Read the following case scenario and respond to the discussion prompts that immediately follow:
Six months ago, Mrs. Plicibo, a 42-year old patient with Stage IV non-small cell lung cancer and an inoperable brain metastises was referred to Dr. Rogue by her Oncologist, who had exhausted all other treatment options. Dr. Rogue is known as an expert herbologist, having spent years studying alternative natural medicines used around the world.
Dr. Rogue prescribed the standard therapies of anti-seizure medications and steroids to reduce brain swelling, but he also offered her the option of trying a ‘secret’ natural supplement that he had discovered on his latest trip to the Orient. Explaining that the treatment would require a weekly injection, but that he would cover the cost, Dr. Rogue took considerable time explaining to Mrs. Plicibo that he could make no guarantees as to the effectiveness of the treatments, other than the fact that other patients had reported positive results along with no adverse side effects. Desperate for a chance, Mrs. Plicibo had tearfully agreed.
Today, after examining Mrs. Plicibo and reviewing her recent lab results, it is clear that her condition is deteriorating rapidly, despite the apparent improvements she has made over the past few months. “I just don’t understand,” sobs Mrs. Plicibo, “I was doing so well with the shots—it was like a miracle. Isn’t there something more you can do?” “We can try upping the dose for the next week or two, Mrs. Plicibo, but if there is no improvement, I am afraid we will have to discuss some options and support services to make things easier and to keep you comfortable.” “Please don’t tell me that, Dr. Rogue. I think this will work!” Promising to give it a try, Dr. Rogue leaves to get his assistant. Taking her aside he whispers “Molly, please prepare the ‘hope shot’ for Mrs. Plicibo – and of course – do not tell her that it is only water!” “Of course not, Dr. Rogue,” smiles Molly. “Why mess with something that is working!”
Discuss the following:
Given the positive outcome over the last few months, and Mrs. Plicibo’s insistence that Dr. Rogue continue the shots, was Dr. Rogue’s treatment ethical? Why or Why not? Remember to justify your response using the ethical theories (listed below).
250 word min
Utilitarianism – Ethical actions are right to the degree they promote overall happiness or pleasure (this is a metaphor for a good outcome). Utilitarians are concerned about the aggregate happiness (good outcomes or greatest amount of benefit) of all. John Stuart Mill was a 19th century proponent. This is a consequentialist theory – one makes ethical decisions based on the expected outcome.
Duty-based Ethics (Deontology) – Relies heavily on the work of Immanuel Kant and stresses doing one’s duty and following rules. Deontologists stress adherence to principles rather than outcomes or consequences when determining the rightness of an ethical choice. W.D. Ross, another early deontologist, developed a version of deontology somewhat less absolutistic than Kant’s. But, Ross felt that ethical decisions cannot be based on what is useful; they must be based on what is right. (Munson)
Virtue-based Ethics – Focuses on the goodness or badness of people’s character rather than the rightness or wrongness of their actions. Aristotle felt we cannot achieve true happiness unless we use the capacity that distinguishes us from plants or animals. This capacity is the human ability to reason. Compliance alone is not enough; only continual striving to be a good human as well as a skilled professional is acceptable.
Natural Law-based Ethics – Law is the highest reason, implanted by nature, which commands what ought to be done and forbids the opposite (Munson). Nature (God) has hard wired us to live, to procreate, to love, to know and so forth. People defy nature when they choose death over life, childlessness over procreation, ignorance over knowledge, etc.
Rights-based Theories – All persons, it is assumed, have individual rights. According to George Annas, rights “..help people prevent people from being treated as interchangeable, inanimate objects….” Rights may be negative, rights to noninterference, like the right to refuse unwanted medical treatment. Positive rights might include the right to receive certain goods and/or services.
Care-based or Feminist Approaches to Ethics – Includes approaching ethics using values such as compassion, empathy, nurturance and kindness. Whether a health care professional is a man or a woman, they should not only be encouraged to act in a caring way, but also be respected for so acting (Tong).
There are, according to Beauchamp and Childress, four co-equal principles that govern health care ethics. These principles are non-maleficence, beneficience, autonomy and justice. They point out that non-malificence finds voice in the Hippocratic Oath, “at least do no harm.’
Principle of Non-maleficence – Also known as the Standard of Due Care – treating patients attentively and vigilantly so as to avoid mistakes – do no harm.
Principle of Beneficience – Patients want more than not to be harmed, they want to be benefitted. Paternalism can come into play here. “To act beneficently is to do for the patient the good the patient desires; to act paternalistically is to do for the patient the good the health care professional thinks the patient should desire.” (Tong)
Principle of Autonomy – Munson tells us that we act autonomously when our actions are the outcome of our deliberations and choices. This includes the right to be informed about treatment options and the right to refuse treatments.
Principle of Justice – W e believe it is unjust to treat one person better or worse than another in similar circumstances (Tong). Rawls states that “rational persons want to live in just, rather than unjust societies. To allocate scarce medical resources to patients on the basis of social worth for example…… rather than on the basis of medical condition is more often than not wrong.”
These short excerpts on theories and principles are taken from a number of sources including the following:
Beauchamp and Childress, Principles of Biomedical Ethics (sixth ed), New York: Oxford University Press.
Munson, R. Intervention and Reflection: Basic Issues in Bioethics (9th ed). New York: Wadsworth Concierge Learning.
Tong, R (2007), New Perspectives in Healthcare Ethics. Upper Saddle River, NJ: Pearson Education Inc.