Running head: Ethics in Healthcare 1

Ethical Dilemma

David Proctor

Grand Canyon University

HLT520

Module 1 Assignment

August 24, 2010

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Ethical Dilemma

Consider the following scenario: A 96-year-old male patient

is admitted to the ICU with terminal liver cancer. He is

confused and disoriented, very skinny and appears underfed, and

is covered with bruises, which are common in patients with liver

disorders. His daughter, who is a naturopathic physician,

insists that she can cure her father by administering unknown

substances, some of which smell like feces and look like tar,

down his feeding tube. He is clearly in pain after she does

this. She insists that these are life-saving interventions on

her part, but the nursing and physician staff caring for the

patient are very upset and concerned that she is hastening his

death.

Objective analysis is paramount to understanding an

ethical dilemma. The facts of this scenario are several. The

first is the patient that is 96 years old. We are told that he

has liver cancer. There is no mention of any others diseases or

complications; however, given the patient’s age, there are

probably other health issues. It is not clear how advanced his

disease is or how long he has been diagnosed with the disease.

According to the National Cancer Institute, typical symptoms of

liver cancer are, pain in the upper abdomen on the right side, a
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lump or a feeling of heaviness in the upper abdomen, a swollen

abdomen, loss of appetite and feelings of fullness, weight loss,

weakness or feeling very tired, nausea and vomiting, yellow skin

and eyes, and fever (National Cancer Institute, 2009). These

symptoms somewhat mirror those listed in the scenario with the

exception of being confused and disoriented and the presentation

of bruises. The fact that the National Cancer Institute does not

list bruises as a symptom does not preclude the fact bruises may

be a symptom of liver cancer. The note that the patient was

confused and disoriented could be symptoms of dementia,

Alzheimer’s, or some other mental disorder. It is interesting

that chemical poisoning also presents with some of the same

symptoms as liver cancer along with the confusion and

disorientation (Wrong Diagnosis, 2010). From the description in

the scenario, it is not clear who brought the patient into the

hospital.

The second person of interest in the scenario is the

daughter of the patient. We are told that she is a naturopathic

physician. Naturopathic physicians are trained at any number of

schools throughout the world and practice naturopathy which is a

traditional approach to health that is holistic, meaning that it

encompasses the whole being (Association of Accredited

Naturopathic Medical Colleges, 2010). The daughter is insisting

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that she can cure her father by some smelly tarry substance.

This implies several things; first that she has been

administering the treatment for some time and that possibly she

was not the one that brought her father to the hospital. Because

chemical poisoning symptoms are so closely related to that of

the symptoms of liver cancer, some of the daughter’s treatments

could be masking the liver cancer symptoms causing problems of

correct diagnosis and treatment.

The daughter’s treatment is being given through the

father’s feeding tube. The scenario states that the patient is

in pain after the substance is given. The fact that the patient

is in pain after the daughter’s treatments could mean one of

three things, first, that the substance is reacting with some

other treatment that the patient receiving for the liver cancer;

second, that the daughter’s treatment is actually poisoning her

father, or three that because the liver is not functioning to

full capacity, toxins are building up in the father’s system and

the daughter’s treatment is somehow reacting to or adding to the

toxins already present. Of course, it could be a combination of

the three or none of the three.

Finally, the scenario makes it clear that the attending

doctors and nurses are upset and concerned that the daughter

might be hastening the death of her father. Even though the

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scenario states that the daughter is a naturopathic physician,

it not clear how or if she is licensed to practice or if she can

practice legally in the hospital where her father was admitted.

With these facts in hand, then it is possible to apply the

four aspects of ethical decisions along with the four ethical

principles (Pozgar, 2007). The four aspects of ethical decisions

are welfare, interests, moral status, and social mores; whereas,

the four ethical principles are, autonomy, beneficence, non-

malfeasance, and justice.

Autonomy refers to the patient’s right to make their own

decisions and informed choices about the care they want or are

to receive (ibid). In this case, autonomy could be compromised

because the patient has been described as being incoherent. The

patient may not be able to make proper decisions nor may he even

understand what is wrong or what could be done to make him

better. In making an ethical decision, the aspect of interest

comes to play. As the patient may not be able to make his own

decisions, whom can best make the decisions for the patient –

the doctors or the daughter?

Regarding principle of beneficence requires that all

actions taken on behalf of the patient be done so to provide the

best possible outcome (ibid). The daughter obviously feels that

it in the best welfare of her father to receive the treatment

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that she has prescribed. The doctors feel their treatment is the

best. From description in the scenario, it is not clear how long

the patient has been treated by doctors or by his daughter. It

is clear however that the daughter’s treatment is causing her

father’s condition to worsen. Her treatment does not seem to be

in the best interest of her father and she should be made to

realize this. What is not clear as to why the doctors are

allowing the daughter to practice as a physician. The doctors

may be at fault here by allowing a person who is not licensed to

practice medicine either in the hospital or in the state in

which they are located.

Non-malfeasance is the aspect associated with do not harm

(ibid). Clearly, from the scenario, both healing parties are

inflicting harm on the patient. First, the daughter’s treatment

is causing her father’s well being to be compromised. The

evidence of this is how her father’s condition is after the

treatment. Second, the doctors and nurses are not doing what

they should be doing to inflict no harm by essentially doing

nothing and allowing the daughter to treat her father with some

questionable medicine. Doctors, in this case, should by whatever

means available to them to ensure that no harm comes to the

patient including legal proceedings such as a court injunction

against the daughter.

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Justice is the ethical aspect that focuses on the finite

resources of health care (ibid). This can be explained by the

fact that there are only so many hospital beds, doctors, nurses,

and to some degree medicine. The question asked if the person

that is in question is taking up a resource that another person

would benefit. In the case presented in the scenario, the

justice aspect does not seem to apply. The patient is obviously

in need of intensive care and from a triage point of view

probably is just as deserving as anyone else. The fact that the

patient is 96 years old should not necessarily enter into the

ethical equation at this time as he should first be made

comfortable and his health stabilized as much as possible before

a decision can be made for other accommodations such as hospice.

A solution in this case is not a difficult one based upon

the use of ethical decision making. The doctors or hospital

staff should take the situation in hand and stop the daughter

from administering the questionable substance. The father

deserves the right to be treated in a manner that does not cause

further harm to him. In addition, his symptoms might stabilize

such that he would become coherent and be able to decide for

himself the treatment that would be best for his health. If, for

some reason, the father does not regain his mental facilities,

then someone other than his daughter should make decisions

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related to his health.

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References

Association of Accredited Naturopathic Medical Colleges. (2010).

About the AANMC. Retrieved from http://www.aanmc.org/about-
aanmc.php

Pozgar, G. C. (2007). Legal aspects of health care

administration, 10th ed. Sudbury, MA USA: Jones and
Bartlett Publishers, Inc.

National Cancer Institute. (2009). Liver Cancer Symptoms.

Retrieved from
http://www.cancer.gov/cancertopics/wyntk/liver/page5

Wrong Diagnosis. (2010, August). Chemical Poisoning. Retrieved

from http://www.wrongdiagnosis.com/c/chemical_poisoning/
intro.htm