BIOLOGY 4

MODULE 1.3 | APPLYING THE PRINCIPLES OF BIOETHICS

ASSIGNMENT 6
LYZTER JOHN DEUDA
12 - A

Instruction: Consider the following scenario. Discuss briefly the Ethical Principles
involved on the following cases presented, based on the discussion on the Principles of
Bioethics from the previous lesson (Principle of Autonomy, Principle of Beneficence,
Principle of Non-Maleficence, and Principle of Justice -McCormick, 2018). This is a
graded assessment.

Case 1
Ethical Principles involved: The case involves the Principle of Autonomy, specifically
Paternalism, and the Principle of Beneficence. In the situation given, the patient, due to
shock, fear, or any other underlying mental illness, is refusing to get treatment that could
save her life because of fear that she will get a scar that will affect her work. The
physicians upheld the Principle of Paternalism by taking over the patient’s right to decide
for herself on matters regarding their body or health and performing the surgery. By doing
so, the physicians also upheld the Principle of Beneficence, as they performed an action
with the intent of promoting an individual’s wellbeing by preventing or removing any harms
threatening the individual, which in this case, led to the patient surviving a deadly
aneurysm. However, the actions were done against the patient’s will or consent.
Questions:
1. Do you believe that the physician's actions can be justified in any way? Is
there anything else that they could have done?

The physician’s actions can be justified. Physicians swore by an oath

to ensure that the best means to preserve life and health are faithfully
followed. The woman was willing to risk her life for a superficial, unsure, and
temporary issue: a scar. The physician, as any other sane person, simply
concluded that she was mentally unwell, probably due to the shock brought
about by the life-threatening aneurysm and the fact that the only way to
save her is a risky procedure that could also end her life.
The physician could have asked consent from the woman’s civil
partner (husband or wife), family, next of kin, or any individual that has been
legally granted the right to decide for the patient’s autonomy.
 2. Is it ever right to take away someone's autonomy? (Would a court order make
the physicians' decisions ethical?) What would you do if you were one of the
health care workers?

In an ideal world, it is never right to take away someone’s autonomy,

or any right for that matter. One should be able to make their own decisions,
especially on matters regarding their body and life. However, medicine, or
in any field that deals with the life and death of individuals, is complicated
and full of gray areas where right and wrong become blurry. In cases where
an individual can harm other people, including themselves, by asserting
their right to bodily autonomy, those who have the power, knowledge, and
legal authority to prevent such tragedies from occurring should exercise
authority over the individual’s autonomy. This should happen regardless of
any court order; however, a court order could make exercising unilateral
authority over another individual easier by helping people like physicians
avoid any legal repercussions in the future. Nevertheless, this should only
be done in extreme cases when all other alternatives that do not step on the
individual’s rights have been exhausted.
If I were one of the healthcare workers, I would have reassured the
patient that their fear, in this case getting the scar, is somewhat impractical
as it could easily be removed through surgery or other dermatological
solutions such as creams or lotion. Additionally, we should have gotten an
expert on mental health or any individual that could reason out with the
patient such as their family or friends. The patient was clearly in a state of
shock and fear as her life was hanging by a thread. The healthcare workers
should have given her time with some people she is comfortable with and
let them convince her to take the surgery to prevent violating the patient’s
right to autonomy.

Case 2
Ethical Principles involved: The case involves the Principle of Beneficence. In the
situation given, the doctor observes the horrific scene of a child covered in bruises and is
in unimaginable pain. The doctor seeks to perform an action that will benefit the child,
and other individuals that are practicing the “cao gio”. By debating with the mother and
threatening to report to Child Services, the doctor will help prevent future harm and
improve the situation of others.
Questions:
1. Should we completely discount this treatment as useless, or could there
be something gained from it?

There is always something that we could gain from every experience

that we encounter. Before we condemn or take any action on the “cao gio”,
we should first try and understand where the mother was coming from. We
should conduct research and gather more information regarding the
treatment, discuss with peers and other experts, and try to identify if there
are any benefits or long-term harm behind the treatment. However, even
when the treatment has no practical uses in practical medicine, it can benefit
the field of medicine and the medical community through political means.
In most places in the world, healthcare is not easily accessible. In
some places, healthcare is non-existent or impossible to access. Most
places lack healthcare facilities such as hospitals and clinics, and even
when facilities are present, there is a high chance that the technology,
practices, or equipment they use are outdated and ineffective. Moreover,
some are just too poor to afford healthcare. Because of this injustice and
lack of accessible healthcare, majority of the people rely on treatments such
the “cao gio” that have been passed down in their respective communities
to handle health issues. Some treatments involve scientifically proven
means such as herbal medicine. However, some are just downright voodoo
magic or baseless treatments, such as faith healing, that could lead to
further harm and even death of an individual. We could use the case with
the mother and child to call for accessible healthcare from our governments
as everyone has the right to proper healthcare. Nobody must go through
painful and even baseless treatments just because they are too poor and/or
because the hospitals or clinics are too far.

2. When should a physician step in to stop a cultural practice? (If someone

answers "when it harms the child" remind that person that there is some
pain in many of our medical procedures, for example, having one's tonsils
removed)

Cultural or traditional practices have been a part of countless

communities for centuries. It has been passed down from generation to
generation and has shaped entire cultures, civilizations, and even our
modern practices, especially medicinal practices.
A physician should condemn and stop a cultural practice when it
seeks to replace modern medicine, despite having no scientific proof and is
sabotaging or endangering the health of numerous individuals, such as the
case in Cebu City when their local government promoted the use of “steam
inhalation” for COVID 19. Furthermore, doctors should step in when it
 involves individuals who cannot decide for themselves such as minors or
those mentally incapacitated. However, physicians should try their best to
discuss with those who practice these harmful cultural practices and
respectfully convince them that what they are doing is wrong.

3. Should the physician be concerned about alienating the mother and other
people of her ethnicity from modern medicine? Do you think that the
physician should report the mother?

The physician should be very concerned about alienating the mother

and her people from modern medicine. Some cultural or traditional practices
have been with communities for a long time. There are communities which
consider these practices crucial culturally, spiritually, and even mentally.
The physician must therefore take extra effort that the mother and her
people will not be dissuaded from using modern medicine. The physician
must carefully explain to them the benefits of modern medicine, how they
work, and how they are not things to be afraid of.
Before reporting the mother, the physician should first educate
themselves first regarding the “cao gio”. Next, the physician should inform
the mother their findings regarding the “cao gio”. If it has some benefits,
discuss with the mother some alternatives that are more effective or, at
least, less painful. The doctor could also try to give them a way that they
can continue their tradition while incorporating modern medicine. However,
if it is truly harmful with no medical benefits, the physician must warn the
mother and respectfully persuade her to abandon the treatment anymore. If
ever the mother continues to use such dangerous acts and the child’s health
worsens, only then should the physician try to reach out to the proper
authorities. Overall, the physician should practice extreme patience as
cultural or traditional practice have been with some communities for such a
long time. These communities were able to “survive with those practices”,
so it should be no surprise that they would prefer methods that were “proven
and tested” by their ancestors for generations.

Case 3
Ethical Principles involved: The principles involved are the Principle of Beneficence
and the Principle of Justice. Greg being able to think about the safety of his peers and
other people showcases his adherence to the Principle of Beneficence. By isolating
himself, he will avoid infecting his peers or any individual he encounters, he will be
committing an act for the benefit of others or help prevent harming others.
Consequentially, this shows the Principle of Justice, as it shows respect for equal rights,
specifically the people’s right to safety.
Questions:
1. Should Greg have a moral obligation to stay home?

Greg has a moral obligation to isolate himself from other people and
stay at home. A member of society has a moral obligation to think of the
collective good, or the good that would benefit the society they are part in
and all the members in said society. Furthermore, as a public health major,
Greg should know the dangers of infectious diseases and the role of every
individual when it comes to protecting the public’s health.

2. How should Greg balance his responsibility to himself with his

responsibility towards Alison? Towards other people?

Greg must prioritize his own health. His ability to think about other
people’s health and the consequences of his actions in a wider scope is a
skill that most people lack. Greg’s knowledge regarding public health and
his appreciation of the value of thinking for the benefit of others will make
him a valuable public health official and a productive member of society.
Greg must therefore survive for society, and the world in general, to benefit
from his skills.
First, Greg must contact a physician, preferably the school physician
so the professor would trust the recommendations more. Greg should get
himself examined and discuss with the physician if it is possible for him to
continue with the presentation. Next, Greg should inform his professor that
he is sick and ask for the presentation to be postponed, regardless of
whether or not it is possible for Greg to continue as he must prioritize his
own health above all. If the professor insists that the presentation must
continue, then Greg must therefore try to do his responsibility towards
Alison and the others. If the physician strictly advised Greg to stay at home
and rest, then Greg should do so and just report to the proper channels that
his professor was strictly unfair and that he was forcing students to be in
harm’s way. However, if the physician said that it was possible for Greg to
go on with the presentation, then he should continue. He must follow all
safety measures such as wearing masks, practicing social distancing, and
practicing proper hygiene like washing his hands often.
By doing these, Greg should be able to maintain his grades and
health while also being able to protect the people around him. Greg would
consequently balance his responsibilities to himself and other people.
 3. Would his obligations be different if he had something other than the flu?
What values play into Greg's decision?
Greg’s obligations will not be entirely different if he had something
other than the flu. He would still have to take care of himself first and others
later. He should still try and ask for the presentation to be rescheduled to
recover, even if the disease was not as contagious as the flu or that serious,
since he could still burden his groupmates and sabotage his grades by not
performing well due to the discomfort and, possibly, pain.

Case 4
Ethical Principles involved: The principles involved are the Principle of Autonomy
(Paternalism) and the Principle of Beneficence as it involves doctors trying to take over
an individual’s right to decide for themselves in terms of health-related decisions and the
preservation of lives or actions done for the benefit of others.
Questions:
1. Were the parents of Tanya Tarasoff right in filing a suit against the
University of California?

The parents of Tanya Tarasoff were right in filing a suit against the
University as the psychologist and his superior abandoned some ethical
principles, which led to the death of an individual. However, the doctors did
so to uphold a right of an individual to protect their privacy and data, or,
specifically in this case, the “patient-doctor confidentiality. It was arguably
the best move as it led to reforms regarding the “patient-doctor
confidentiality” and some data privacy laws, therefore preventing
unnecessary deaths in the future should a similar case arise.

2. Is the consulted Psychologist duty-bound to execute a warning to the

person to whom his/her patient has threatened to harm? What about the
patient-doctor relationship, in which confidentiality is an utmost
concern?

Looking at the case in an objective point of view and with the

principles of Consequentialism, Beneficence, Casuistry, and Paternalism in
mind; yes, the psychologist had a moral and professional obligation to warn
the person that their patient has threatened to harm.
 While I do understand the importance of data privacy, the patient-
doctor confidentiality agreement, and the possibility that revealing sensitive
information could lead to some complications, especially in the law or legal
aspects, but in this particular case, doctors should always weigh the
possible risks and prioritize preserving life as much as possible. Saving lives
are what doctors were bound to do in the first place.

3. What principle of Bioethics is at play in this particular scenario?

The Principle of Consequentialism, Principle of Beneficence, and
Principle of Paternalism can be observed in this tragic case.
The psychologist’s attempt at trying to hospitalize the patient despite
the patient’s refusal showcases the Principle of Paternalism and
Beneficence in action as the doctor tried to take over Poddar’s autonomy
as the doctor have concluded that Poddar is not fit to do so and that he
could harm himself and possibly other people.
Meanwhile, the psychologist and his superior’s adherence to the
patient-doctor confidentiality agreement shows the Principle of
Consequentialism and Beneficence being upheld and, at the same time,
violated. The doctors opting to protect sensitive patient information was a
product of the Principle of Consequentialism and Beneficence because if
the family reported the authorities on Poddar after receiving information
about the threat, and everything Poddar said turned out to be hollow threats,
then the school and the doctors could have faced some legal repercussions
as they could have destroyed Poddar’s life through, for lack of a better term,
“slander”. The doctors, being the professionals that they are, could have
never thought that someone would actually murder an individual over some
misunderstanding of feelings. However, the doctors also failed to follow the
Principle of Consequentialism and Beneficence as they did not pursue the
outcome that is the “most good”, which in this case is preventing the death
of an innocent young girl.