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The Ethical Dilemmas Surrounding Medical Treatment for Mentally Disabled Patients

May 17, 2023 | 0 comments

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May 17, 2023 | Essays | 0 comments


Many times the actions of our medical physicians have been questioned on ethical grounds based on many ethical issues. The case of Stephen Dawson is one case in the medical field that illustrates many ethical questions not only from the medical practitioner’s point of view but also from parents’ and guardians’ views. Stephen, a seven-year-old boy with severe mental disabilities was born prematurely and shortly after suffered extensive brain damage from meningitis that left him profoundly mentally disabled with no control over his faculties, limbs, or bodily functions. Also, Stephen has passed through the hands of many different institutions for physically disabled children and even to a foster home.


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Most of the time individual rights of patients and their loved one’s views have numerously clashed on treatment, discontinuing of treatment just to mention a few. The Dawson case is one such case that illustrates several predicaments and life-threatening decisions that need to be made to save the life of the seven-year-old. The case illustrates the relevant questions on the value of the life of an incompetent person and various medical ethics with regards to treatment, including the moral status of persons with disabilities, who gets to make life and death decisions for such patients? That is, whether the courts of law are morally obligated to intervene to save a life? secondly is the difference between withholding and withdrawing treatment and how much should the quality of life of a mentally handicapped person to affect their treatment options. Fourthly, is that should medical treatment be stopped if we do not know the will of the patient? Should the decision be left in the hands of parents, caregivers, or medical practitioners? The last issue of the case is the rights of persons with disabilities. This paper shall deliberate these ethical issues, concerning the case of Stephen Dawson and other relevant sources.

 Ethical issues in the case.

Should courts of law be used to correct parental control over a child and the performance of a life-sustaining surgery? The idea of having minors acquire the capacity and the right to make decisions about their health care has been established in several federal-state policies. Several states have specifically authorized minors to consent to contraceptive services, testing, and treatment for HIV, prenatal care and delivery services, treatment of alcohol and abuse, and outpatient medical care. Traditionally, parents have been recognized to make all health care decisions on the child’s behalf before they attain the majority age. It has always been assumed that young people lack the experience and judgment, to make fully informed decisions (John & Waluchow, 1998). In the case of Stephen Dawson, the state was morally correct in seizing parental control of the child and allowing the performing a life-sustaining surgery. Even with his severe health and physical issues, Stephen was still a human being to whom moral obligations apply. About the question of who should make decisions about the health of a disabled child, the matter should be left to medical practitioners. This is not to say that the parents and family members as incompetent. In this case, however, Stephen had not been living with his parents for a couple of years they were, however, fully aware of the severe pain and suffering he was undergoing. Because Stephen could not speak or understand what is going on, it was in the best interest of his health that the medical doctors with the help of the court decide for him. There are however certain instances, such as medical emergencies where there is no time to obtain parental consent. In such circumstances, the minor if of sound mind is allowed to make the decision. In certain circumstances, the medical practitioner through a court order is allowed to make the right decision to save lives.

The second ethical issue of the case is the role of parents in ensuring the well-being of their children. In Dawson’s case, the parents elected not to complete the surgery of their son and choose death over his life. By their decisions, the parents were dismissing the value of the life of their son. In the case analysis the Supreme Court Judge, Justice Lloyd McKenzie, categorically stated that the life of a severely handicapped child had been placed above that of a healthy child. The question, therefore, is should the needs of parents be placed before the needs of a child? From the case, we also find out that Stephen was removed from the home of physically handicapped children and placed in foster care, and not in the care of his parents despite them knowing how the complications of his health. The Dawsons illustrated that they were selfish and did not see their son as a priority in their lives. The court was, therefore, morally right for granting the Performance of the life-sustaining surgery.

The third ethical question is Withholding medical treatment for an incompetent patient. The question asked in court was whether it was necessary to withdraw treatment for an incompetent patient; under what conditions are withdrawal of treatment acceptable and who can exercise this right. Withholding of treatment is a medical terminology that means to take action to end a patient’s life, for example not administering the necessary treatment to a critical patient is withdrawing treatment for such a person. So is it possible to withdraw treatment of a patient who is incompetent such as Stephen Dawson? It is not ethically right for the Dawson’s to suggest that their son be left to die in peace. Their son is an incompetent person and cannot make that decision himself. The surgery was not aimed at deteriorating his health, but to improve it. It would be, therefore, wrong to withhold treatment for any patient more so an incompetent one.

The fourth ethical issue relates to the question of whether or not it is morally acceptable to cease life sustaining treatment of a disabled person if you can’t know his or her will regarding the decision? This is however not the question of the right of a disabled person to access the same life-sustaining treatment as that of a competent person. The question arises of how far medical experts should go to sustain the life of a mentally disabled person with a very low quality of life and certainty of death when they cannot know their will. This is a question of non-maleficence, and whether or not a low quality of life does more harm to a person than death. If the patient is mentally competent the obvious decision would be to simply allow them to make the decision on their own about whether their quality of life is worse than death (Beauchamp & James, 2001). However, with Stephen being a child and mentally disabled, we cannot know anything definite about how he feels or how his quality of life is. We can only make assumptions about what we see. If Stephen had a chance of getting better, I believe this case would be much easier to decide. However, it is apparent that performing this surgery, despite its low risks, would simply be extending life of low quality where he would continue to worsen until he died.

Another ethical question that arises from the case is the right of mentally disabled persons. The Universal Declaration of Human Rights and the Citizens Commission on Human Rights has provided extensive provisions on the rights of mentally disabled persons. The Citizens Commission on Human Rights, particularly provides under article 1, that any patient has the right to be treated with dignity as a human being (The Citizens Commission on Human Rights). As argued in the case, keeping Stephen alive and in the institution for the mentally disabled would be a waste of resources and time. Ending Stephen’s life and withholding treatment is even more inhuman (Lockyear, 2006). We cannot end the life of a handicapped people just because they hold us from going on with our lives. Just like any other human Stephen was born and he is living and has therefore the right to be kept alive.


Even with all these ethical issues in mind, the judge was morally right to allow the State of Columbia to grant them permission to allow Stephen to undergo the life-sustaining surgery since it would increase his chances of a longer life. To many, including Stephen’s parents, he seems to have nothing to live for except for pain and suffering. The problem with denying Stephen the right to undergo the surgery would be deciding for his parents, which is ethically wrong. Stephen as a mentally challenged and child is incompetent and lacks the cognitive capacity to make the right decision for himself and it is the responsibility of his parents to make that decision for him. However, since his parents do not spend much time with him, it is automatically believed that the medical practitioners who spent much time with him to be competent to make the right choice for him. The Dawson’s having entrusted Stephen under the care of Sunny Hill and are questionably less informed of Stephen’s up-to-date status and quality of life. On the other hand, the decision, whether or not to perform the surgery is the main question before the court. Is Stephen better off without the surgery as his parents allude? Medical experts ethics hold the view that when there is doubt about the treatment at any time, the medical presumption should always be that the treatment will be in favor of the patient especially with regards to disabled infants. We cannot make a life or death decision for mentally disabled persons because of what we think their quality of life is. Consequently, we cannot simply know for sure and what if we are wrong, and kill a boy who is disabled but otherwise happy. At the end of it all, it would be morally wrong to harm a patient by perceiving his quality of life as poor and letting him or her die than to continue treatment and allowing him to live for the rest of his life.


John, T., & Waluchow, W. (1998). Well,, and Good.: A case study Approach to Biomedical Ethics. 3rd ed. Broadview Press Ltd, n.d. Print.

Beauchamp, T & James, F. (2001). Childress: Principles of Biomedical Ethics. 5th ed. New York, Oxford UP. Print.

The Citizens Commission on Human Rights (CCHR). Mental Health Declaration of Human Rights.

Lockyear, B. (2006). Legal Rights of Persons with Disabilities. State of California Department of Justice. Web.

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