- /Ethics Report
Members of the board, our hospital currently finds itself in between two cases that asks ourselves about our role, not in the preservation of life but the termination of it. In one case, we have a young man named Roosevelt Dawson (21) who was introduced to our facilities with a condition that has permanently damaged his spine which ultimately has taken everyday important functions such as eating, moving, and breathing away from his life. Without assistive machinery, he will inevitably face death. As a caring institution, we have informed the patient and their family’s options of living with a skilled health care worker or living in a skilled care facility year round. Although we have taken every measure to satisfy the patient, he has requested for the hospital to release him, contrary to our social worker’s advice. Our social workers along with a couple of Dawson’s physicians have reason to believe he will seek assisted suicide once outside hospital boundaries. Our role as a hospital is to better our patients but this particular patient may not want to better himself.
In the second case, we have HIV positive mother who took Thalidomide medicine during her pregnancy. Her new born 10 hour old baby has had complications, leaving the individual to be born without limbs and anomalies in the mouth/throat which can be surgically corrected. In the wake of the health issues, the mother has decided to decline a relatively successful surgery which will better the Esophageal Atresia condition of the baby. The neonatal unit has urged the hospital administrator to seek for a court order demanding a surgery for the child but this option will be disregarding the decision of the mother which is unwilling to care for the baby thus creating our dilemma as a well established hospital.
Both given cases have created a predicament between ourselves and the ethical answer, even though they are different in many ways. The first case regarding the life of Roosevelt Dawson is about a 21 year old adult deciding for himself meanwhile the second case is whether to let a mother decide the fate of her own child. We take the concept of autonomy very serious which is why we encourage our patients to take control/ decision of their life but when that decision may be affected by a traumatic experience, we urge our patients to consider waiting and honing in on their best decision. In one case, a young male fails to show signs of autonomy while the other consists of the baby not having autonomy because of its age. Even though lack of autonomy is expressed in both patients, traumatic experiences affecting present emotions may play a role in their decision making that is why we can not trust the decisions of both Roosevelt Dawson and the mother of the recently born baby. Given the tough circumstances our patients are facing, we assure them we are doing our best to better their situation.
In this hospital we strive for a speedy and healthy recovery for all of our patients but this is never assured. Many situations are not just solved by a organized format where it is simple as 1, 2, and 3. Each and every one of our patients are respectfully different in their own nature. For this, we examine each and every Doctor-Patient relationship model in order to insist we are making the right medical decisions for us and the patients. In the case of Roosevelt Dawson, time plays an enormous role. Although he has been hospitalized for his condition for some time now (approximately 13 months), staff members still believe more time is needed. A paternalistic approach is not a common approach we take here but is encouraged by staff in this case. Due to the patient’s traumatic experience, staff has acknowledged his depressive state and has taken precautions. That is why we can not push for any other Doctor Patient models that give the patient power/autonomy. A paternalistic approach is best suited for this case because the social workers and physicians advise it. Given time, Dawson may hopefully be alleviated from his mental/emotional trauma thus giving him a clear mind to make decisions for tomorrow rather than today. Theoretically, If he is released today he will more than likely seek assisted suicide. Many can argue the case that we are stopping him of making his own decision by force but it will be giving him more time to think about his decision. We will release him from the hospital inevitably.
The second case regarding the HIV positive mother and her child is also a great ethical dilemma. Since the Esophageal Atresia surgery we offer is very effective, the baby will have a better form of life. Being that the child is only 10 hours old, the mother may still be traumatized by her situation thus making her act quickly and unwisely. That is why we must disregard her decision to not give the baby the surgery. She and others may argue that we will leave her with a baby that she may not be able to care of one day because of financial, mental, or physical conditions but we are seeking a court order for the surgery simply because of the law regarding this situation. Since its enactment in 1984, the baby doe law ensures children can not have treatment withheld unless they are permanently comatose or their chances of survival are slim to none. Any other arguments to withhold a child’s treatment is meaningless. In this case, we are obligated to rely on a paternalistic approach because of the laws set forth. This will ensure the best case scenario.
In many hospital cases, it is likely that patients who receive autonomy are likely given it because they have capacity. Knowing whether a patient can understand, analyze and react properly can determine whether if they are morally autonomous. In order to have capacity one must accurately communicate/understand, express thoughts through conversation and convey a sense of improvement. Once all have been proven, one may be granted moral autonomy by the hospital. This is the sole reason why we are here today. In our case regarding Roosevelt Dawson, we can almost all agree the individual can not be granted autonomy. His lack of communication caused by paralysis deter us fully from giving him autonomy because this contributes to not knowing his reason and ideas for good in our interpretations. Thus, we must take initiative for this patient and seek a court order to help him have time to think of irreversible decisions he may take.
To evaluate if the baby’s mother can be given autonomy , we must check if she has capacity. Although the mother can do most thing required to receive autonomy, she has failed to convey she has an idea for good in both interpretations. Regardless if we gave her autonomy or not, her only option may be to give the baby the surgery to improve the child’s Esophageal Atresia. Since the only argument possibly set forth to not give the surgery and let the baby die is the fact that he suffers from no limbs(poor quality of life), it is insufficient reasoning to stop the federally mandated surgery.
In the case of Roosevelt Dawson, choosing a decision between life or death can not only affect himself but those who are around him. Finding a moral answer to this dilemma can be difficult especially in the case of people who believe in Utilitarianism. Searching happiness for many others instead of ourselves is a utilitarianism approach we may be encountering.By stopping him from leaving, we find happiness in us and those around him although he will be sacrificing his own. Dawson can either leave the hospital and look for assisted suicide for his own “happiness” or he can stay and bring us all to peace. Whatever decision is taken, it will not be a solution for everyone.
When introduced to the case of the unnamed baby being born with no limbs and anomalies of the mouth/throat, we decided to take all options/thoughts into consideration from each party in this situation. First, the mother did not want to exercise the option of giving the baby a surgery which will her with eating food. In addition, she did not want to keep the baby alive. The second party in the situation may be considered the baby itself but since it’s not eighteen years of age, she can’t represent herself. The last party of the situation is the Hospital board (us). If we were to allow her to reject the baby’s surgery and let her suffer an avoidable death, that would only bring her (mother) happiness. If we perform the surgery and help the baby through these obstacles, that would bring the board happiness and essentially happiness to the future of the baby. The option the mother wants to exercise may be seen as selfish because she is only thinking for herself. A utilitarian fights for the happiness of the majority.
In these two case studies, we are dealing with two people who are considered to be part of the vulnerable population. Knowing this, the hospital must react accordingly and approach the individuals as any others or even better in order to have health equity regardless of their socioeconomic standings. Our obligations are higher than normal in cases such as these. Being members of the vulnerable populations, the health disparities encountered through the medical field may be evident today as they were in the 80’s. Attention should be focused towards what’s needed and not what’s wanted. The difference made by being in a vulnerable populations is that those in the population receive worst quality of care although they are exposed to more overall cumulative risks. Having great health literacy will raise communications between patients and staff members for the better.
Roosevelt Dawson has spent much of his days simply at the hospital. He is not in any immediate danger and has not been in a while. His desire to live is not evident and has given us suspicion he will seek assisted suicide. I don’t believe anyone would like to spend most of their life in a hospital unless they had to. Even then, a hospital is not a place illuminated by life. Dawson seems to be exhausted of the life he is living now and if we hold him, his reason to live won’t suddenly come to life. When discussing the will to live in her son, Brenda Dawson said “He gave me the keys to his Neon…. He kept those keys all that time”. Dawson has spent the past year in hospital care with enough time to seriously think about the decision he desires to take. When describing the case of Schloendorff v. Society of New York Hospital (1914), Justice Cardozo said “Every adult human being of adult years and sound mind has a right to determine what shall be done with his own body”. If Dawson genuinely and continuously seeks to be let out of the hospital, we should respect his decision.
A person has so much to live for when given the opportunities. Cancelling treatment on this particular baby will stop just that. Maybe the mother does not have the financial stability to care for the child or she may not have the desire. Whatever the case may be, medical advancements have lead us to incredible successful Esophageal atresia surgeries. Performing this surgery will improve the future of the child. Although the mother is the one who birthed a child with no limbs, she is not responsible for the future of the baby. The child is neither brain dead or suffering from an chronic heart condition which is one of the conditions of the baby doe law. The baby doe law enacted decades ago clearly states that she can not discontinue the life of a newborn just because its quality of life is hindered. Our reasoning comes more from a legal standpoint than a moral one. As a hospital, we will have to exercise the only option we are given. We will have to keep the child alive without her blessings.
I’m a freelance writer with a bachelor’s degree in Journalism from Boston University. My work has been featured in publications like the L.A. Times, U.S. News and World Report, Farther Finance, Teen Vogue, Grammarly, The Startup, Mashable, Insider, Forbes, Writer (formerly Qordoba), MarketWatch, CNBC, and USA Today, among others.