Esther K Case

When addressing the needs of a previously competent patient, doctors are often placed in a quandary. He or she must consider various legal, familial, health positions when determining how to care for his or her patient. An example of this predicament can be seen in case 8 of Philosophy and Medicine. Here, I am presented with a situation where the patient, Esther K, has pancreatic cancer. When the patient was initially diagnosed, she made a will. In this will, she refused all aggressive therapies and any treatment that she determined would be considered as “extraordinary measures:” chemotherapy, respirators, or resuscitation. Unfortunately, a few months after the diagnosis, the patient was admitted in a confused state. Furthermore, it was found
Dr. P diagnosed the situation as gangrene and wanted to remove the foot before the disease spread further. In her state, the patient consented to the surgery. However, the patient’s family became upset that Dr. P suggested the surgery. Furthermore, they believe that the surgery would go against the patient’s will.
This case, in my opinion, puts the doctor in a relatively difficult position. On one hand, the patient, through her will, expressed that she will not consent to “extraordinary” medical practices. However, on the other hand, if nothing is done, there is a great chance that the necrosis will spread. Because of these factors, I believe there are two possible courses of action for the doctor to take. One course of action would be to continue with the surgery despite what her family thinks is the best for her. One consideration for this method of action is that the doctor has already received what he or she believe is consent. Philosopher Gopal Sreenivasan would agree with this. In his article, "Does Informed Consent to Research Require Comprehension?" Sreenivasan posits that a patient cannot ignorantly give
For this option to be considered, I must consider whether if Esther is of sound mind. To do this, I can look to the work of Ronald Dworkin. Dworkin, a philosopher, questioned essential the same problem: can a person who is longer of sound mind provide consent? Per Dworkin, the patient can. How? In the chapter, “Life Past Reason,” of his book, Life’s Dominion, he posits that one can respect the patient’s autonomy by referring to the patient’s precedent autonomy. This means that I should look for a time where Esther previously stated her wishes. Per the case, Esther wrote her will soon after finding out that she was diagnosed with pancreatic cancer. This means that she wrote the will when she was of sound mind. So, per Dworkin, the doctor should respect her previous wishes to not extend her life by any extreme measures, and I believe amputation surgery would fall under that category. While this seems like an extreme reach, in the end, the doctor should respect the autonomy of his or her patient. There is another reason why the doctor should not perform the surgery. If one considers that the patient is not capable of autonomous choice, the doctor should not compel the patient to make a choice that would go against the patient’s wishes. Instead, the doctor must go through a surrogate or a representative (i.e. a spouse, adult children, parents, etc.) to reach a decision