenager at later stages of pregnancy and the role of the parents in the matter. The parents and the clinic committed a grievous transgression. The parents being the legal guardians of Jane, they should have suggested morally acceptable methods to solve the issue of the pregnancy such as giving up the child for adoption or simply taking the child to an orphanage. Suggesting abortion, especially at the latter stages of the pregnancy was inhuman from an ethical standpoint (Harris, 2001).
Philosophically, the act of abortion is only permissible in the case of rape or cases where cautionary measures were taken to avoid the pregnancy, this is a liberal view held by philosophers such as Judith Thomson. Another liberal view by Thomas, he views abortion as a morally condemnable practice. With or without consent, a woman should not kill a growing fetus. In support of this view is the conservative philosophical view by John Noonan. He states that the life of a person begins at conception, hence a fetus has a serious right to life and the termination of the fetus is allowed when the life of the mother is at stake. To further elaborate on the gravity of abortion is the moderate stance taken by Jane English. In her view, during the early months of pregnancy, abortion can occur depending on the consent of the woman in question or her family. However, abortion is not allowed in the second and third trimester as the fetus takes the resemblance of a person, the only exception allowed is when the life of the pregnant woman is endangered by the continuity of the pregnancy. The opinions forwarded by these philosophers negate the act of abortion. It was morally wrong for Jane to consent to abortion and for her parents to demand her to procure it considering there was no potential risk to her health.
Medical Malpractices
Medical malpractice is the neglect exhibited by a medical practitioner when the medical treatment prescribed for the patient results to physical harm or death. These treatments are usually not up to the standards set for the medical practice. In Jane Smith’s story, a medical malpractice is committed by the doctor who attends to her after she is involved in a fatal car accident. On reaching the hospital, she was diagnosed with a potentially life threatening injury. Dr. William Gross approached her after which she informed him of her plans of terminating the pregnancy. She implored the doctor to do everything in his power to save her life without considering the risk of the unborn child dying during the process. The doctor was conflicted and disgusted by her stance regarding the child’s life and he decided to save the child instead, this resulted to the Jane’s demise.
Ethically, the decision made by the doctor to save the child expense of the mother’s life was a grave mistake. The medical ethics states the ‘abortion’ is permissible in cases where the life of the pregnant woman is at peril (Harris, 2001). The doctor should have saved Jane’s life instead. His decision was in breach to the medical ethics. Another medical malpractice committed that goes against the medical ethics is the doctor negligence to the life threatening condition the Jane was incurred in the accident. The doctor was expected to make immediate decisions that were aimed at saving both the child and the mother, and if that were not possible, the mother’s life would have been saved. In the scenario of conflict in deciding on whom to save, another doctor with a different opinion would have taken up the task.
The doctor went against the rights of autonomy that recognizes the patient’s right to make sound decisions in life and death situations. Jane had decided her life was paramount than that of her child seeing that she had a life threatening injury, thus her decision should have been respected. He also breached the ethic of non-maleficence that state the health care provider should do no harm to the patient but instead offer treatments that are likely to benefit the patient (Oakley, 2009). He put Jane under a local anesthesia instead of conducting medical procedures that would save her life. He harmed her in the worst possible way, which goes against every moral ethic and principles of health care.
Organ donation
After intentionally failing to save Jane’s life, Doctor Gross decided to salvage organs from Jane’s body to allow others to benefit from them. He called up a black market organ dealer with whom he negotiated a fair price for the organs. The donated heart benefited a five-year-old girl called Ava who was suffering from congenital heart abnormalities and extends her life. Analysis of this extract shows that, regardless of his well-intended motives, his actions were morally and legally unacceptable. He was in violation of several medical ethics.
He violated the rights of consent in the donation of the organs. The approval of organ donation should have been allowed by Jane’s father who the only surviving parent which reflects on autonomy, the liberty to make sound decision as regards to donating organs. The doctor failed to follow the procedure required in organ donation, which is carried out by the medical facility. The organ donation follows criteria in selecting eligible patients requiring the organ transplants (Oakley, 2009). This system ensures organs are distributed fairly and adequately to the patients enlisted in need of organs. He participated in an illegal crime that is organ trafficking, which is illegalized in the Rhode Island State.
Neonatal Euthanasia
The issue of child euthanasia arises when Jane’s father implores the doctor to take baby Julia feeding tubes off which would result to her death. The doctors refuse yet they have made prior observations that the child was severely premature and had a 20% probability of surviving and being allowed to survive would develop severe mental defects and lifelong disabilities to the child. She was also in constant pain and required constant treatment. Ethically, the request to remove the infant from the feeding tube was right.
The issue of euthanasia has been a dilemma with most bioethicists terming as “ethically moral” in cases which are similar to baby Julia. In support of the idea, neonatal euthanasia supports the basic moral principles of medicine such as beneficence (Oakley, 2009). It describes the moral obligation to perform medical duties that are beneficial to another person. The act of withdrawing feeding tubes and letting the infant die, would have abated the pain and suffering baby Julia was gong through thus euthanasia was beneficial to her. Another moral aspect that supports the moral stance of neonatal euthanasia is non-maleficence. This suggests that a morally correct act is that which does not cause harm (Oakley, 2009). Prolonging the life of baby Julia would be an act of prolonging suffering that would cause her harm than it did good. The mental defects and life long disabilities would be a source of suffering to her life and that of her caregiver. Neonatal euthanasia offered a chance for her to forgo the suffering that was so eminent if she survived.
Legally,
neonatal euthanasia is considered legal in secluded cases. An amendment made by
the health and human services department under the child abuse prevention and
treatment act was in support euthanasia. It stated that in cases where the
infant was in a chronic state of coma, where rendered treatment: prolonged the
dying process and would not be effective in solving the defects the child had,
the euthanasia was permissible. Treatment rendered to the infant was unable to
cure her mental defects and abnormalities therefore the request to have baby Julia’s
feeding tubes removed was both morally and legal acceptable. The refusal by the
doctors who were attending to the infant was unethical as the consent of the
guardian, who at that particular moment was Jane’s father, would have warranted
them to perform euthanasia.
References
Harris, J. (2001). Bioethics. New York: Oxford University Press.
Oakley, J. (2009). Bioethics. Farnham, England: Ashgate