Ethics Case Study: A two year old male child is suffering from physical deformities and also is mentally retarded. The Physician informed that he would probably have lived to his fifth birthday but not more than that. The parents of the boy have no formal education and are working at a factory with a monthly salary of Rs. 3000 to sustain their life and another 3 children with no health insurance. Monthly expense for medication and special diet for the child is Rs 2,500. The parents have requested for the Physician to provide any sort of help as they don’t have enough money to take care of the child. They even said that if there could not be any way out, it will be better for them to let the child die. What should the doctor do and why? How the doctor should balance the Beneficence and non-maleficence? (150 W/ 10 M)

Mentor’s Comment:

Case study is an essential part of Section B of Ethics paper and is scoring in nature.

Case studies offer descriptions and data of situations, from which we have to:

Firstly:

Identify key points or issues

Weigh up the situation

Consider the information you do and don’t have

Further:

Define the problem/issue to be addressed precisely

Outline the objectives: the desirable outcomes

Identify resources/techniques helpful to opening up the case study

Generate ideas or alternative solutions.

In the above case, “first do no harm,” the foundational proscription of medical profession, is called in ethics “the principle of non-maleficence. Introduction should talk about the ethical ideology of doctors, Oath taken and its adherence.

Assess the ethical options available with Physician, in order to cop up with the dilemma s/he faces.

Next mention the various available options with the physician with justification of their consequences.

Conclude with balance note.

 

Model Answer:

  • Ethics permeates all that we do in medicine. Medical training indoctrinates doctors to practice in ways which have their foundations in historical ethical principles. Although each day we “act ethically,” we sometimes don’t recognize the ethical aspects of our actions because we are not acquainted with the terminology and methodology of ethics.
  • For instance, the mandate that we “first do no harm,” the foundational proscription of medical profession, is called in ethics “the principle of non-maleficence.
  • In the above case, the Doctor is in dilemma what to do? If he let the child die he will feel guilty. The ability of the family to support the child is really low as they also need to feed the other 3 child, need to go to school and they are prone to be suffering from malnutrition, its morally wrong for the other child to suffer as well.
  • The case generate moral dilemma in doctors. However, whichever way the pendulum swings, the Physician must at all times be conscious of the dictum: ‘aegroti salus suprema lex’ (i.e., the good of the patient is the highest law).

Available options with the Physician:

  • In order to help the patient and his parent, the physician may request some NGOs who work for caring such medical conditioned persons and ask to take the responsibility of the child as long as he lives. On the other hand the physician may also search for options for providing help from the government if possible.
  • He can discuss this matter with his senior members and ask them to request the concerned authority. He can also request the authority to provide some help to either of his parents to get some other job so that he can look after the child with adequate earnings within the person’s capacity.
  • This will provide some sort of help for children to survive till the age he can and also support to his parents and other children. This will also bring some moral satisfaction in Physician.

Balancing Beneficence and non-maleficence:

  • However, such situations are often being faced by doctors in medical profession. In such condition it becomes important to balance the beneficence and non-maleficence. It is the balance between the benefits and the risk of treatment.
  • The duty of the physician is to provide necessary information to the relatives of the patient, the information necessary to understand the scope and nature of the potential risks and benefits in order to make a decision.

Conclusion:

  • Having taken the oath to consider the life of the patient above all, the doctor cannot let the child die just because of the reason that the family cannot support the treatment of the child. Alternative options should be looked up to support the treatment of the child.