Medical Ethics

The case: Leslie Conrad is a 52-year-old woman who has recently discovered a lump in her breast. Her physician sent her to the hospital for a biopsy, which revealed a malignancy. Unfortunately the cancer has already spread extensively throughout her lymphatic system and has begun to invade her lungs. Even with aggressive treatment (surgery, chemotherapy and radiation), her oncologist, Dr. Arthur Sanchez, predicts she will live no more than six to eight months. Without treatment, Sanchez believes that she will likely live no more than three months. At this point she is generally symptom-free, although she has begun to experience fatigue. Mrs. Conrad’s husband Paul (51-years-old) is an independent custom auto parts fabricator.

He has his own shop, and their 25-year-old son Joshua works with him, while also taking mechanical engineering courses part time at the local technical college. Their daughter Liz is a 28-year-old doctoral student at a large university about 300 miles away. She is nearing completion of her dissertation in psychology, and expects to graduate in May, two months from now. Mrs. Conrad tells Dr. Sanchez that she doesn’t want aggressive treatment, explaining that she wants to spend her remaining time at home, not in a hospital. She especially wants to be able to attend her daughter’s graduation. Moreover, she tells Dr. Sanchez that she doesn’t want her family to know about her condition at least not yet. She knows that at some point her condition will become apparent to at least her husband, and that she will need much more from him then.

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But right now she wants Liz to focus on finishing her PhD, and doesn’t want her to be worrying about her mom at this crucial time. And Paul and Josh are currently working ten to twelve hours a day constructing suspension systems for six cars for Roush Racing. This is a huge opportunity for them to really establish themselves in the field and Leslie wants them to focus on their work. Dr. Sanchez has asked for your opinion on this case. You are the director of the hospital’s Center for Counseling and Social Support. You are both aware that state law requires that patients’ requests for confidentiality be honored. Yet your experience and knowledge tell you that most families want to be included in end of life plans. You are also concerned that their bereavement may be more difficult if her death is unanticipated. Your four-part assignment (with part 2 having four sub-sections):

1. Identify the relevant factual issues: what factual matters need to be laid out and considered? For example, how long will it take for Paul and Josh to complete their work?

2. Determine if and how the four moral principles apply. What harms are at issue? What benefits? Does Justice apply, and if so, how? How does the Principle of Autonomy apply?

Note: one or more principles may be inconclusive for example, if there are more or less equal benefits from different courses of action, then Beneficence might be inconclusive, in which case that’s what you should conclude. Principles can also be inconclusive due to factual uncertainty (identified in step 1), in which case, you should reason conditionally (see July 2) about how the principle in question applies. 3. Identify the significant values: what good things are at stake? (Your work in part 2 applying Beneficence can be brought over to this step.) 4. What course(s) of action seems to do the best job of promoting all the values at stake, i.e., integrating values)?

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