The Case of Baby Doe

This case of baby Doe was a complex case and a rare one too. It was unfortunate that by that time there were no laws guiding provisions of care as we do today. Today health care managers have more tools in their disposal to help them tackle the challenges of ethical dilemma issues. Both states and federal laws now makes health care managers more aware of ethical issues compared to 1970s, they now closely regulate cases like the one of baby Doe described in page 16 of our text of Ethics in Health Services Management by Darr (2011).

What makes the case of baby Doe an ethical dilemma? Before going into detail of the case of baby Doe, it is very important to understand the term ethical dilemma. According to Darr (2011), “ethical dilemmas occur when decision makers are drawn in two directions by the competing courses of the action that are based on differing moral frameworks, varying or inconsistent elements of the organizational philosophy, conflicting duties or moral principles, or an ill-defended sense of right and wrong.” Page 3

Respect for person is treating every person, as you would want to be treated, and from the case of baby, Doe both the parents and the hospital staffs did not exhibit respect for baby Doe because they allowed him to die without giving him the chance to undergo the surgical procedure offered by the doctors. Both the parents and the hospital knew that the surgery could help baby Doe but denied the surgery basing it on the mental retardation condition which according to the story was not even given time to be properly evaluated. According to Darr (2011), “respect for a person has four elements and the four elements are autonomy, this requires that one act toward others in ways that allow them be self-governing – to choose and pursue courses of action and to do so, a person must be rational and unforced. Other elements of respect for a person are truth telling, confidentiality, and fidelity which is doing one’s duties or keeping one’s word.”

Did the hospital/physicians allow the parent of Doe to be autonomous in their decision- making? The answer to the above question is yes and is because the physicians gave to the parents of Doe all the possibilities and probabilities of the surgical procedure. The procedure presented to the parents had high success rating for the duodenal atresia surgery which according to the physicians would help baby Doe get the necessary nourishment his body would need to survive but the because of his mental retardation condition the parents decided to deny him the procedure hence it resulted into baby Doe’s death. According Christman, John, “Autonomy in Moral and Political Philosophy”, The Stanford Encyclopedia of Philosophy (Spring 2011 Edition), Edward N. Zalta (ed.),

URL = <http://plato.stanford.edu/archives/spr2011/entries/autonomy-moral/>.

“Individual autonomy is define as an idea that is generally understood to refer to the capacity to be one’s own person, to live one’s life according to reasons and motives that are taken as one’s own and not the product of manipulative or distorting external forces.” Retrieved from http://plato.stanford.edu/entries/autonomy-moral/

Beauchamp, Tom, “The Principle of Beneficence in Applied Ethics”, The Stanford Encyclopedia of Philosophy (Fall 2008 Edition), Edward N. Zalta (ed.), URL = <http://plato.stanford.edu/archives/fall2008/entries/principle-beneficence/>. “Paternalism is defined as the intentional overriding of one person’s known preferences or actions by another person, where the person who overrides justifies the action by the goal of benefiting or avoiding harm to the person whose preferences or actions are overridden. An act of paternalism, in short, overrides the value of autonomous choice on grounds of beneficence.” Retrieved from

http://plato.stanford.edu/archives/fall2008/entries/principle-beneficence/

From the above paragraph, one can easily argue that the parents of baby Dow were indeed allow to exercise paternalism because they were allowed by both the physicians and the hospital to deny baby Doe the necessary surgery. According to Darr (2011), “extending the principles of beneficence and nonmaleficence is acceptable for the organization to seek intervention and obtain permission to treat an infant against the parent’s wishes. The moral compulsion to do so is especially great when the parents are not acting in the child’s best interests, but it also noted that this moral duty must be exercised as a last resort.”

Did the hospital/physicians act beneficently? The answer to this question is no and is no because from the definition of beneficence from the Stanford Internet Encyclopedia, “beneficence is the term beneficence connotes acts of mercy, kindness, and charity, and is suggestive of altruism, love, humanity, and promoting the good of others. In ordinary language, the notion is broad; and understood still more broadly in ethical theory, to include effectively all forms of action intended to benefit or promote the good of other persons. The language of a principle or rule of beneficence refers to a normative statement of a moral obligation to act for the benefit of others, helping them to further their important and legitimate interests, often by preventing or removing possible harms.” Retrieved from

http://plato.stanford.edu/archives/fall2008/entries/principle-beneficence/

From the above definition had the physicians and the hospital intervene to stop the parents of baby Doe, one can say yes the exercised beneficence and therefore acted beneficently but in baby Doe’s it was not and the parents’ paternalism prevailed that was why the physicians withdrew the system that provided Doe with nourishment and eventually he died of dehydration.

From the beginning of the case, yes the physicians considered nonmaleficence that was why they recommended surgery for the duodenal atresia. They said it has high success rate and that was the first step in not causing harm to one self but since the parents of Doe did not considered nonmaleficence, they opted to deny him the surgery ultimately causing him his life.

According to Washington department of education, nonmaleficence requires of us that we not intentionally create a needless harm or injury to the patient, either through acts of commission or omission. In common language, we consider it negligence if one imposes a careless or unreasonable risk of harm upon another. Providing a proper standard of care that avoids or minimizes the risk of harm not only supported by our commonly held moral convictions, but also by the laws of society as well. In a professional model of care one may be morally and legally blameworthy if one fails to meet the standards of due care. Retrieved from

http://depts.washington.edu/bioethx/tools/princpl.html#prin2

There was no justice to baby Doe from the side of the hospital to baby Doe. There was no justice from the side of both the hospital and the parents and is because the hospital could have intervened on behave of baby since they know that if the surgery is done it will give baby the nourishment lifeline. Merriam –Webster dictionary define justice as, “the quality of being just, impartial, or fair.” Retrieved from http://www.merriam-webster.com/dictionary/justice

According to Darr (2011), “Rawls defined justice as fairness.” Page 30 from this definition, according Darr it implies that a person get what is due them. Nevertheless, for baby Doe’s case the parents and the hospital did not act in a just way such that they could accord to baby Doe what is due to him and in this case what was due to baby Doe was his life.

The hospital did not do what it could because they did not use the option of nonmaleficence and beneficence which would allow them to act on behave of babe Doe to provide for baby Doe the necessary treatment in that case was the provision of the treatment of surgery. In explaining the condition of baby Doe, the hospital has had explanation adequate for the surgical procedure, but they did not properly explain the mental retardation condition and it was because of the mental retardation condition that made the parents of baby Doe to decide against the surgery for the correction of the duodenal atresia. However, the success rate is very high and could help baby Doe live.

References:

Darr, K. (2011). Ethics in Health Services Management: Health Professions Press, Inc. Baltimore, Maryland 21285-0624
Retrieved on January 08, 2013 from http://depts.washington.edu/bioethx/tools/princpl.html#prin2
Retrieved on January 08, 2013 from http://plato.stanford.edu/archives/fall2008/entries/principle-beneficence/
Retrieved on January 08, 2013 from http://www.merriam-webster.com/dictionary/justice
Retrieved on January 08, 2013 from http://plato.stanford.edu/entries/autonomy-moral/