Who should have the final say in deciding life-changing events for a patient? When confronting ethical and moral dilemmas such as this, it becomes logically-necessary to define conditions under which specific problems can be solved, in order for any true progress to be made in the area of interest. In this case, the area of interest includes ethical problems faced by health-care professionals. Simply asking what “should” be done is not sufficient for a decision to be made, as it may be possible to contrive alternate solutions that sound more persuasive.
Medical professionals and other scientists deal exclusively with the epistemically-objective reality. Therefore, any logical solution to an ethical dilemma in this field must be conditional to avoid the naturalistic or “is-ought” fallacies created by statements which are founded solely on assumptions and subjective preferences (such as the statement, “Pleasure is good.”). To humor this exam, the preceding problems will be ignored for the most part, and the usual assumptions, which have made past arguments presented in this course possible, will be made, although solutions will still be conditional and retain some structure.
This case deals with the problems involved in deciding whether a child or her parents should have the final say in a potentially life-changing event in the child’s life. It also focuses on the difficulties with making sound choices that may go against personal preferences, no matter how well-intentioned these preferences are believed to be. It is definitely true that the parents’ goal is to allow their child, Mary, to avoid risk, even if that means taking a strong paternalistic approach, ignoring her personal desires. Mary on the other hand, although young, exhibits the decision-making qualities and autonomy of an independent, mature adult. Thus, it becomes necessary to examine various solutions and attempt to present the best possible one.
First, the parents’ approach will be examined. As stated above, their goal is to allow Mary to avoid the most risk and live the longest, even if it means giving up her future ambitions. This paternalistic stance, whether weak or strong, is ultimately in line with the ethical obligations of the health-care professional, whose goal is for the patient’s well-being. As the oft-cited Hippocratic Oath clearly states (with respect to the patient):
“I will keep them from harm and injustice. I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.”
This oath is effectively stating that a doctor should provide the patient with the least dangerous remedy to her ailment. Even though the odds are still in her favor for survival without amputation, the difference between the risk associated with amputation and without is so large (20%) that, for the parents, the only possibility appears to be amputation. This is made especially true considering that Mary still has her whole life ahead of her, leaving plenty of time to find another calling. One could therefore end the discussion at that, leaving the decision to the parents, and ending Mary’s current hopes of going to college.
The problems with the previous argument, however, may force another solution. First, the Hippocratic Oath is not an actual oath taken by health-care professionals, and the majority of the oath contains statements which do not apply to today’s society, such as belief in the god Apollo, or pledging not to use a knife. Second, by taking a strong paternalistic stance, the doctor violates the patients’ right to autonomy. The wording of the case seems to make it clear that the patient is mature, goal-oriented, and has specific plans for the future. These are all important qualifications for determining the competence and decision-making abilities of an adolescent.
As stated by Brock, “it is the patient’s self-determination and well-being that are at stake in the determination of whether the patient will decide about his or her own treatment.” (Children’s Competence for Health Care Decision-making. ) It is clear that the patient is aware of the facts stated in the excerpt, and is motivated and able to make important choices affecting her. Because the probability associated with survival without amputation is still in her favor, it can be argued that she is also working for her well-being. Thus, she meets the qualifications for determining her own treatment. While the parents’ stance is the safest, hers is more of a “necessary” compromise, a concept familiar to medical ethics.
Before it can definitely be said that treatment without amputation should be the proper course, however, the family should inquire about certain information that is lacking in this case’s description. For example, though she might survive without amputation, her leg might be permanently affected. They should find out how other patients have been negatively impacted by choosing not to amputate, as her swimming future might turn out to be impossible in either scenario. The family should also ask how many patients have survived with versus without amputation, as percentages might be misleading. There may be a few orders of magnitude difference between these two numbers. It would also be nice to know how the doctors at their hospital have faired in either situation. These important factors will help make the decision clear for the family.