Wednesday, April 15, 2020

Midterm paper free essay sample

When considering the moral issues of both cases of Roosevelt Dawson and the ten hour old baby, there are a few concerns that should be reflected upon. In Dawson’s case, he has lived for twenty-one years and the use of his limbs has been dramatically taken from him. His quality of life can be seen as a moral issue because he would have to relearn how to function without limbs. This could take place outside of the hospital setting and in an assisted living home, which would more than likely be frustrating. He would have to endure the stares and the stories of his paralyzed limbs. The moral issue of discharging Dawson from the hospital should be considered because he is suspected of leaving and committing assisted suicide due to his quadriplegic condition. In the case of the baby, the moral issue is also of quality of life. The mother has decided to not have the surgery performed and have nutrients taken away from her child. We will write a custom essay sample on Midterm paper or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page The baby has lived for less than ten hours and obviously cannot yet make a decision for herself. If the surgery was to be performed and the baby fully recovered, the quality of life would still come into play. Because she does not know how it is to live with working limbs, she would be able to cope and learn how to function better than in Dawson’s case. Although she would be would most likely cope better without limbs, the question arises of ‘what would she be able to do on her own? ’ She would need someone to be with her at all times: to feed her, bath her, go to the restroom with her, dress her, and all other everyday tasks. Thus, the quality of life in this child should be considered when deciding if she should have the surgery to remove the anomalies or not. Previously, the Metropolitan Hospital board had agreed to refrain from providing breathing assistance and/or nourishment for people who have so stated their wishes. Thus, in this case of Roosevelt Dawson, he has previously met with both his mother and his social worker discussing his choices as to what his options were after he is discharged from the hospital. This can create a legal issue due to the fact that Dawson was originally going to be able to be discharged from the Metropolitan Hospital. If the Metropolitan Hospital were to refrain from discharging Dawson, then that could cause some disagreements with Dawson’s wishes and the wants of his social worker and his physicians. Dawson has also been found completely competent, which can provide stability to his life after his current stay at the hospital and thus strengthen his case to leave. Regarding the case of the baby girl, it has been stated, in our text, that contemporary ethical and legal norms hold that all human beings born alive should be treated equally, regardless of disability. This can call for a legal case because if this baby girl were to have been born with legs and arms, would the mother still not want surgery performed? And if she did not wish to have surgery, then that would call into her competence and if she were able to make a proper decision about the situation? If all human beings born alive should be treated equally, then why does the mother not want to have surgery performed on her baby girl? Thus, because the mother is not treating her child as if she were a baby without a disability, the hospital can be accused of following through with the wishes of an incompetent woman. According to the Child Abuse Amendments (CAA) of 1984, which ended the political controversy over the federal role in decisions to withhold treatment from handicapped newborns, legal issues could arise from the hospital not treating the baby. This amendment strongly protects the rights and interests of those with disabilities and leaves little room for non-treatment decisions to be based on expected low quality of life or the interests of parents. All children, whatever the extent of their disabilities, are to be granted medical treatment unless they met the narrowly defined exceptions. Also, in our text, at the very least, CAA could be perceived as setting the standard of care to which hospitals and doctors would be held, both by accrediting bodies and by courts hearing challenges to nontreatment decisions. The baby girl case has similarities with the case of Miller v.  HCA, in our text. In this Texas Supreme Court decision, while recognizing that parents ordinarily have the right to consent to or to refuse medical care for their children, the court also recognized that an exception to the parental consent requirement arises when an emergent condition exists and treatment must occur immediately to prevent the death of the child. Although, in Miller v. HCA, the court found that the doctor’s initial resuscitation in Miller was justified because the situation was an emergency and there was not enough time necessary to get consent form the parents or from a court. The court only found the doctor’s actions rationalized because the doctor did not have enough time to consult with the parents before making the life or death decision. In this case, the physician has time to get consent from the mother, which could then be argued, that if the neonatal team would have been taking action without the mother’s consent, and would not be justified. The two cases of Roosevelt Dawson and the baby girl have a several significant similar qualities to them: loss of limbs, the quality of their lives would be questionable, and both Dawson and the baby have other parties trying to make a life or death decision for them. In terms of quality of life, Dawson is a recent quadriplegic patient and the baby girl has been born without limbs. When calling into account the quality of their lives without limbs, should the baby have surgery and Dawson leave the hospital, could be considered of extremely difficult quality of life. Finally, Dawson’s social worker is pushing a court order for Dawson to stay in the hospital and not be discharged, while the baby’s neonatal staff is pushing a court order to disregard the mother’s decision on not having the baby undergo surgery and removing the nutrients currently being given. Although there are some similarities surrounding the cases of Dawson and the baby, there are positively some differences that cannot go unmentioned. Firstly in the case of Roosevelt Dawson, he is a twenty-one year old completely competent male, wishing to leave the hospital. But, according to his social worker, he is has the intentions of assisted suicide. In the case of the baby, she is a less than ten hour old female. She cannot take nourishment orally because she has anomalies of the mouth and throat, which can be surgically removed. Her mother is refusing to give the neonatal staff permission for surgery and has asked the hospital not to nourish her baby girl. Because the baby cannot make a decision for herself, her mother is her making judgments for her. Thus, there are some similarities of the two cases, but there are specific differences between them, how they should be handled, and how their physicians should interact with both them and their families. In order to relate to the patients in these cases, there are four types of physician-patient relationship models that should be considered. The first type of relationship representation is the paternalistic model. According to our text, this model ensures that the patients receive the interventions that best promote their health and well being. In other words, the physician is acting as a guardian to the patient strongly suggesting or telling the patient what the best option for him or her would be in that particular scenario. The second type of relationship model is called the informative model. Here, the objective of the physician-patient interaction is for the physician to provide the patient with all relevant information, and the patient selects the option they want, and the physician follows through with their wishes. A fairly to-the-point model: provide the information, make a decision, act accordingly. The third model is the interpretive model. The aim for this model is to illuminate the patient’s values and what he or she actually wants, and to help the patient select the available medical interventions that realize their values. This model is more interpretive, the physician tries to assess the patient’s core values and help them make a decision after considering them. Lastly, is the deliberative model with the goal of this model is to help the patient determine and choose the best health-related values that can be realized in the clinical setting. In this model, the physician would suggest the best option for the patient’s health, not considering any moral values, but only those that would be best clinical wise. Considering all the types of physician-patient relationships explained in the previous paragraph, the best relationship that should be established in the case of Roosevelt Dawson should be the interpretive model. This model would best fit Dawson’s case because he needs to know what he values. Because what he values (could be his life, family, friends, functioning limbs) could have him change his mind in wanting to be discharged. Because what would be best for his health and therefore his values, could be to have him stay in the hospital or at home with a physician assisting him and his family. Thus, if he were to realize that his moral values were to stay alive, then the best way to do that would be to listen to the physicians around him. The type of relationship that should be established in the baby girl’s case should be the paternalistic model. This is because in this model, the physician would act as the baby’s guardian and implement what is best for the baby’s life and has obligations, including that of placing the baby’s interest above his or her own and soliciting the views of the mother, who seems to lack adequate knowledge of the situation. This is the best model for this case because the physician would initially be the guardian for the baby, rather than the mother, and will thus make the best decision for the baby and disregard the views of the mother. To keep in mind moral autonomy when assessing the physician-patient relationships is vital. Moral autonomy is defined in our text as: to act freely, is to act autonomously; to act according to a law you give yourself and not according to the desires of nature or pleasure; and to respect each person’s liberty to self-determine their own idea of the good. For the case of Roosevelt Dawson, moral autonomy can be valuable when looking at various perspectives. Dawson’s choice to leave the hospital relates to his ability to act freely; if he does in fact wish to commit assisted suicide, it is to act according to a law he has given unto himself. Thus, to respect each person’s liberty to self-determine their own idea of the good is to respect Dawson’s idea that being discharged from the hospital is his best option. In regards to the case of the baby and her mother: the baby girl is unable to act according to a self-given law, therefore the mother should be able to make decisions based upon a self-given law in regards to her child; because the baby is unable to make a decision for others to respect, the mother has made the decision to not follow through with surgery that the neonatal staff is having trouble respecting; and because the baby girl needs someone to make decisions for her, it would be her mother and the mother should be able to act freely, thus her decision to not give her baby the surgery or not. Also keeping in mind, as described in our book, utilitarian is a form of consequentialism and the results of actions are the only relevant feature in assessing actions. Considerations of someone’s intentions, feelings or convictions are seen as irrelevant to the question of ‘what is the right thing to do? ’ Under the point of view of utilitarian, the right thing to do is to maximize utility; good is determined by the overall net happiness that can be achieved. A utilitarian considers his or her own happiness, but no more and no less than the happiness of others, they are committed to the value of equality; with this, the right thing to do is to maximize utility (utility being the balance of pleasure over pain; happiness over suffering). In the case of Roosevelt Dawson, the parties involved are Dawson and his family. Regarding a short duration of time, some considerations for a utilitarian would be that Dawson is suffering while he remains alive but would be happy during death; this would be opposite for his family, they would be generally happy while Dawson is alive and they would suffer for a period of time after his death. Thus, death gives happiness to Dawson, but the reverse to his family in short term. But looking at the long term circumstance, his family along with Dawson himself would suffer because his family would have to take care of him and Dawson would have to cope with being quadriplegic (assuming Dawson is not going to commit assisted suicide). When discussing the case of the baby girl, the mom, the baby herself, and the neonatal staff would be the participants when discussing the situation under utilitarian pretenses. In this case, if the surgery were to be performed, then the mom would suffer because she would be taking care of a baby without limbs and neonatal staff being happy that they saved a child’s life. If the surgery was not performed, then the mother would be pleased to not have to take care of a limb-less child and the neonatal staff would be depressed about not being able to save a child’s life. Considering both short term and long term paths, if the surgery were to be preformed, it would cause the mother to suffer because her child does not have limbs, and the baby girl would struggle, due to the fact that she does not have any limbs. If the surgery were to not be performed, it would make the mother happy because she would not have a burden child, and the neonatal staff would be unhappy because the baby would have died. Again to take into consideration is communitarianism. This according to our text is ethical truth that must be sought in the universal belief of rationality. Whether ethical norms are conceived in terms of enlightened self-interest, maximized utility, or the recognition of autonomy and human rights, they are viewed by this tradition as objective and universal, applicable to all times and places. Since different individuals will naturally have different values and conflicting visions of the good life, a truly liberal society will not adopt any particular conception of the good life to the exclusion or lessening of others. Unlike utilitarian beliefs which would pose the question of ‘what option would maximize utility? ’ the communitarian view would ask ‘which policies will promote the kind of community in which we want to live? ’ According to our text, in the case of Roosevelt Dawson, communitarians reject the desire for elevating the individual above the social group or community. Consequently, letting Dawson out of the hospital with the suspicion that he would commit assisted suicide, would not be what was best for the community because a member could potentially die. On the basis that there is a potential loss of life if Dawson were to be released from the hospital, would have a negative effect on the community and therefore be the unwanted plan of action. Similarly, in the case with the baby girl and her mother, not performing surgery and taking away nutrients from the child would also cause negative feelings around the community. Therefore, in order to keep the population happy, to follow through with the surgery so the baby would be able to eat orally, would be the communitarian desired option. Taking into thought, as discussed in lecture, vulnerable populations are those of group identities where there is historical evidence that a group has been treated unequally badly by medical professionals. In both cases, because Roosevelt Dawson is a twenty-one year old African American man and the child is a less than ten hour old female, there is more of an obligation to let a twenty-one year old man make his own decisions and have someone else make the decisions for the newborn child. Due to the fact that Dawson is a part of the group considered ‘adults’, he should be able to make his own verdict on whether to leave the hospital or not. At this age, a person should be able to make a decision about his or her own life without someone, even though may be in a ‘higher position’ than you. The fact that Dawson is African American should not be a factor in how the hospital should treat him, race should not be taken into play at all, the hospital should be treating Dawson as they would treat any other twenty-one year old that has been checked into the hospital. Rather than his race, the hospital should be obligated to take into account Dawson’s age when considering his wishes, and they have more of an obligation to grant his wishes because of his adult status. On the other hand, the baby should obviously not be making its own decisions, because she does not know anything about the situation. She is only less than ten hours old and has yet to make any decisions in her life at all. The obligations of the hospital to keep her alive should be no different than the obligation to keep any person alive, but because the baby cannot have an opinion or a decision in the matter, the mother’s decision should be considered. Although, because the mother is making the decision to withdrawal nutrients and not follow through with the surgery, her opinion and her thought process behind it should be taken into account. Taking consideration of the baby’s inability to make a decision of life or death on her own, the hospital is more obligated to keep her alive even if her mother is telling the neonatal staff to let her die. My recommendation for the case of Roosevelt Dawson is to let him leave the hospital and be free to make his own decisions. From our text, this is a rights-based approach; this advances the idea that simply, by being human, people have rights regardless of the legal system under which they live. My suggestion to let Dawson be discharged from the hospital is also because of the principle-based method. The principle of utility, or utilitarianism, would in this case ultimately maximize happiness. This response is formulated by the Doctrine of the Double Effect (DDE). According to our text, the DDE is in response to the recognition that an act may have both a good and a bad effect. The permissibility of the action depends on whether the bad effect is intended or for seen and permitted to happen. Therefore, the act of letting Dawson leave the hospital is not intrinsically wrong. The good effect is produced directly by discharging him and not by the speculation that he may or may not wish to commit assisted suicide. There is only speculation that Dawson wants to commit assisted suicide, not concrete evidence, thus letting him leave the hospital would be in the best interest for Dawson, his family, and this hospital. With the case of the ten hour old baby girl, my proposal is to follow through with the surgery to remove the anomalies in her throat and have her be able to consume nutrients orally. This recommendation is stemming from the hobbesian contractarianism. From our text, everyone is better off restricting his or her own liberty to injure others, so long as the others do likewise. Thus, harming the baby (not removing the anomalies and taking away her nutrients) is not inherently wrong in this way, but it is to our mutual advantage to accept conventions that define such harm as wrong. By removing nutrients, we would be harming the baby, which would be restricting the liberty and therefore wrong. Also, to maximize utility would be to follow through with the surgery and keep the baby alive. This would make the maximum amount of people happy, including the hospital, and thus would be maximizing utility.

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