Bryce Paulson Phil 383 10/30/2013 1) We are faced with 2 separate cases, involving a patient and a parent choosing

on ehalf of her child, to refuse further life sustaining treat!ent" #his treat!ent if allowed has the high pro a ility of sustaining the patient$s and the child$s life" #he first case % will address is the case of 21 year old, &oosevelt 'awson" (r" 'awson previously contracted a viral infection that has lead to hi! eco!ing a )uadriplegic, dependent on reathing assistance" *e has een in this state for the past 13 !onths and is now re)uesting to e re!oved fro! reathing assistance and released fro! the hospital" #he second case we are dealing with is a new orn a y of a !other with *"%"+" 'ue to a side effect caused y the !other eing treated with #halido!ide, the a y has een orn with no ar!s or legs" -lso the a y is una le to receive nourish!ent orally due to ano!alies of the !outh and throat" .urgical treat!ent can correct these issues, however the !other has refused per!ission to operate" -s you are aware, in the past at (etropolitan *ospital, the hospital oard has honored the whishes of patients and parents that have re)uested we refrain fro! providing reathing assistance and/or nourish!ent" #hese two cases have

raised disagree!ents etween doctors and patients, leading to the pursuit of legal action" Both of these cases ring up the issue of patient autono!y" But are oth contrasted with the doctor$s oath of non !aleficence" %n each case the patient life can e saved or at !ini!u! prolonged y !edical treat!ent" By not forgoing treat!ent the a y will inevita ly die" Because the a y is una le to choose for herself this is an act of non/voluntary/passive euthanasia" #i!e constraints also e0acer ate this issue" %f we do don$t pursue swift legal action the a y will die" (r" &oosevelt will not e a le to survive without reathing assistance" *is social wor1er and physician$s fear that he re)uesting to e released in an atte!pt to end his own life" 'ue to his young age and de ilitated state we fear that his co!petence !ay have een co!pro!ised" *is values !ay e altered leading hi! to no longer e a le to properly choose for hi!self" #he !other$s co!petence !ay e altered ecause of her fear that her own disease will not allow her to e a good parent" *owever we !ust consider the patients 2 a y) est interests in this case" While we !ust respect the autono!y of the patients, the staff feels that in oth of these cases the decisions to refuse treat!ent are eing !ade in haste and not in the patient$s est interests" 3ach patient !ay e a le to have a !uch !ore fulfilling life than currently elieved or 1nown y the decision !a1er" 2) %n the case of (r" &oosevelt, % would reco!!end that the staff adopt the %nterpretive (odel of doctor/patient relationship" #he %nterpretive !odel is ased

off the %nfor!ative !odel" #he %nfor!ative (odel provides the patient with all relevant infor!ation related to their !edical situation" #he doctor does not contri ute or influence the patient with any of his or her own personal values" What the %nterpretive (odel adds is the assu!ption that the patient does not always have a clear sense of what their values are" (r" &oosevelt !ay feel that it is in his est interests to end his life at this point" But this !ay e a hasty decision caused y depression and a fear that he will have no type of !eaningful life" *is age also is a factor in his choice !a1ing" *e is at what !ost people his age elieve to e the pri!e of their life and !ay have felt invinci le prior to this viral infection" #he interpretive !odel allows the to doctor help (r" &oosevelt reconstruct his actual goals, aspirations, co!!it!ents and character, shedding light onto so!e false assu!ptions he !ay have a out his current situation or future" #his !ay or !ay not lead to different values" 4nce these values are actuali5ed, the doctor then suggests !edical courses of action that will wor1 est to achieve these" -ssu!ing that the patient is co!petent, the patient is in charge of all decision/!a1ing in this !odel, the doctor only is a resource for infor!ation and a guide to etter self/understanding" %n the case of the a y girl % would reco!!end that the staff adopt the 'eli erative (odel of doctor/patient relationship" #he 'eli erative !odel assists the patient 2!other in this case) deter!ine the est heath related values" #hese values only pertain to the different options of treat!ent for the a y" #hey do not e0tend to anything outside of the health related world" 6onsidering only what the est values are for the current !edical dile!!a" #he !other !ay e falsely

assu!ing that the a ies condition will lead to nothing good and that pursuing the surgery will only prolong the a y$s inevita le suffering and lac1 of an en7oya le life" #he doctor$s role is of a teacher or a friend that only wants the est for the patient" #hey !ay reco!!end what they would do in a given situation and the reasons for it, ut it is not in an authoritative or de!anding !anner" %t is only a concerned suggestion, of what action to ta1e" #he decision of what to do is still all the patients through a process of !oral self/develop!ent" 3a) #o answer your )uestion regarding (oral -utono!y % will address each case separately" %n the case of (r" &oosevelt, we have good reason to elieve that he wishes to end his life" #he conse)uences of this decision cannot e retracted or addressed after the fact due to hi! ceasing to live" %f it were a case of a patient refusing to have a ro1en finger reset, we would infor! the patient as to the ris1s of this decision and the enefits of !edical treat!ent using the %nterpretive (odel, ut allow the! autono!y without intervention" *owever this is one of the !ost i!portant decisions a person can ever !a1e" We !ust e sure he is fully co!petent and is fully aware of all options and their outco!es" #o assess co!petence, the patient needs the capacity for co!!unication and understanding, the capacity for reasoning and deli eration and a set of values or conception of the good" We also need to refrain fro! su consciously i!parting our own values onto hi!, wrongly la eling hi! as inco!petent, si!ply ecause he wishes to end his own life"

#he autono!y of the a y girl is 7ust as difficult to discern" Because the a y is non/co!petent, at this current stage, the decisions fall upon the !other" *owever there is the possi ility that the !other is not co!petent herself" % feel that the !other is concerned with her a ility to ta1e care of the child due to her condition" -lso there is the ris1 the a y was orn with *"%"+" #hese concerns !ight nullify any suggestions/infor!ation that the staff has provided to the !other, no !atter the !erit" #he standard for continuation of treat!ent of a ies against their parents wishes rests upon deter!ining if the child can grow up to have a !eaningful or sy! olic relationship" %t is assu!ed that if this is possi le it is in the patient$s est interest to pursue treat!ent" #he !others refusal of treat!ent leads !e to elieve that she does not thin1 that her a y is possi le of having a !eaningful or sy! olic relationship and that she has the est interests in !ind for her a y" With the use of the 'eli erative !odel we help the !other understand her options and their outco!es" 3 ) -pplying the principle of utility to the case of (r" &oosevelt leads to a dar1 conclusion" We would have to assu!e that his continuation of life and any good rought a out fro! it would e astrono!ically overweighed y the, e!otional, financial and ti!e urdens that he would cause hi!self and his fa!ily" -llowing hi! to die is the etter option under the principle of utility" We could harvest his organs in order to save others, sell his car to support his fa!ily left ehind and reuse his clothes and elonging$s for his si lings"

%n the case of the a y girl, the principle of utility also does lead to a hopeful conclusion" 8nowing that she will never e a le to ta1e care of her self, she will e forever dependent on others for every aspect of her life" *er !other is diagnosed with *"%"+" !eaning that her life e0pectancy will e drastically shorter than nor!al !others" #his will urden whoever is left to ta1e care of the child" %t would est to opt for no surgery" #his will save the hospital and health care industry !oney and ti!e, allowing the! to focus their ti!e and energy on !ore i!portant cases" #he !other will feel guilt to so!e e0tent for not allowing her daughter to survive, ut % elieve that she would feel even !ore guilt 1nowing that due to her having *"%"+" and needing to e treated with #halido!ide lead to the current issues plaguing her daughter" .he would have to deal with ta1ing care of her daughter everyday, constantly re!inding her of the cause of her state" %f the daughter is *"%"+" negative her organs could e donated to other children in need, possi ly saving !ultiple lives, leading to !uch !ore happiness overall" 3c) - co!!unitarian is only concerned with values and choices that are est for the co!!unity as a whole" %n the case of (r" &oosevelt % elieve that under the definition of co!!unitarianis!, it would e est if we were to allow )uadriplegics to ta1e their own lives" While the universal approval of suicide would not e advocated y co!!unitarianis!, a case such as this is !uch !ore li1ely to e est for the whole co!!unity" %n the case of the a y co!!unitarianis!, would approve of the !others decision to not opt for surgery" #his is ecause, the co!!unity would enefit, fro! !others eing a le to choose for their a ies"

#he !others are going to e the ones ta1ing care of and providing for their children" %f they were forced to allow !edical intervention, in cases such as this, they !ight resent the !edical co!!unity and possi ly eco!e urdened, in so!e cases passing the urden onto the co!!unity" 3d) #he hospitals responsi ility to vulnera le populations, is a factor in these cases" (r" &oosevelt is a 9ow/inco!e -frican -!erican with a disa ility" We !ust not forget the tragedy of the #us1egee syphilis e0peri!ent" #his :e0peri!ent; wrongly too1 the lives of an esti!ated 28 to 100 low inco!e lac1 !ales, y allowing the! to go untreated, in order to study the de ilitation effects of syphilis" We !ust e sure that we do not treat low inco!e -frican -!ericans any different than our other patients, assuring that this type of unnecessary death never occurs again" #he a y is not co!petent and disa led" We !ust re!e! er the countless 1illings of disa led people in <a5i =er!any" -lso the case of, The Long Dying of Baby Andrew, co!es to !ind" Both of these cases !ust e 1ept in !ind to disallow any si!ilar !isdeeds eing done to the patient" %n oth of these cases we !ust ensure that our decisions are not iased or affected y these factors, especially race in (r" &oosevelt$s case" *owever as we have seen the doctors are going a ove and eyond in these cases to save the live of each of these patients" But if they were to act differently in these or other cases ecause of these factors then they would e in the wrong" 'isa ility is difficult factor to account for" We !ust not assu!e that since so!eone is or will eco!e disa led that they are not worth treating, there are countless cases of people rising a ove their disa ilities to lead a happy and productive life" %t is up to

the patient to decide for the!selves, ut we !ust infor! the! a out the possi le positive outloo1s in their otherwise lea1 outloo1" #reat!ent does not and will no depend on a person$s race or any type of disa ility" 3very patient !ust e treated e)uita ly here at (etropolitan *ospital"

>) %n the case of (r" &oosevelt we should use the %nterpretive (odel to assess and ring to light his values" *e is a young that !an that has his would turned upside down in the !atter of a year" *e is !ost li1ely depressed and this is causing his outloo1 to e gri!" *is financial situation is also a real factor that !ay lead hi! to see no possi le right future" 4nly seeing hi!self as a urden and una le to provide for his already struggling fa!ily" % however feel that he is co!petent and would li1e a reevaluation of his !ental state y assessing if he has the capacity for co!!unication and understanding, the capacity for reasoning and deli eration and a set of values or conception of the good" %f he is found to e co!petent, % advise that we allow hi! to e discharged" We !ust re!e! er that it is his life and his choice as to what he wants to do" By prolonging his life we !ay only e causing hi! !ore har!" %n the case of the young a y % would reco!!end that the staff adopts the 'eli erative (odel in order to help the !other deter!ine the est health related values for her a y" We !ust !a1e sure that her !other is aware of the !any cases of others with her sa!e condition that have gone on to lead happy and productive lives" *er case is very difficult due to the !other$s condition as well as the a ies" *er !other is going to e the one ta1ing care of the child and has to

are the financial and parental urdens of having a child with no ar!s or legs" We could possi ly reco!!end adoption, ut % would insist on researching the adoption rates of disa led a ies eforehand" % elieve that the !other should e a le to choose for her daughter in this case, despite the sadness of the case we !ust not i!pose our own values onto patients"