Ethical Issues
Autonomy – The ideal of self-determination is the basis for autonomy. It is important that a patient be allowed to decide what should be done to his or her own body. In other words, nobody else has the right to assert their power over another. Likewise, a physician should be allowed to decide not to perform a procedure if doing so would conflict with his or her values. In the Cruzan case, Nancy’s autonomy by way of her parents’ substituted judgment was overridden in favor of the State of Missouri’s policy to preserve life. Although the Supreme Court did not deny that Nancy had the right to refuse nutrition/hydration, there was not enough clear and convincing evidence to know that refusal was what Nancy truly wanted. Also, the autonomy of the hospital staff was taken into consideration because they did not feel it was right to withdraw treatment without a court’s consent. At first glance, it may seem that Nancy’s autonomy was not taken into consideration because her parents had to wait so long for the courts to agree to withdraw nutrition/hydration. However, the courts were actually erring on the side of caution because there was no advance directive indicating refusal of treatment as an option. Once Nancy’s parents found three more witnesses to attest to her wishes, the Supreme Court agreed that Nancy would have wanted refusal of treatment.
Beneficence/nonmalificence – Physicians strive to do what is good for the patient while avoiding doing harm in the process. In the Cruzan case, the definition of good may be debatable. Some may see preserving life as doing good, while others may argue that using life-sustaining interventions that have little or no benefit is doing more harm than good. Moreover, there is a question of who is to decide what is considered “good” for a patient when the patient is incompetent. Is it the physician, the family, State, or Supreme Court? The physician has medical knowledge of what will sustain life while the family has knowledge of the patient's wishes. The State of Missouri has a policy emphasizing preservation of life that intends to protect the citizens of that State, while the Supreme Court has a duty to do what is good according to the Constitution in order to protect the rights of American citizens. In the end, the decision to withdraw nutrition/hydration could be seen as an act th...
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...dgment as to how that very patient would act if he or she was competent. The surrogates in the Cruzan case were Nancy’s parents. The surrogate, whether he or she has received written documentation, oral communication, or no communication at all by the patient, gives or declines consent to recommendations for treatment from the physician. If the patient has documented or orally communicated his or her wishes for treatment prior to the onset of incompetence, the surrogate should use substituted judgment. In the Cruzan case, the state of Missouri (like many other states) required clear and convincing evidence concerning Nancy’s feelings about consenting to treatment. The state required clear and convincing evidence because they did not want to impinge on Nancy’s autonomy; they also believed that in considering her autonomy it would be better to err and keep her alive than err and end her life. A surrogate decision maker is needed in place of an incompetent patient to accept or refuse consent to treatment in end-of-life issues, but they are only efficient in using substituted judgment when clear and convincing evidence exists concerning the wishes of the once competent patient.
Alan Goldman argues that medical paternalism is unjustified except in very rare cases. He states that disregarding patient autonomy, forcing patients to undergo procedures, and withholding important information regarding diagnoses and medical procedures is morally wrong. Goldman argues that it is more important to allow patients to have the ability to make autonomous decisions with their health and what treatment options if any they want to pursue. He argues that medical professionals must respect patient autonomy regardless of the results that may or may not be beneficial to a patient’s health. I will both offer an objection and support Goldman’s argument. I will
Although the hospital was following the directive in order to maintain legal immunity for its hospital staff, the rights of the family were violated along with the medical fundamental principle to “first, do no harm”. First of all, despite the wishes of Marlise Munoz, she continued to receive the help of machines and hospital staff at John Peter Smith Hospital even after being declared dead. Marlise was found on her kitchen floor after more than an hour without oxygen on November 26, 2013. Arriving at the hospital, the staff placed Marlise on life support in accordance with section 166.049 of the Texas Advance Directives Act. The directive states, “A person may not withdraw or withhold life-sustaining treatment under this subchapter from a pregnant patient.”
... others with decision making at the end of life through the Cruzan Foundation.The Cruzan case drew national attention, and the family was put under media throughout the process. Missouri now allows health care directives (though not living wills) to instruct that medically assisted nutrition and hydration be removed after a diagnosis of permanent or persistent vegetative state has been made. The Cruzan case became the first "right to die" argument ever heard by the United States Supreme Court.
Four doctors, three terminally ill patients, and a nonprofit organization called Compassion in Dying, came together to file a suit arguing that prohibiting PAS is against a person’s right to liberty (Illingworth & Parmet, 2006). This became known as the Washington et al. v. Glucksberg et al. case. This case went to the Supreme Court in January of 1997 and by that following June was ruled constitutional to uphold PAS as illegal (Washington et al. v. Glucksberg et al., 1997). The penalty for any assistance in a ...
Because the Missouri Supreme Court ruled against the removal of Nancy Cruzan’s artificial hydration and nutrition on the grounds that “clear and convincing” evidence of Nancy’s wishes was not provided, the Cruzan family appealed the decision to the United States Supreme Court arguing that Nancy was being deprived of her right to refuse medical treatment. The Supreme Court ruling affirmed that competent patients have the right to refuse unwanted medical treatment, but also noted that incompetent patients are not capable of exercising this right. Consequently, states may establish their own safe-guards to govern cases in which a substituted decision maker wishes to refuse treatment for an incompetent patient. This ruling therefore upheld the decision of Missouri’s Supreme Court.
Henry Ford was born in Michigan and was the first of William and Mary Ford's six children. With his great imagination, he was fascinated by technology and spent lots of time inspecting watches and trinkets to see how things worked. (Auto 2). Henry began constructing things at a very young age since he did not have much interest in school. Ford learned at a young age the importance of money but since he was so young he failed to understand that staying in school and getting a degree would get you a good job and in turn get you money. Ford thought that if he did not attend school during the day he could work and make more money. Although this is different from what many people think when they hear one of the biggest and most largely known entrepreneurs but it is true. Ford dropped out of the school at the age of fifteen and began working at a relative’s farm. In 1879, sixteen-year-old Ford left home for the nearby city of Detroit to work as an apprentice machinist, although he did occasionally return to help on the farm. He remained an apprentice for three years and then returned to Dearborn. During the next few years, Henry divided his time between operating and repairing steam engines, finding occasional work in a Detroit factory, and over-hauling his father's farm implements, as well as lending a reluctant hand with other farm work. Upon his marriage to Clara Bry...
The so-called ‘right to life’ debate has been beaten to death with no resolution in sight…but what of the ‘right to die’ issue? In California, legislation was passed last year that allows terminally ill patients, who are not expected to live more than six months, to request physician-assisted suicide. However, as with the other four states that have adopted similar legislation, the patient must be capable of administering the lethal drug to himself or herself, medical personnel are not required to participate in any way, and the relief does not benefit any others, such as quadriplegics or those suffering from chronic debilitating diseases("State-by-State Guide to Physician-Assisted Suicide"). Therefore, healthcare professionals can choose to follow their own moral values regardless of the patient’s wishes…and they do. The option to choose not to follow a patient’s wishes, or to deny assistance, steps squarely on the personal rights and freedoms of the
Autonomy is a concept found in moral, political, and bioethical reasoning. Inside these connections, it is the limit of a sound individual to make an educated, unpressured decision. Patient autonomy can conflict with clinician autonomy and, in such a clash of values, it is not obvious which should prevail. (Lantos, Matlock & Wendler, 2011). In order to gain informed consent, a patient
A divergent set of issues and opinions involving medical care for the very seriously ill patient have dogged the bioethics community for decades. While sophisticated medical technology has allowed people to live longer, it has also caused protracted death, most often to the severe detriment of individuals and their families. Ira Byock, director of palliative medicine at Dartmouth-Hitchcock Medical Center, believes too many Americans are “dying badly.” In discussing this issue, he stated, “Families cannot imagine there could be anything worse than their loved one dying, but in fact, there are things worse.” “It’s having someone you love…suffering, dying connected to machines” (CBS News, 2014). In the not distant past, the knowledge, skills, and technology were simply not available to cure, much less prolong the deaths of gravely ill people. In addition to the ethical and moral dilemmas this presents, the costs of intensive treatment often do not realize appreciable benefits. However, cost alone should not determine when care becomes “futile” as this veers medicine into an even more dangerous ethical quagmire. While preserving life with the best possible care is always good medicine, the suffering and protracted deaths caused from the continued use of futile measures benefits no one. For this reason, the determination of futility should be a joint decision between the physician, the patient, and his or her surrogate.
In the case of Cruzan by Cruzan V. Director, Missouri Department of Health “Right to Die” is the issue at hand. Nancy Cruzan twenty-five on January 11, 1983 was thrown from her car in a crash a few miles from her home. When police and paramedics arrived on the scene of the crash her brain had been deoxygenated for somewhere in between the time frame of twelve to fourteen minutes. Sadly
Henry Ford was born on July 30th, 1863 in Wayne County, Michigan on his family's farm. From a very young age, Ford showed a great amount of promise. When he was fifteen years old his dad gave him a pocket watch. He was able take it apart and then put it back together successfully. He was so good at it that his neighbors asked him to fix their watches and clocks. What made this even more impressive was that Ford really didn't have a top notch education. Taking apart and reassembling a pocket watch is a very difficult task. So if you can do at without even having an excellent education,you have a gift. This was very true for Henry Ford. Ford was not happy working on the farm, so at the age of 16 he left for Detroit. There, he would
Henry Ford was born in born in Springfield Township, Michigan on July 30, 1863. His parents were William and Mary Ford; he grew up on his parent’s farm. Henry was the oldest of six children. Before making cars Henry Ford was know for tinkering, he would take pieces of metal and turn them into small machines. When Ford wasn’t helping his father with the harvest he went to a one-room school for eight years. At the age of 16 he left home to work in Dearborn Michigan, at Flower Brothers Machines Shop, working as an assistant machinist. Ford was fired from his first job. Mary Ford was Henry’s inspiration as a child, and his role model and later his friend was Thomas Edison. In 1888 he married Clara Barynet. In 1893 Clara Barynet give birth to Edsel Ford, Henry Fords only child.
The two indices penetration of microfinance (MPI) and Intensity of penetration of microfinance among poor (MPPI) have been presented in the 2009 report for the first time. The calculation of the index has been carried out as follows:
In the book “Creating a World without Poverty” of Muhammad Yunus, he expresses and addresses an issue concerning on how to solve a problem about the poverty in the society. Muhammad Yunus focuses primarily on the different aspects concerning about human nature, problems with private enterprise, society's perspective concerning poor people, definition of Microfinancing, definition of Social Business, challenges confronted while opening the Grameen Bank, and lastly, the success of the Grameen Organizations.
Yunus is a trailblazer of the micro-lending or microcredit concept. He argues that credit is a human right that e...