A woman enters the emergency room with stomach pain.

  She undergoes a CT scan and is

diagnosed with an abdominal aortic aneurysm, a weakening in the wall of the aorta which causes
it to stretch and bulge (this is very similar to what led to John Ritter’s death).  The physicians
inform her that the only way to fix the problem is surgically, and that the chances of survival are
about 50/50.   They also informed her that time is of the essence, and that should the aneurysm
but, she would be dead in a few short minutes.  The woman is an erotic dancer, she worries that
the surgery will leave a scar that will negatively affect her work; therefore, she refuses any
surgical treatment.  Even after much pressuring from the physicians, she adamantly refuses
surgery.  Feeling that the woman is not in her correct state of mind and knowing that is of the
essences the surgeons decide to perform the procedure without consent.  They anesthetize her
and surgically repair the aneurysm.  She survives and sues the hospital for million of dollars.
                                                                                                                              
Questions:
 
 Do you believe that the physician’s can be justified in anyway?
 Is there anything else that they could have done?
 Is it ever right to take away someone’s autonomy? (Would a court order make the
physicians decision ethical?)
 What would you if you were one of the health care workers?
 
 Answer:
 Ethics are standards of behaviors that tell us how to behave in situations we find ourselves.
 
The case here is one of a professional dilemma.  The doctors were torn between doing the right
thing and acting against the rights of the patient.
A look at some ethical principles will guide us to decide whether the doctors actions were
justified in anyway. 
As professionals, Gene Lackzniak’s standard of ethics suggests that one take actions that a
disinterested panel of professional colleagues would view as proper.
 They could also weigh their decisions in the face of the “TV test”. Would they feel comfortable
explaining to a national TV audience why they decided on that line of action?
 In applying the multiple-rule non consequential theory on the principle of proportionality, the
doctors could say that they are not responsible for unwilled side effects since they have sufficient
reason for risking or permitting the surgery.  The CT scan shows an aneurysm and the only way
out was through surgery.
 
Gene Lackzniak’s golden rule advices the doctors to act in a way that they would expect others
to act towards them.  This is a medical emergency and attending to the medical needs of the
patient took precedence over her worry of a scare that would negatively affect her work.  The
principle of proportionately, according to Garret hold that even a minor evil may be permitted,
risked or even willed if there is proportionate reason to do that.
From Kant’s Categorical Imperative on Single Rule Non-consequential, in determining the total
worth of our actions, Kart believes that a good will takes precedence over all else. Contained in a
good will is the concept of duty.  Only when we act from duty does our action have moral worth.
 
The doctors in this case acted out of duty to save a life and following the guiding principles
mentioned above, we can say here that,
 
YES their actions can be justified.
 
 Is there anything else that they could have done?
Yes ,
a) The pain could be managed immediately while the patient is counseled to
understand that she couldn’t continue dancing without any life in her. 
b)  The patient’s fears could be annulled by explaining to her that she could even
have a plastic surgery afterwards if she still wanted to do the erotic dancing.  
The two points listed could be done in a bid to get her consent to the surgery.
c)  A substitute consent could have been sought from the next of kin particularly as
it was suspected that she was not in the correct state of mind.
 
d)            The case could have been referred to an ethical consultant of the hospital
for direction.
 e)            They could have called in the Psychiatrist  to confirm the patient’s state of
mind which could vindicate them on the decision to operate without consent.
f)             If reasonable time was available the hospital could have applied to the
courts for necessary action.
 
 Is it ever right to take away someone’s autonomy ( Would a court order make
the physicians’ decision ethical?)
 
NO it is not right to take away someone’s autonomy, but some situational analysis
may permit this. For instance if
 
a)    A case requires an emergency intervention and the patient is not in the capacity to
appreciate the danger he or she finds him/herself. For instance in the case of a minor or
in an unconscious state.
 
b)    Patient not being of a sound mind and thus incapable of a sound decision.
 
c)    Beneficence can supersede autonomy when there is a sufficient ground to promote
good and prevent harm to the patient.  As it were in the case above the life of the patient
in question was saved by the surgery.
 
However in court, based on the law that consent should be sort the doctor’s actions could be
judged wrong. This then would have been a deviation of the law from ethics since the law would
not have taken into consideration the good intentions of the doctors.
 
What would you do if you were one of the health care workers? 
a.            Involve other members in the circle of care such as social workers
b.            Seek advise from the ethics consultant or review board of the hospital.
c.            Exploit the possibility of a court order to carry out the operation if there
was sufficient time to do so.