Patient Into A Course Of Treatment example essay topic

The case of Dr. Lowell and Mrs. Jackson revolves around a conflict between the doctor, who advocates the implementation of a particular treatment and the patient who disagrees with the doctor and wishes to do things her own way. The doctor feels that the suggested course of action is disastrous and threatens to have the patient declared mentally incompetent. The question now is whether or not the doctor is morally justified in taking action against the patient in order to implement the course of treatment she feels would be most effective. Is this an infringement on the autonomy of the patient or is the doctor morally obliged to do everything that he / she can possible do in order to restore the patient's health even if that includes to go so far as to take this decision out of the hands of the patient? I would like use Rule utilitarianism and Kantian deontology to help determine what course of action could be morally justifiable in this case. Rule utilitarianism says "A person ought to act in accordance with the rule that, if generally followed, would produce the greatest balance of good over evil, everyone considered".

(Mappes & Degrazia, 13) So according to rule utilitarianism, when one faces a moral dilemma one should map out the consequences of one's action and then act in so as to produce the greatest net amount of utility or happiness. So if I was faced with a moral dilemma concerning whether or not I should cheat on an exam, I should follow the rule that creates maximum happiness, which in this case would be that I should not cheat because if every one in the world cheated on every exam then there wouldn't be a need to take or give exams. There would no longer be a dependable system to gauge a student's knowledge on a subject. Kantian deontology however follows a different path. According to this moral theory, consequences are of no matter and duty is what is important. (Lecture, 01/27) Just as in rule utilitarianism, Kant says that an act can be considered morally right when it is in observance with a rule.

This rule, however, must satisfy the conditions of what he calls the categorical imperative. There are three formulations of the categorical imperative (Lecture 01/27) that each maxim or rule must adhere to. Firstly, "Act only according to that maxim by which you can at the same time will that it should become a universal law". The second formulation says that "Act so that you treat humanity, whether in your own person or in that of another, always as an end and never only as a means".

The third formulation says that "Treat others as autonomous agents, capable of self directed action". So an act would require fulfilling all these three formulations for it to be morally justified. In a case where there is debate about the morality of whether or not one should lie, the theory outlines the maxim that one should never lie. This maxim fulfils all three requirements of the categorical imperative; one can consistently will this maxim as a universal law, it does not treat others or oneself only as a means and it does not violate anyone's autonomy, including oneself. Applying rule utilitarianism to the case of Dr. Lowell and Mrs. Jackson: the theory says that the rule that would afford the maximum utility would be one that said that a patient must follow that course of treatment that the doctor deems most effective. Any other rule that allowed the opposite to happen, one that said the patient always has the final word regarding what the treatment should be applied, would result in overall dis utility as patients might chose not to take courses of treatment that might be painful but beneficial.

Such behaviour might result in either prolonging of the disease or further complications, all consequences that would result in overall increased dis utility. The emphasis in diagnosis would shift to a system wherein a doctor's knowledgeable opinion comes secondary to a patient's wishes about what course of treatment to follow. After all it is not likely that a doctor would intentionally try and do a patient harm. A rule that undermines a doctor's authority would only result in net dis utility as it would produce a devaluation of doctors and courses of treatment based on scientific knowledge and understanding. Therefore rule utilitarianism would say that the doctor is morally correct in trying to undermine her patient's wishes. However, another consequence of applying this rule would be that it would disregard a patient's wishes especially in those cases where individuals have wishes grounded in religious or personal beliefs.

Such disregard for a patient's autonomy might also produce dis utility. Generally speaking, most patients tend to follow the suggestions offered by their physicians. The dis utility suffered by the few odd patients who experience an infringement upon their autonomy by a disregard for their personal wishes surely would be far less than the general good that is produced by people heeding the words of advice given by their doctors. After all, not listening to a doctor's advice could lead to, in this case, death that produces a great of unhappiness for all the family and friends involved versus having to endure a course of treatment that one dislikes producing unhappiness only to oneself. A Kantian approach to this problem might go along the following lines: a maxim that would pass the tests posed by the categorical imperatives might be that a patient always has a right to decide what course of treatment is most suitable for him / her self because any course of action that does not take into account a patient's wishes would violate his / her autonomy. This maxim passes the test of universal application and does not result in the use of others or oneself merely as means to an end.

The maxim also undoubtedly agrees with the third maxim of conserving the autonomy of all parties involved. Therefore according to Kant's philosophy the ethically correct thing to do would be to respect the patient's wishes and allow Mrs. Jackson to try and fight the cancer by following a dietary regime comprising of high-fiber and lots of water. The maxim's universal applicability however could be called into question for the reasons stated in the previous paragraph, of taking the risk of not adhering to a course of treatment based on scientific grounds. But as mentioned, the utilitarian course of actions would cause an impingement upon an individual's autonomy, which is an acceptable consequence for the rule utilitarian but not for a de ontologist.

In a similar manner, loss of overall utility is an unacceptable consequence for the utilitarian but an acceptable one for the de ontologist so long as autonomy is conserved. Since both theories seem to contradict each other, I think that more factors need to be taken into consideration in order to help decide if Dr. Lowell's actions are morally acceptable or not. The question now is how one goes about determining whether or not the patient has the capacity to make these kinds of decisions. If a patient's autonomy is always supreme, is it morally right for a physician to intervene and possibly go against the patient's wishes? This issue now leads us to the question of informed consent.

Informed consent means consent to a particular treatment based on a patient's voluntariness, the amount and relevance of information they have and the capacity to consent. (Lecture 02/03) A voluntary decision is one that is made free of external or internal constraints. These would include both physical and mental hindrances forced against a person in order to persuade them to choose a particular course of action. Dr. Lowell's threat to declare Mrs. Jackson as mentally incompetent constitutes an infringement upon her voluntariness.

If Mrs. Jackson were to decide to follow the recommended course of treatment because she fears what Dr. Lowell would do then informed consent is not applicable. A doctor could also disseminate information in such a way so as to influence a patient to take a specific action. Such a manipulation could also be considered to be an infringement upon informed consent. As seen in the case, a doctor can claim that a patient does not have the capacity to consent and is mentally incompetent. This raises issues such as how can one determine a patient's capacity to consent and what are the criteria. Dr. Lowell claims that Mrs. Jackson's refusal to undergo the standard treatments for cancer make her incompetent.

But is it the case that Dr. Lowell's claim is based purely on her need to see a particular course of treatment through or is Mrs. Jackson truly mentally incompetent? In this situation, I do not think that Mrs. Jackson can be labelled as incompetent. Since there is hope for Mrs. Jackson to cure the cancer through chemotherapy and radiation, the assumption is that the cancer is not so far advanced that it impedes her capacity to make a voluntary and informed decision about the course of treatment that she feels is right for her. Therefore, there are no grounds to Dr. Lowell's claim that Mrs. Jackson is mentally incompetent.

Thus by questioning her mental state in order to coerce her into following another form of treatment, Dr. Lowell is acting in an unethical manner since she is imposing on Mrs. Jackson's autonomy. Also, the patient doctor relationship is based on trust in between the parties involved. A decision that forces a patient into a course of treatment unwillingly would also destroy this trust between patient and doctor. If Mrs. Jackson is forced into radiation and chemotherapy perhaps she will avoid going to Dr. Lowell the next time she or members of her family have a problem that requires medical attention. The need for informed consent arises in cases where doctor and patient disagree about a particular course of treatment. Dr. Lowell's insistence that Mrs. Jackson follow an active course of treatment involving chemotherapy and radiation might be grounded in a utilitarian frame of reference, however I feel it contradicts both the de ontological principles of autonomy and the criteria for informed consent.

Even though a utilitarian response would be one that preserves the doctor's authority over a patient, since it is the patient who is directly affected by any course of treatment taken, the final decision should remain in the hands of the patient. The risk of losing patient autonomy by allowing doctors a free hand with what they think is the correct treatment seems to be too high. The patient should have the right to accept or reject any course of treatment so long as that decision is made with informed consent. Thus it would be ethically incorrect for Dr. Lowell to try and coerce her patient into following her recommended treatment. However, I think that Dr. Lowell would not be morally incorrect in trying to explain to Mrs. Jackson about the details of the treatment. Perhaps Mrs. Jackson has a fear of losing her hair during chemotherapy and Dr. Lowell could explain to her that hair loss does not occur inevitably with chemotherapy but varies person to person.

Maybe if Mrs. Jackson knew more about what the treatment entails she might change her mind about it.

Bibliography

Mappes, Thomas A., David Degrazia. Biomedical Ethics - Fifth Edition. Fairfield, PA: Mc-Grow Hill Higher Education. 2001 Robert, Jason Scott. Lecture. Bioethics. LSE 106, ASU, Tempe, AZ.