The Case Study
Jessica is a 30-year-old immigrant from Mexico City. She and her husband Marco have been in the U.S. for the last 3 years and have finally earned enough money to move out of their Aunt Maria’s home and into an apartment of their own. They are both hard workers. Jessica works 50 hours a week at a local restaurant, and Marco has been contracting side jobs in construction. Six months before their move to an apartment, Jessica finds out she is pregnant.
Four months later, Jessica and Marco arrive at the county hospital, a large, public, nonteaching hospital. A preliminary ultrasound indicates a possible abnormality with the fetus. Further scans are conducted and it is determined that the fetus has a rare condition in which it has not developed any arms, and will not likely develop them. There is also a 25% chance that the fetus may have Down syndrome.
Dr. Wilson, the primary attending physician is seeing Jessica for the first time, since she and Marco did not receive earlier prenatal care over concerns about finances. Marco insists that Dr. Wilson refrain from telling Jessica the scan results, assuring him that he will tell his wife himself when she is emotionally ready for the news. While Marco and Dr. Wilson are talking in another room, Aunt Maria walks into the room with a distressed look on her face. She can tell that something is wrong and inquires of Dr. Wilson. After hearing of the diagnosis, she walks out of the room wailing loudly and praying out loud.
Marco and Dr. Wilson continue their discussion, and Dr. Wilson insists that he has an obligation to Jessica as his patient and that she has a right to know the diagnosis of the fetus. He furthermore is intent on discussing all relevant factors and options regarding the next step, including abortion. Marco insists on taking some time to think of how to break the news to Jessica, but Dr. Wilson, frustrated with the direction of the conversation, informs the husband that such a choice is not his to make. Dr. Wilson proceeds back across the hall, where he walks in on Aunt Maria awkwardly praying with Jessica and phoning the priest. At that point, Dr. Wilson gently but briefly informs Jessica of the diagnosis, and lays out the option for abortion as a responsible medical alternative, given the quality of life such a child would have. Jessica looks at him and struggles to hold back her tears.
Jessica is torn between her hopes of a better socioeconomic position and increased independence, along with her conviction that all life is sacred. Marco will support Jessica in whatever decision she makes, but is finding it difficult to not view the pregnancy and the prospects of a disabled child as a burden and a barrier to their economic security and plans. Dr. Wilson lays out all of the options but clearly makes his view known that abortion is “scientifically” and medically a wise choice in this situation. Aunt Maria pleads with Jessica to follow through with the pregnancy and allow what “God intends” to take place, and urges Jessica to think of her responsibility as a mother.
Write an analysis of "Case Study: Fetal Abnormality." Be sure to address the following questions:
1. Which theory or theories are being used by Jessica, Marco, Maria, and Dr. Wilson to determine the moral status of the fetus? Explain.
2. How does the theory determine or influence each of their recommendation for action?
3. What theory do you agree with? How would the theory determine or influence the recommendation for action?
Ethics in medical care require making decisions between preserving life and taking away an individual’s life. Different strands of thought in ethical decision making exist that shape the decisions that are formed by practitioners within the field of medical care. These are utilitarianism and deontological approach. These theories guide the ethical dilemmas that exist in conflict on duty. This is based on four fundamental principles of autonomy, beneficence, nonmaleficence, and justice (Garbutt & Davies, 2011). This essay analyses the application of utilitarianism in the fetal abnormality case study.
Proponents of this theory base their decisions on actions that maximize the utility of the individual. This means that the sum of all pleasures that will be derived from a situation need to uphold the basic happiness principle. Utilitarian approach is based on decisions that lead to the greatest benefit to the individual and achieving of total utility (Harriss, 2005). This is a consequentialism approach where outcomes are based on morality of the intervention that maximizes pleasure and reduces pain. Every decision that a medical practitioner arrives at is based on a balance between benefits and harms without considering other factors like past experiences or evidence (Rachels & Rachels, 2012). This means that the healthcare system and resources need to be used to achieve the best outcome to the patient. In making medical decisions practitioners are required to weigh circumstances and the state of the decisions to determine the benefit that the result of the decision will bring to the patient.
Mandal, Ponnambath, & Parija, (2016) suggest that deontology is an ethics of duty that looks at the morality of the action and the nature of the action. This means that the decision may be good for the individual but may not produce a benefit for the society (Norcross, 2009). This means that the relationship between the doctor and the patient is deontological in nature to control medical negligence. This means that the doctor should consult the patient and give all the available options to allow the patient to make a decision on which course of action that can be taken.
From the utilitarian approach, two courses of action can be weighed against each other to determine the pain and pleasure that each action will bring. The action that brings the highest number of utilities is the one that will be adopted. This should be a balance between the degree of pain and pleasure that the individual will receive from a certain action that is taken towards the individual (Mill, 2011). The decision that the doctor, the patient and other interested parties in the case arrive at should be based on maximum pleasure and the interests of all the parties. This means that the decision of a safe abortion or keeping the pregnancy should be based on the feeling of the mother and the life that the baby will lead in case it grows to birth.
Ethical Decision Making in Medical Care
Consequentialism allows the parties involved to meet the consequences of the situation. This entails keeping the pregnancy and see the baby suffer the challenges of the deformity or having a safe abortion to save the baby and suffer maternal blues that are associated with the pregnancy. Further, the welfare suggests that the rightness and wrongness of any decision is based on the effect that it has on the wellbeing of the society. The child’s wellbeing is the determining factor since the parents have to make a decision that will determine the kind of life in future. The decision to keep or remove the pregnancy is thus based on the decision between losing the baby to save it from the worst future that it will lead or save the baby and expose it to a future that will be challenged by life deformities.
Utilitarianism is based on the decision that maximizes utility and brings the best pleasure in life. This means that the doctor and the patient need to be influenced by the need to achieve pleasure for the patient (Mandal, Ponnambath, & Parija, 2016). This theory will influence the decision that will be arrived at since it is a decision of maximizing utility and bringing the best pleasure to the fetus. Therefore the decision that Jessica will make regarding the pregnancy need to be based on the best pleasure by weighing the right thing to do to achieve maximum happiness for herself and the baby
Ethical theories emphasize the right to life but are limited to the conditions that the same life will lead the individual to. In choosing whether to protect or take life, the decision is based on the benefits that the society will receive when such a life is taken. This means that rightness and wrongness of a decision will depend on the circumstances of the situation.
Garbutt, G., & Davies, P. (2011). Should the practice of medicine be a deontological or utilitarian enterprise? Journal of Medical Ethics, 37, 267-270.
Harriss, I. (2005). Ethics and euthanasia: natural law philosophy and latent utilitarianism. 12th Annual Conference of Australian Association for Professional and Applied Ethics .
Mandal, J., Ponnambath, D. K., & Parija, S. C. (2016). Utilitarian and deontological ethics in medicine. Journal of Tropical Parasitology, 6(1), 5-7.
Mill, J. S. (2011). A System of Logic, Ratiocinative and Inductive. Forgotten Books.
Norcross, A. (2009). Two Dogmas of Deontology: Aggregation, Rights and the Separateness of Persons. Social Philosophy and Policy, 26, 81-81.
Rachels, J., & Rachels, S. (2012). The Elements of Moral Philosophy. McGraw-Hill Higher Education.
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