Nursing Case Study Ethical Dilemmas
The following case study is a moral dilemma in which a doctor must chose a course of action with respect to patient’s case. In this case, the doctor must consider the morality, criminality, and ethical implications of killing, abortion, farmed organs, and allowing a patient suffer when there is a cure. Then and only then, can the doctor to determine what actions are morally permissible and allow to make an informed and proper decision as to what course of action he should take.
The case study reveals that the doctor’s patient is on dialysis, and is suffering from the severe side effects of his treatment, is growing desperate, inpatient, and frustrated by the life-restrictions derived from his illness. The patient cannot work regularly because of his dialysis treatment schedule. His mental and physical state has progressively deteriorated to the point that the patient has threatened to commit suicide if he has to remain indefinitely on dialysis.
In an effort to help her husband, the patient’s wife suggests to the doctor a possible solution that would help her husband’s predicament. The spouse states that she is …show more content…
willing to become pregnant, allow the fetus to grow for at least five-and-a-half months of age, and then abort the fetus for the sole purpose of harvesting the organs needed for her husband’s transplant surgery. The doctor knows that such an organ transplant could be performed, and it would probably have a greater chance at being successful because the graft would probably not be rejected by the patient’s tissues. However, he must consider the moral, ethical, and legal implications of the decision he renders. The doctor’s patient is a male engineer who is 28 year old, married, and has no children. The patient was adopted as a young child and he does not know his biological family. The patient has been on dialysis for at least and is suffering from the severe side effects of his treatment. He has already investigated the possibility of obtaining a transplant. However, due to his adoption and his rare tissue type, it is highly unlikely that a suitable donor or cadaver kidney can be found. Moreover, the patient is depressed and his state of mind is progressively deteriorated. The patient has also threatened to take the active approach of suicide if he has to remain on dialysis indefinitely.
Aside from agreeing to and performing the transplant, there are few alternatives. The doctor can refuse to perform the transplant and order the patient to continue dialysis treatment and wait for a suitable downer. The doctor could also refuse to do the transplant and along with the patient make a more concerted effort to locate the patient’s biological family to acquire a kin-donation.
I believe that it would be unethical, for the doctor to perform the transplant using the farmed organs. My opinion is in accord with the Kantian philosophical perspective. I believe that all life is sacred and therefore wherever it exists, it must be respected and allowed to thrive. If you formulate the maxim “treat all life as sacred” from my opinion, and universalize it, Kant’s’ categorical imperative indicates that this action is morally good and therefore permissible.
On the other hand, if the doctor agrees to the patient’s spouse’s solution, and performs the transplant of harvested organs, the doctor may also be complicit in an unlawful abortion.
A fetus five and a half to six months of age could be declared viable. The current standard for doctor-determined-fetus-viability with respect to lawful abortion was established by the Supreme Court case Planned Parenthood v. Casey, 505 U.S. 833 (1992). According to Anher et.al, who conducted a study on the ethical implications of aggressive obstetric management, a fetus 24 weeks of age should be “regarded as viable” because their survival rate exceeds 50% (Ahner, 2001, p. 124). Furthermore, killing a fetus, especially, when it was created, carried, and then killed for the sole purpose of harvesting its organs violates the “do-no-harm” clause of the doctors Hippocratic
Oath.
Deontology is a normative theory “regarding which choices are morally required, forbidden, or permitted. In other words, deontology is a moral theory that guides and assess an individual’s choices of what he/ she should or should not do (Alexander, L. & Moore, M, 2015, p.1). Deontological theorists stand opposed to consequentialist and their morality theory perspectives. Immanuel Kant (1724–1804), “was the greatest philosopher of the German enlightenment and one of the most important philosophers of all time,” Kant was both an absolutist and a rationalist (Pojman, 2012, p. 122). He believed that rational beings could, by way of reason, develop a set of moral principles which were consistent and could not be overridden (Pojman, 2012).
Author Louis Pojman, in his book, Discovering Right and Wrong (2012), states that Kant’s perspective argues that “morality’s value is not based on the fact it has instrumental value, that it often secures non-moral goods such as happiness, rather, morality is valuable in its own right” (p. 126). Kant believes that good will is the only thing truly intrinsically good (Pojman, 2012). According to his theory, “A good will is a will whose decisions are wholly determined by moral demands” thus, all moral acts derive from duty (Johnson, 2014).
Kant considered all moral duties or obligations to have imperative force, because any mention of duty could be translated into an imperative or command. His work distinguishes to types of imperatives: categorical and hypothetical (Pojman, 2012). The hypothetical imperative formula is very simple; if you want good grades, then study hard in school. A hypothetical imperative is a means ends obligation and not the type of imperative which describes the qualities or peculiarities of a moral action.
On the other hand, the formula for a categorical imperative is simply, study hard in school (Pojman, 2012). Categorical imperatives show proper recognition for the imperial status of moral obligations. These intuitive, immediate, and absolute obligations are commands that all rational agents comprehend “by virtue of their rationality” (Pojman, 2012, p. 128). Kant argues that an agent’s action is moral only when he/ she perform the act for the sake of duty. Furthermore, Kant asserts that the moral quality of a particular act can be found in the principal or maxim on which an individual acts. (Alexander, L, & Moore, M, 2015).
Kantian philosophical perspective maintains that the categorical imperative is a process by which a rational agent can ascertain the morality of any course of action to be taken. The general systematic plan of action of the categorical imperative is to first determine the maxim of the action, then universalize the maxim, and lastly accept a successfully universalized maxim or reject unsuccessful maxim (Pojman, 2012).
While Kant’s theoretical perspective recognizes only one categorical imperative, it proffers three formulations for it. The first is the principle of the law of nature, where an agent should act as through the maxim of his action were by his will become a universalized law of nature. The next one is the principle of ends which states that agents should treat all rational beings as ends in themselves and never as a means to an end. The last formulation is the principle of autonomy, which states that an agent should act in such a manner that his will, can, regard itself while simultaneously making universal law through his maxims (Pojman, 2012).
There are many other philosophies that address morality. Utilitarianism is one such model. Utilitarianism is a normative ethics theory which maintains that the best moral action is the one that maximizes utility producing the most amounts of good. According to the utilitarian perspective an agent ought to maximize the overall good by considering the good of others as well as his/ her own good (Driver, 2014).
According to English philosopher Jeremy Bentham (1748-1832), utilitarianism has two main characteristics known as the consequentialist principle and the utility or hedonist principle. The consequentialist principle holds “that the rightness or wrongness of an act is determined by the goodness or badness of the results that flow from it (Pojman, 2012, p. 103). On the other hand, the utility principle holds that, “An act is right if it either brings about more pleasure than pain or prevents pain, and an act is wrong if it either brings about more pain than pleasure or prevents pleasure from occurring” (Pojman, 2012, p. 103).
(Utilitarian criticism)
Life is paramount to all rational beings; it exceeds, excels, and surpasses all other moral imperatives in class, standing, and privilege. In its absence reason is non-existent, thus making all else moot. It should never be deliberately extinguished or hindered as long as its existence does not threaten the life of another. Therefore, I believe that it would be unethical for the doctor to perform a transplant using organs that were acquired from a fetus which was created, carried, and aborted for the sole purpose of farming and harvesting its organs. I chose the Kantian philosophical perspective because it is the viewpoint that best reflects my opinion.
The case study reveals that the doctor’s patient is on dialysis, and is suffering from the severe side effects of his treatment, is growing desperate, inpatient, and frustrated by the life-restrictions derived from his illness. The patient cannot work regularly because of his dialysis treatment schedule. His mental and physical state has progressively deteriorated to the point that the patient has threatened to commit suicide if he has to remain indefinitely on dialysis.
In an effort to help her husband, the patient’s wife suggests to the doctor a possible solution that would help her husband’s predicament. The spouse states that she is …show more content…
willing to become pregnant, allow the fetus to grow for at least five-and-a-half months of age, and then abort the fetus for the sole purpose of harvesting the organs needed for her husband’s transplant surgery. The doctor knows that such an organ transplant could be performed, and it would probably have a greater chance at being successful because the graft would probably not be rejected by the patient’s tissues. However, he must consider the moral, ethical, and legal implications of the decision he renders. The doctor’s patient is a male engineer who is 28 year old, married, and has no children. The patient was adopted as a young child and he does not know his biological family. The patient has been on dialysis for at least and is suffering from the severe side effects of his treatment. He has already investigated the possibility of obtaining a transplant. However, due to his adoption and his rare tissue type, it is highly unlikely that a suitable donor or cadaver kidney can be found. Moreover, the patient is depressed and his state of mind is progressively deteriorated. The patient has also threatened to take the active approach of suicide if he has to remain on dialysis indefinitely.
Aside from agreeing to and performing the transplant, there are few alternatives. The doctor can refuse to perform the transplant and order the patient to continue dialysis treatment and wait for a suitable downer. The doctor could also refuse to do the transplant and along with the patient make a more concerted effort to locate the patient’s biological family to acquire a kin-donation.
I believe that it would be unethical, for the doctor to perform the transplant using the farmed organs. My opinion is in accord with the Kantian philosophical perspective. I believe that all life is sacred and therefore wherever it exists, it must be respected and allowed to thrive. If you formulate the maxim “treat all life as sacred” from my opinion, and universalize it, Kant’s’ categorical imperative indicates that this action is morally good and therefore permissible.
On the other hand, if the doctor agrees to the patient’s spouse’s solution, and performs the transplant of harvested organs, the doctor may also be complicit in an unlawful abortion.
A fetus five and a half to six months of age could be declared viable. The current standard for doctor-determined-fetus-viability with respect to lawful abortion was established by the Supreme Court case Planned Parenthood v. Casey, 505 U.S. 833 (1992). According to Anher et.al, who conducted a study on the ethical implications of aggressive obstetric management, a fetus 24 weeks of age should be “regarded as viable” because their survival rate exceeds 50% (Ahner, 2001, p. 124). Furthermore, killing a fetus, especially, when it was created, carried, and then killed for the sole purpose of harvesting its organs violates the “do-no-harm” clause of the doctors Hippocratic
Oath.
Deontology is a normative theory “regarding which choices are morally required, forbidden, or permitted. In other words, deontology is a moral theory that guides and assess an individual’s choices of what he/ she should or should not do (Alexander, L. & Moore, M, 2015, p.1). Deontological theorists stand opposed to consequentialist and their morality theory perspectives. Immanuel Kant (1724–1804), “was the greatest philosopher of the German enlightenment and one of the most important philosophers of all time,” Kant was both an absolutist and a rationalist (Pojman, 2012, p. 122). He believed that rational beings could, by way of reason, develop a set of moral principles which were consistent and could not be overridden (Pojman, 2012).
Author Louis Pojman, in his book, Discovering Right and Wrong (2012), states that Kant’s perspective argues that “morality’s value is not based on the fact it has instrumental value, that it often secures non-moral goods such as happiness, rather, morality is valuable in its own right” (p. 126). Kant believes that good will is the only thing truly intrinsically good (Pojman, 2012). According to his theory, “A good will is a will whose decisions are wholly determined by moral demands” thus, all moral acts derive from duty (Johnson, 2014).
Kant considered all moral duties or obligations to have imperative force, because any mention of duty could be translated into an imperative or command. His work distinguishes to types of imperatives: categorical and hypothetical (Pojman, 2012). The hypothetical imperative formula is very simple; if you want good grades, then study hard in school. A hypothetical imperative is a means ends obligation and not the type of imperative which describes the qualities or peculiarities of a moral action.
On the other hand, the formula for a categorical imperative is simply, study hard in school (Pojman, 2012). Categorical imperatives show proper recognition for the imperial status of moral obligations. These intuitive, immediate, and absolute obligations are commands that all rational agents comprehend “by virtue of their rationality” (Pojman, 2012, p. 128). Kant argues that an agent’s action is moral only when he/ she perform the act for the sake of duty. Furthermore, Kant asserts that the moral quality of a particular act can be found in the principal or maxim on which an individual acts. (Alexander, L, & Moore, M, 2015).
Kantian philosophical perspective maintains that the categorical imperative is a process by which a rational agent can ascertain the morality of any course of action to be taken. The general systematic plan of action of the categorical imperative is to first determine the maxim of the action, then universalize the maxim, and lastly accept a successfully universalized maxim or reject unsuccessful maxim (Pojman, 2012).
While Kant’s theoretical perspective recognizes only one categorical imperative, it proffers three formulations for it. The first is the principle of the law of nature, where an agent should act as through the maxim of his action were by his will become a universalized law of nature. The next one is the principle of ends which states that agents should treat all rational beings as ends in themselves and never as a means to an end. The last formulation is the principle of autonomy, which states that an agent should act in such a manner that his will, can, regard itself while simultaneously making universal law through his maxims (Pojman, 2012).
There are many other philosophies that address morality. Utilitarianism is one such model. Utilitarianism is a normative ethics theory which maintains that the best moral action is the one that maximizes utility producing the most amounts of good. According to the utilitarian perspective an agent ought to maximize the overall good by considering the good of others as well as his/ her own good (Driver, 2014).
According to English philosopher Jeremy Bentham (1748-1832), utilitarianism has two main characteristics known as the consequentialist principle and the utility or hedonist principle. The consequentialist principle holds “that the rightness or wrongness of an act is determined by the goodness or badness of the results that flow from it (Pojman, 2012, p. 103). On the other hand, the utility principle holds that, “An act is right if it either brings about more pleasure than pain or prevents pain, and an act is wrong if it either brings about more pain than pleasure or prevents pleasure from occurring” (Pojman, 2012, p. 103).
(Utilitarian criticism)
Life is paramount to all rational beings; it exceeds, excels, and surpasses all other moral imperatives in class, standing, and privilege. In its absence reason is non-existent, thus making all else moot. It should never be deliberately extinguished or hindered as long as its existence does not threaten the life of another. Therefore, I believe that it would be unethical for the doctor to perform a transplant using organs that were acquired from a fetus which was created, carried, and aborted for the sole purpose of farming and harvesting its organs. I chose the Kantian philosophical perspective because it is the viewpoint that best reflects my opinion.