According to Darr (2011), ethics are the principles of a morality of duty and obligation and separate the right from the wrong. Ethical dilemmas are situations where individuals are supposed to make a single decision or take one action between two options that have a competing course of actions based on differing moral principles (Darr, 2011). In healthcare facilities, the promotion of quality patient care and safety is based on ethical morals from the administrators and employees of the healthcare affiliation. Even though all attempts are made to uphold patient care ethics in the hospital setting, some ethical dilemmas emanate from complicated cases of decision-making. These dilemmas are often characterized by the difficulty of finding a morally best solution to address the medical conditions of the patient; following one solution transgresses the ethical morals of the other (Darr, 2011).
Response to the Baby Doe Case
Why it is an Ethical Dilemma
Ethics and laws are related where each component affects the other in a dynamic way. In most cases, ethical standards in healthcare facilities are consistent with legal standards and requirements in health care (Rawbone, 2015). However, there are some circumstances in which the legal standards clash with ethical standards and moral duty in health care. When ethics and legal laws collide, an ethical dilemma ensues (Darr, 2011). The ethical dilemma, in this case, involves legal issues. In the case of Baby Doe, the ethical dilemma was whether to let the child die and be relieved of suffering from the Down’s syndrome or treat the child of tracheoesophageal fistula and let him live with Down’s syndrome which would have caused suffering in his life. There was a collision between the legal concept and the ethical concept of the hospital. The legal component here was the Right to Life of Michigan which prohibited euthanasia whereas the moral component was that the hospital center and the parents of Doe had resolved to let him die to relieve him of potential suffering from Down’s syndrome which he was infected with.
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Implications of this Case in Terms of Moral Principles
Baby Doe’s case can be analyzed in terms of four ethical principles; respect for persons, beneficence, nonmaleficence, and justice. In terms of respect for persons, autonomy or self-governance in decision making is provided for. Nonetheless, honesty in information, confidentiality, and keeping promises are components of this principle (Rawbone, 2015). In baby Doe’s case, the parents were given autonomy in decision-making regarding the condition of their son. By being in acceptance of the doctor’s advice that they should let their son die, the parents exercise their autonomy in decision-making. Similarly, the doctor did not restrict their authority in decision-making based on his advice and therefore there was no element of paternalism. Beneficence principle of ethics implies positive duties in healthcare by offering benefits and balancing them with harm (Bidgood, 2015). As per positive duty, the doctor was supposed to do all he could to save the life of bay Doe. This was not the case as the doctor suggested that the child is left to die. Therefore, in this case, the hospital did not act beneficently. However, in terms of balancing benefits and harms, the hospital acted beneficently. Due to the fact that the risks of living with Down’s syndrome outweighed the implications of letting the child die, the hospital could not exercise kindness thus the decision was made.
Nonmaleficence principle requires that no harm or at least the least harm should be inflicted in healthcare so as to reach a beneficial outcome (Darr, 2011). In terms of nonmaleficence, the hospital conformed to the principle. The act of withdrawing medical care from baby Doe was risky and caused discomfort and even worse it had the harm of causing death but it was meant to prevent a worse situation from occurring as the child would become retarded from Down’s syndrome (Bidgood, 2015). Lastly, in medical care justice implies fair treatment of individuals, equality in treatment, and equitable treatment of individuals (Rawbone, 2015). The hospital did not act justly as the obstetrician led to the withdrawal of medical care from baby Doe. He should have been treated equally and fairly as other patients but was starved to death.
My Thoughts on the Actions of the Hospital in the Case
In my thoughts, the hospital did not do all it could. Without surgery to open the esophagus, baby Doe would not be able to eat. Even worse, he was starved for six days without food and water. Even though the surgery had more than a 90% success rate, the doctor vetoed to perform it and advised the parents who accepted the decision (Bidgood, 2015). With the rate of surgery success being that high, I think that the hospital would have performed it to avoid starvation of the child. Although the nurses from the hospital advanced a case to save the child through surgery, the decision of the obstetrician who had examined baby Doe prevailed. Even though the doctor argued that the child would be retarded, children with Down’s syndrome have right to life like normal and healthy ones. Therefore, causing the death of a retarded child or one with Down’s syndrome by withholding medical care is a violation of their civil rights.
References
Bidgood, J. (2015, September 21). Details Emmerge in Massachussets 'Baby Doe' Case as Couple Are Arraigned. The New York Times , pp. 26B-27B.
Darr, K. (2011). Ethics in Health Services Management (5th ed.). Baltimore, Maryland: Health Professions Press Inc.
Rawbone, R. (2015). Principles of Biomedical Ethics (7th ed.). Oxford: Oxford University Press.
