Roosevelt Dawson Case Summary
For the Roosevelt Dawson case, Dawson a young man who suffered from a viral infection that affected his spine, caused inability to move his limbs and breathing. What we need to keep in mind is that he is not suffering from any severe, untreatable pain or a terminal illness or disease. Also that he is about twenty-one years old.
Based on past cases in this hospital, the hospital board has granted patient's (or whoever was put as the guardian) assistance for breathing and or nourishment. Looking at the patient's competency does not apply to this case, at least in my opinion. He seems to be competent having fulfilled the standards of it, which are: capacity to understand or communicate, capacity to reason or deliberate and have some …show more content…
sort of values and ideal of good. If a patient is competent, the patient has "a right to refuse necessary medical care when they face instructive treatment or life in a compromised state" (Dresser, 1989/2013). In the textbook, Ethical Issues in Modern Medicine discusses that competence should be a "threshold" concept and a patients' decisions will obviously best suit patient's "aims and needs" when competent. Dawson also proves he wants to make significant, medical decisions and has a desire to be independent, seeking out, what would be the best judgment of his own life, based on his values or beliefs. What can be a conflict in others views of his decision of assisted suicide is whether this is the best, possible choice in his current state and age. Also, if the medical professional or physician is not "failing to protect a person [or patient] from [making] harmful consequences of their decision" (Buchanan & Brock, 1986/2013). This is considered an error if the physicians decides this and most importantly, when deciding competency, there has to be a minimal occurrence of error as it states in Buchanan and Brock's "Deciding for Others: Competency." Buchanan and Brock also state that the patient must have a favored choice and express it, which personally I cannot say he has expressed his decision on his life and well-being, but wants to be released from the hospital. Deciding on whether Dawson's being reasonable and rational, based on the social workers’ beliefs of the patient's real intention or actual outcome will be, is questionable since he has not said specifically what he prefers to do with his life, if he gets released from the hospital. But what Buchanan and Brock described when making a competency evaluation by a medical profession on a patient is "[...to] address the process of understanding and reasoning, not the content of the decision"(Buchanan & Brock, 1986/2013). Just comprehending what the patient's decisions are considered competent and as medical professionals should come to conclusions based on those choices.
But let's say Dawson was incompetent, if he didn't fulfill one or more the standards of being competent. For instance one could argue that Dawson may not have a set of values ideals of good due to the social workers beliefs’ of Dawson, wanting assisted suicide and not valuing his life and future. There will have to be an executive power of attorney to make his medical decisions, as well as if he were under anesthetics or unconscious for any reason. But he does fulfill having made his decision, seems to understand and know his alternatives, options and can reason, which gives him about 75% of competency, based on these competency standards.
Now the second case is based on an unnamed baby girl who has no limbs, possibly due to the mother taking thalidomide. Thalidomide is known to (like most prescription drugs) cause birth defects, which was a phenomenon in the 50s and 60s. Many mothers who took this for a certain illness, many of the babies such as in this case had no limbs. Not only does the baby have no legs or arms, but as "abnormalities" of the mouth and throat. What is the conflict or deciding whether to allow the neonatal unit staff to have a court order to perform the surgery and that would nourish the baby. But the mother does not want any of these.
This goes back to the case of the "Baby Doe" controversy and after this the laws that were made. In Robertson's "Extreme prematurity and Parental Rights After Baby Doe," he stated that the general norm is "[...] that all human beings [who are] born alive should be treated equally regardless of disability"(Robertson, 2004/2013). Basically the right to live essentially. Comparing the Baby Doe Controversy to this case is completely relevant. In the 1980s, Baby Doe was born with Down Syndrome, trachea esophageal fistula and esophageal atresia. Esophageal atresia is a digestive system disorder in which the esophagus doesn't develop correctly, leaving the upper esophagus disconnected to the stomach and lower esophagus. What made this case controversial was when the parents refused to consent to an operation that was standard (to help the baby to be nourished by mouth), the hospital in Indiana and doctors wanted approval from a "family court" to perform the operation, even though it was against the parent's decision. That court thought that parents should decide. So then it went up to the Supreme Court to decide, which took time and Baby Doe died before a decision was made. My point in summarizing this event caused a commotion and uproar for premature babies and or rights for babies with disabilities, whether they have a right to life and as well as the parents, if they have a right to decide whether their baby premature and disability, should have treatment if they want their baby to or not. This created the Baby Doe Laws in 1984 which "[...]mandate that federal funding, hospitals and physicians must provide maximal care for any impaired infant, unless exceptions are met. If a physician or parent chooses to withhold full treatment when the exceptions are met, they are liable for medical neglect." Reagan signed it as amendment and it became law. Law had to step in, in order to decide what would or should have happened for the Baby Doe case. If the parents decide to refuse treatment, or in this case of the mother deciding for her unnamed baby, she will be held accountable for her choice of action. As stated in the Baby Doe Laws it says parents can deny treatment if "exceptions are met." These exceptions are if the infant is terminally ill, comatose, or the treatment would be pointless. What makes this difficult is the lean toward treatment over "quality of life." What the CAA (Child Act Amendment) shows more respect for human life (whether it be a disability or not) over parent decision-making. In other words, CAA can be considered "very demanding" and having the baby go through many surgeries, procedures and regulations at such a young age, which should be kept in mind. The baby belongs to the mother, not the hospital or government.
How the Dawson case and the unnamed baby case is similar is the competence level. Dawson seems to be competent in deciding what he wants for his life and the mother, who is the guardian of the baby and has her wishes for her baby's life and the mother, who is the guardian for the baby and has her wishes for her baby's life, is most likely competent. She knows she does not want treatment or surgery for the baby. Both cases are decisions based on life and death, in a sense if Dawson really does seek assisted suicide if he will be released from the hospital. Also that the patient’s are both very young (twenty one year and a less than ten hours old) and have disabilities that they will have to face if they live longer than their wishes or the mother’s wishes. Also they both choose to refrain from living, even though there are other options or alternatives that has a chance for them to survive and have treatment done.
The differences in these cases are that Dawson can decide for himself, basing his beliefs, values or morals on his decision. Also if it is true that he plans on having assisted suicide done rather than the unnamed baby's mother doesn't want the baby to have treatment or surgery. Is it not a clear statement that the mother wants the baby to have an actual pre-meditated murder or death. But that doesn't rule out the high chance or probability the baby will die if she has no treatment. Also that the mother, the guardian is deciding for her baby's treatment because obviously the baby cannot decide for herself or at least state any wishes.
There are four different physician-patient relationship models that can be used in these two cases; paternalistic, informative, interpretive and deliberative. One of the first models that was ideally used in the past was referring to the "Hippocratic Oath," or tradition, which was in other words, a patient-centered consequential approach. Providers basing their directions based on consequences for the patients well-being, which is the opposite of utilitarianism. It can be considered controversial due to how it identifies the patients well being and health. This Hippocratic tradition is considered paternalistic, which Goldman (who wrote "The Refutation of Medical Paternalism") argues that it "[...] fails to recognize the independent value of self-determination and respect that people are entitled to as 'choosing beings"' (Steinbock, London & Arras, 2013). Which mean it fails to respect a person's autonomy, giving away a patient's choices over to, in a way to the medical professional. The paternalistic model, patients receive the invention that will best promote a patient's health and current state. Physicians or the patients condition as well. One might favor this approach for both cases due to having the physician act as a patient's guardian and patient doesn't have any responsibilities. There are objections as I've stated for one that the patient does not know all the possible information if his or her condition would be hurtful to the patient. The patient must also be compliant, therefore physicians hardly recommend this as the ideal model. On the other hand, there is the informative model. In this model, the physician must treat the patient as an equal, gives every kind of factual information to the patient, being truthful and technical. In both cases, patients would know every detail and information possible, but there are of course objections to this model as well. There is no sense of caring approach that the patient would receive from the physician. There is also the interpretative model, which respects the patient's values and beliefs. The physician doesn't give professional advice, but tries to articulate the patient's values. This may seem ideal for Dawson and the unnamed baby cases, but again there is an objection to the interpretive model. The objections are that the physician may not have enough time and skill to interpret the patient's views. Lastly, there is the deliberative model. The physician must determine the best "health-related values" and must information on the patient's situation through a clinical standpoint. Like every model there is objections. One could tell that one objection is that this is "impractical," the physician "[...] judge[s] patients' values and promote particular health-related values" (Emmanuel & Emmanuel, 1992/2013).
Looking at all the professional-patient relationship models, it completely depends on the patients' cases and circumstances, not one model is perfect for every case. For the Dawson and unnamed baby case, I believe the deliberative model would be the best due to a few reasons. The deliberative model does respect the patient's views of autonomy and physician must realize the patient's autonomy in the process of deliberation integral. Also the physician ideally should be caring who must use all the information he or she knows, as well as the patients' values and use these to create the best recommendations for the patient. Also this model is not paternalistic, even though others may feel it is. The physician must also have relevant values to the patient. These reasons may be reasonable enough, but there is always room for improvement and appropriate change for the "best" of the patient. The deliberative model according to the Emmanuels uses all the important, considered best points or characteristics of all the models.
As for philosophies, which always comes into play when it comes to these ethical cases. The first philosophical view I will discuss is autonomy, which I did touch on throughout, but let's go into detail how this plays a role in both cases. Moral autonomy means to be governed by one's own self, a person can make their own decisions. In the Dawson's case, one could say Dawson is being completely autonomous, making his own decisions, in a categorical reasoning way (locates morality in certain duties and rights, regardless of the consequences). Dawson according to autonomic views by John Stuart Mills, that people should have "the capacity to determine their own destiny" and should be respected. The social worker and Dawson's physician are not respecting his wishes or decisions, therefore going against the definition of autonomy. As for the mother and guardian of the unnamed baby, refused to seek treatment on her baby, making her own decisions and deciding the destiny of her child, which somewhat goes against autonomy, but since the baby is barely ten hours old, someone must decide for the baby.
As for another philosophical view, utilitarianism can also be considered in each case. Utilitarianism is "the greatest happiness principle," which philosophers Jeremy Bentham and John Stuart Mills. Greatest happiness could also be known as greatest utility, hence the word utilitarianism. A couple of reasons why Dawson's views aren't utilitarian is for one, if one goes according to the social worker's beliefs, if he wants to have assisted suicide, it is not in everyone's "happiness" and respecting the consequentialist reasoning. Not everyone will be "happy," such as the hospital, most likely family, friends and significant others for care for Dawson and want him to live. One could say according to the cost benefit analysis, he doesn't want to live and make, whoever will be financially responsible, the cost of him living cheaper and end his life. But in this case, the hospital and loved ones do not wish this, therefore would contradict utilitarianism. For the mother's decisions for her baby would probably not be considered in favor of utilitarianism due to her own decisions for the baby, going against what the majority of the neonatal unit staff wants, that's why they want a court order. Remember to always ask for those in favor of utilitarianism, whose views matter more than others?
We should recognize that the Dawson case, the adult is an African-American and has a disability as well as the other patient in the other case is a baby with a disability as well.
In general, patients would belong to the "vulnerable population." In general, there should be no discrimination or bad judgement based on characteristics on the patients, which is obvious and never be forgotten since it is against the law. One should make no assumptions based on stereotypical views and make no difference in hospital care due to their disabilities, but having memberships in these groups should make no difference in hospitals …show more content…
obligations.
Finally I have made my decision and will give the following advice on those two cases.
Dawson, a young twenty one year old man, if according to the social workers’ beliefs of him wanting assisted suicide, they should definitely remind him and tell him again what his alternatives and options are again. Let him realize and think about what he really wants. Also to meet with a psychiatrist to see if he is actually depressed about his current state, if this decision, this is just not a "spur of the moment" decision. They should also ask if this is what he really wants, but not to be paternalistic or advising him suggestions in any way. He could refuse not to see a psychiatrist if he wishes not to. If he does not show any depression, on this is a good sign, but still keep in mind if he really does want to seek suicide. Also for him to consult and speak with his loved ones, if he wishes to. Letting him realize is he does wish to take away his own life once released, he should know for a fact what his family wants. He seems to be competent, knowing what he wants for his decision, but euthanasia is against the law. If we were to keep him in the hospital, it would go against his wishes and him being autonomous. He is a grown man of legal age, can make his own choices, whether it be against the hospital, he can and will do what he wishes with his "destiny." If he really seeks to be released after doing all these requests or suggestions, knowing every possible alternative and
option, I would advise the hospital to release him. No one should be held against their own will and wishes.
As for the mother with the unnamed baby, if this were to happen again, the Baby Doe Laws and Baby Doe controversy must be absolutely sure that she wants the baby to not have any treatment or nourishment. Must know all her alternatives and options. If the mother is completely sure of herself, she doesn't want the baby to have treatment, this must also be respected and carried out. She is liable for her action if she decides this.
Based on past cases in this hospital, the hospital board has granted patient's (or whoever was put as the guardian) assistance for breathing and or nourishment. Looking at the patient's competency does not apply to this case, at least in my opinion. He seems to be competent having fulfilled the standards of it, which are: capacity to understand or communicate, capacity to reason or deliberate and have some …show more content…
sort of values and ideal of good. If a patient is competent, the patient has "a right to refuse necessary medical care when they face instructive treatment or life in a compromised state" (Dresser, 1989/2013). In the textbook, Ethical Issues in Modern Medicine discusses that competence should be a "threshold" concept and a patients' decisions will obviously best suit patient's "aims and needs" when competent. Dawson also proves he wants to make significant, medical decisions and has a desire to be independent, seeking out, what would be the best judgment of his own life, based on his values or beliefs. What can be a conflict in others views of his decision of assisted suicide is whether this is the best, possible choice in his current state and age. Also, if the medical professional or physician is not "failing to protect a person [or patient] from [making] harmful consequences of their decision" (Buchanan & Brock, 1986/2013). This is considered an error if the physicians decides this and most importantly, when deciding competency, there has to be a minimal occurrence of error as it states in Buchanan and Brock's "Deciding for Others: Competency." Buchanan and Brock also state that the patient must have a favored choice and express it, which personally I cannot say he has expressed his decision on his life and well-being, but wants to be released from the hospital. Deciding on whether Dawson's being reasonable and rational, based on the social workers’ beliefs of the patient's real intention or actual outcome will be, is questionable since he has not said specifically what he prefers to do with his life, if he gets released from the hospital. But what Buchanan and Brock described when making a competency evaluation by a medical profession on a patient is "[...to] address the process of understanding and reasoning, not the content of the decision"(Buchanan & Brock, 1986/2013). Just comprehending what the patient's decisions are considered competent and as medical professionals should come to conclusions based on those choices.
But let's say Dawson was incompetent, if he didn't fulfill one or more the standards of being competent. For instance one could argue that Dawson may not have a set of values ideals of good due to the social workers beliefs’ of Dawson, wanting assisted suicide and not valuing his life and future. There will have to be an executive power of attorney to make his medical decisions, as well as if he were under anesthetics or unconscious for any reason. But he does fulfill having made his decision, seems to understand and know his alternatives, options and can reason, which gives him about 75% of competency, based on these competency standards.
Now the second case is based on an unnamed baby girl who has no limbs, possibly due to the mother taking thalidomide. Thalidomide is known to (like most prescription drugs) cause birth defects, which was a phenomenon in the 50s and 60s. Many mothers who took this for a certain illness, many of the babies such as in this case had no limbs. Not only does the baby have no legs or arms, but as "abnormalities" of the mouth and throat. What is the conflict or deciding whether to allow the neonatal unit staff to have a court order to perform the surgery and that would nourish the baby. But the mother does not want any of these.
This goes back to the case of the "Baby Doe" controversy and after this the laws that were made. In Robertson's "Extreme prematurity and Parental Rights After Baby Doe," he stated that the general norm is "[...] that all human beings [who are] born alive should be treated equally regardless of disability"(Robertson, 2004/2013). Basically the right to live essentially. Comparing the Baby Doe Controversy to this case is completely relevant. In the 1980s, Baby Doe was born with Down Syndrome, trachea esophageal fistula and esophageal atresia. Esophageal atresia is a digestive system disorder in which the esophagus doesn't develop correctly, leaving the upper esophagus disconnected to the stomach and lower esophagus. What made this case controversial was when the parents refused to consent to an operation that was standard (to help the baby to be nourished by mouth), the hospital in Indiana and doctors wanted approval from a "family court" to perform the operation, even though it was against the parent's decision. That court thought that parents should decide. So then it went up to the Supreme Court to decide, which took time and Baby Doe died before a decision was made. My point in summarizing this event caused a commotion and uproar for premature babies and or rights for babies with disabilities, whether they have a right to life and as well as the parents, if they have a right to decide whether their baby premature and disability, should have treatment if they want their baby to or not. This created the Baby Doe Laws in 1984 which "[...]mandate that federal funding, hospitals and physicians must provide maximal care for any impaired infant, unless exceptions are met. If a physician or parent chooses to withhold full treatment when the exceptions are met, they are liable for medical neglect." Reagan signed it as amendment and it became law. Law had to step in, in order to decide what would or should have happened for the Baby Doe case. If the parents decide to refuse treatment, or in this case of the mother deciding for her unnamed baby, she will be held accountable for her choice of action. As stated in the Baby Doe Laws it says parents can deny treatment if "exceptions are met." These exceptions are if the infant is terminally ill, comatose, or the treatment would be pointless. What makes this difficult is the lean toward treatment over "quality of life." What the CAA (Child Act Amendment) shows more respect for human life (whether it be a disability or not) over parent decision-making. In other words, CAA can be considered "very demanding" and having the baby go through many surgeries, procedures and regulations at such a young age, which should be kept in mind. The baby belongs to the mother, not the hospital or government.
How the Dawson case and the unnamed baby case is similar is the competence level. Dawson seems to be competent in deciding what he wants for his life and the mother, who is the guardian of the baby and has her wishes for her baby's life and the mother, who is the guardian for the baby and has her wishes for her baby's life, is most likely competent. She knows she does not want treatment or surgery for the baby. Both cases are decisions based on life and death, in a sense if Dawson really does seek assisted suicide if he will be released from the hospital. Also that the patient’s are both very young (twenty one year and a less than ten hours old) and have disabilities that they will have to face if they live longer than their wishes or the mother’s wishes. Also they both choose to refrain from living, even though there are other options or alternatives that has a chance for them to survive and have treatment done.
The differences in these cases are that Dawson can decide for himself, basing his beliefs, values or morals on his decision. Also if it is true that he plans on having assisted suicide done rather than the unnamed baby's mother doesn't want the baby to have treatment or surgery. Is it not a clear statement that the mother wants the baby to have an actual pre-meditated murder or death. But that doesn't rule out the high chance or probability the baby will die if she has no treatment. Also that the mother, the guardian is deciding for her baby's treatment because obviously the baby cannot decide for herself or at least state any wishes.
There are four different physician-patient relationship models that can be used in these two cases; paternalistic, informative, interpretive and deliberative. One of the first models that was ideally used in the past was referring to the "Hippocratic Oath," or tradition, which was in other words, a patient-centered consequential approach. Providers basing their directions based on consequences for the patients well-being, which is the opposite of utilitarianism. It can be considered controversial due to how it identifies the patients well being and health. This Hippocratic tradition is considered paternalistic, which Goldman (who wrote "The Refutation of Medical Paternalism") argues that it "[...] fails to recognize the independent value of self-determination and respect that people are entitled to as 'choosing beings"' (Steinbock, London & Arras, 2013). Which mean it fails to respect a person's autonomy, giving away a patient's choices over to, in a way to the medical professional. The paternalistic model, patients receive the invention that will best promote a patient's health and current state. Physicians or the patients condition as well. One might favor this approach for both cases due to having the physician act as a patient's guardian and patient doesn't have any responsibilities. There are objections as I've stated for one that the patient does not know all the possible information if his or her condition would be hurtful to the patient. The patient must also be compliant, therefore physicians hardly recommend this as the ideal model. On the other hand, there is the informative model. In this model, the physician must treat the patient as an equal, gives every kind of factual information to the patient, being truthful and technical. In both cases, patients would know every detail and information possible, but there are of course objections to this model as well. There is no sense of caring approach that the patient would receive from the physician. There is also the interpretative model, which respects the patient's values and beliefs. The physician doesn't give professional advice, but tries to articulate the patient's values. This may seem ideal for Dawson and the unnamed baby cases, but again there is an objection to the interpretive model. The objections are that the physician may not have enough time and skill to interpret the patient's views. Lastly, there is the deliberative model. The physician must determine the best "health-related values" and must information on the patient's situation through a clinical standpoint. Like every model there is objections. One could tell that one objection is that this is "impractical," the physician "[...] judge[s] patients' values and promote particular health-related values" (Emmanuel & Emmanuel, 1992/2013).
Looking at all the professional-patient relationship models, it completely depends on the patients' cases and circumstances, not one model is perfect for every case. For the Dawson and unnamed baby case, I believe the deliberative model would be the best due to a few reasons. The deliberative model does respect the patient's views of autonomy and physician must realize the patient's autonomy in the process of deliberation integral. Also the physician ideally should be caring who must use all the information he or she knows, as well as the patients' values and use these to create the best recommendations for the patient. Also this model is not paternalistic, even though others may feel it is. The physician must also have relevant values to the patient. These reasons may be reasonable enough, but there is always room for improvement and appropriate change for the "best" of the patient. The deliberative model according to the Emmanuels uses all the important, considered best points or characteristics of all the models.
As for philosophies, which always comes into play when it comes to these ethical cases. The first philosophical view I will discuss is autonomy, which I did touch on throughout, but let's go into detail how this plays a role in both cases. Moral autonomy means to be governed by one's own self, a person can make their own decisions. In the Dawson's case, one could say Dawson is being completely autonomous, making his own decisions, in a categorical reasoning way (locates morality in certain duties and rights, regardless of the consequences). Dawson according to autonomic views by John Stuart Mills, that people should have "the capacity to determine their own destiny" and should be respected. The social worker and Dawson's physician are not respecting his wishes or decisions, therefore going against the definition of autonomy. As for the mother and guardian of the unnamed baby, refused to seek treatment on her baby, making her own decisions and deciding the destiny of her child, which somewhat goes against autonomy, but since the baby is barely ten hours old, someone must decide for the baby.
As for another philosophical view, utilitarianism can also be considered in each case. Utilitarianism is "the greatest happiness principle," which philosophers Jeremy Bentham and John Stuart Mills. Greatest happiness could also be known as greatest utility, hence the word utilitarianism. A couple of reasons why Dawson's views aren't utilitarian is for one, if one goes according to the social worker's beliefs, if he wants to have assisted suicide, it is not in everyone's "happiness" and respecting the consequentialist reasoning. Not everyone will be "happy," such as the hospital, most likely family, friends and significant others for care for Dawson and want him to live. One could say according to the cost benefit analysis, he doesn't want to live and make, whoever will be financially responsible, the cost of him living cheaper and end his life. But in this case, the hospital and loved ones do not wish this, therefore would contradict utilitarianism. For the mother's decisions for her baby would probably not be considered in favor of utilitarianism due to her own decisions for the baby, going against what the majority of the neonatal unit staff wants, that's why they want a court order. Remember to always ask for those in favor of utilitarianism, whose views matter more than others?
We should recognize that the Dawson case, the adult is an African-American and has a disability as well as the other patient in the other case is a baby with a disability as well.
In general, patients would belong to the "vulnerable population." In general, there should be no discrimination or bad judgement based on characteristics on the patients, which is obvious and never be forgotten since it is against the law. One should make no assumptions based on stereotypical views and make no difference in hospital care due to their disabilities, but having memberships in these groups should make no difference in hospitals …show more content…
obligations.
Finally I have made my decision and will give the following advice on those two cases.
Dawson, a young twenty one year old man, if according to the social workers’ beliefs of him wanting assisted suicide, they should definitely remind him and tell him again what his alternatives and options are again. Let him realize and think about what he really wants. Also to meet with a psychiatrist to see if he is actually depressed about his current state, if this decision, this is just not a "spur of the moment" decision. They should also ask if this is what he really wants, but not to be paternalistic or advising him suggestions in any way. He could refuse not to see a psychiatrist if he wishes not to. If he does not show any depression, on this is a good sign, but still keep in mind if he really does want to seek suicide. Also for him to consult and speak with his loved ones, if he wishes to. Letting him realize is he does wish to take away his own life once released, he should know for a fact what his family wants. He seems to be competent, knowing what he wants for his decision, but euthanasia is against the law. If we were to keep him in the hospital, it would go against his wishes and him being autonomous. He is a grown man of legal age, can make his own choices, whether it be against the hospital, he can and will do what he wishes with his "destiny." If he really seeks to be released after doing all these requests or suggestions, knowing every possible alternative and
option, I would advise the hospital to release him. No one should be held against their own will and wishes.
As for the mother with the unnamed baby, if this were to happen again, the Baby Doe Laws and Baby Doe controversy must be absolutely sure that she wants the baby to not have any treatment or nourishment. Must know all her alternatives and options. If the mother is completely sure of herself, she doesn't want the baby to have treatment, this must also be respected and carried out. She is liable for her action if she decides this.