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Examining the Ethical Dilemmas in Medical Decision-Making for Incompetent Patients

May 18, 2023 | 0 comments

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May 18, 2023 | Essays | 0 comments

Introduction

The law guarantees that patients whether competent or incompetent possess the legal right to decide whether they want to be treated and which treatment method should be used. Patients have also the right to decide whether to discontinue a certain means of treatment. In theory, persons who suffer certain mental disabilities receive the same rights as competent persons (Shaver, 1989). Many times the medical decisions for incompetent patients come from the family and a few times from the medical practitioners. Physicians face difficult situations of decision making for incompetent patients. It even becomes much harder if the incompetent patient is a child as young as Stephen Dawson is.

 

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The main facts of the case are that Stephen is a young boy who is born with and develops several medical disabilities. The mental disorders cause extensive damage to his brain. He also lacks the capability of controlling his limbs and performing different bodily functions. His parents are very worried about him, and at the same time spent very little time caring for him. The boy is moved from one caregiver to another. One time he is at the Institute for caring for disabled children and later taken to a foster home because the Institute management sees him as a burden and waste of resources. He spends a short time at the foster home and is returned to the institution. A discovery was made that Stephen needed to undergo a life-sustaining surgery to improve his chances of living. His parents, however, opposed this surgery stating that his son needed to left alone to die in peace. The superintendent of the institution seeks custody of Stephen to enable him to receives the surgery. The Lower court ruled in favor of the Dawson’s, the Institution appealed in the Supreme Court of Columbia and was awarded custody of Stephen.

From the above case, several questions of ethics arise, one is the right of parents and family to prevent their incompetent child or a minor from acquiring medical attention that would sustain his life, and what are the limits of their rights over the child? The Second question of ethics is the right of the state to intervene in health decisions concerning its citizens. Thirdly is the position of incompetent persons in acquiring the life-sustaining treatment that they’re next of kin is opposed to. The fourth ethical question is the right to life of incompetent persons. This paper shall analyze the case of Stephen Dawson and the different questions of ethics it portrays.

Reading the Universal Declaration of Human Rights and the Citizens Commission of Human Rights (CCHR), one will automatically notice that the mentally disabled are provided with rights. Under article one of the CCHR, particularly provides that all patients must be treated equally and with human dignity (Citizens Commission of Human Rights). However, the Act does not define dignity. Dignity means with pride, I do not think placing Stephen in a shunt constitutes dignity in any sense. The facts of the case state that Meningitis left the boy with difficulties in controlling his body limbs and functions. Should we then end the lives of persons that are handicapped because of the difficulties they have in performing body functions? In this case, Stephen’s health conditions are so much severe and life-threatening. The medical situation of Stephen does not constitute treating him with dignity. Stephen therefore does meet the relative condition of being positioned as suffering. Performing the Surgery does not guarantee that his condition will change; it means he will continue suffering as usual.

Reading further under article 2 of the (Citizens Commission of Human Rights) provides for the usage of hospital facilities without discrimination such as race, social class, age, religion, and language. In Stephen Dawson’s case, we discover ethical malpractices from the Institution of the disabled who discharged Stephen to a foster home that had no facilities to cater to his health needs. The institution management was discriminative in deciding that Stephen’s stay in the institution was a wastage of resources.

What are the limits of parents and breast cancer. Ann has been a staunch Christian since childhood just like the rest of her family in making decisions for medically incompetent persons? The law gives parents and families the upper hand in making medical decisions for their children especially minors. Most decisions made by such parents are expected to be in the best interest of the child’s health. On most occasions, however, the decisions made by parents are usually to take care of their needs and in doing so may risk the life of a child. For instance, the decision by Dawson’s to let their son die in peace was not competent at the time when there was a possibility of correcting and extending Stephen’s life. The Dawson’s were unethical in preventing their son to undergo the surgery. Even further the Dawson’s were not sincere because they had both isolated the boy from life by allowing him to be taken into foster care when they were the best people to take care of him (Nutovitis, 2015). Stephen’s parents have proven that they did not care about his life. For parents to make life-saving decisions for their incompetent minor, they need to have been around the child and have a better understanding of his life condition; in this case, Stephens’s parents lacked that right.

The third ethical question in the matter is the role the State and Federal Institutions and Courts of law play to ensure the protection of the life of incompetent patients. The state is allowed to limit parental control, especially where the life of a patient is at stake. The medical physicians make medical conditions such as Pregnancy emergencies, which put the life of a minor at risk if the parent is out of reach. When Stephen’s parents refused to grant permission for him to undergo the surgery the Superintendent of Family and Child Services of Columbia intervened to grant himself the custody of Stephen to save his life. Even after the lower court upheld the parent’s decisions, the Superintendent appealed the matter. On appeal the decision was quashed and custody given to him (Nutovitis, 2015).

The Fourth ethical question is when is it right to end the life of a terminally ill incompetent person. Incompetent persons lack the competence to make medically correct decisions. All decisions made on their behalf, therefore, are their will. Legally it is argued that the right of incompetent patients extends surrogate through their next of kin and family. The surrogate is supposed to place themselves in the shoes of the competent person before making the decision (Quinn 1988). However, most of the time the surrogate judgment cannot be ascertained whether it is the true decision of the patient or the surrogate judge. For example, when the parents decided for Stephen not to undergo the Surgery it was assumed that that was his will, he wanted to be relieved from pain. Incompetent patients are said to be incapable of appreciating the non-medical and medical factors in treatment preferences.

The question that remains is what is the limit of such decisions? Terminally ill patients like Stephen who are additionally incompetent have the right to life. Therefore, decisions to prevent them from accessing medical care that would sustain their lives are both unethical and inhumane. Due to the delicate nature of the matter, it would be ethically correct to let a terminally ill incompetent person continue receiving medical care until they die, not even physicians should have the right to end their lives. Section 2966 of the New York General Assembly statute, allows a physician to issue a medical treatment order for an incompetent patient without the surrogate if two physicians agree that it would be for the benefit of the patient. Without the surrogate, the physician together with the hospital ethics committee are allowed to protect the incompetent patient’s right to treatment. In the matter of Conroy, an elderly woman who was incompetent when ill had previously stated that she needed not to be subjected to treatment but left to die. The court ruled that the decision not to be treated must be upheld even if the woman was incompetent.

Conclusion.

With the many ethical dilemmas facing medical experts, the right to life of an incompetent person must be put first. Just because an incompetent person cannot appreciate, medical treatment and related factors, verbally do not guarantee their lives useless. The ethical principle must always be considered. Parents and families should respect the rights of the incompetent patient and not use the surrogate right to exercise their personal needs. Stephen’s life is as important as that of any human being. The court did well in granting the Superintendent custody of Stephen to give him a chance to live. Medical experts and physicians should use their position to influence the decision of family and parents, especially when protecting the rights of a patient. Policies need to be enacted to limit parental control especially when the parent does not understand the medical condition of the child. Stephen’s parents were selfish not to allow their son to undergo life-sustaining surgery.

We can never tell for sure if Stephen’s life would be better without the surgery. Science is full of experiments whose true nature can only be established if it is tried. From the medical physician’s point of view, the surgery had the possibility of extending Stephen’s life unlike if he went without it. It would be both ethically and morally wrong to deny a patient treatment when the treatment would have brought a positive change in his or her life. Lastly, the Institution for the disabled children was ethically wrong by discharging Stephen and sending him to a foster home where he was not cared for well because of limited facilities. I believe the reason such intuitions have to be created is to help patients like Stephen. Incompetent patient’s lives should be respected because they are human.

Works Cited

Citizens Commission of Human Rights. “Mental Health Declaration of Human Rights.” Citizens Commission on Human Rights.

Quinn, Kevin. “The Best Interest of Incompetent Patients: The Capacity of interpersonal Relationships as the Standard for Decision Making.” California Law Review. (1988): Vol 76.

Shaver, Elizabeth. “Do not resuscitate The Failure to Protect Incompetent patients’ Rights of Self-Determination.” Cornell Law Review. (1989):219-220.

Nativity, Jenevieve. “Discussion of case 6.4: Should Severely Mentally patients are treated?” Bioethics Blog. (2015).

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