Bioethics

The case of Dr. Lowell and Mrs. Jackson revolves around a conflict between the doctor, who advocates the implementation of a particular treatment and the patient who disagrees with the doctor and wishes to do things her own way. The doctor feels that the suggested course of action is disastrous and threatens to have the patient declared mentally incompetent. The question now is whether or not the doctor is morally justified in taking action against the patient in order to implement the course of treatment she feels would be most effective. Is this an infringement on the autonomy of the patient or is the doctor morally obliged to do everything that he/she can possible do in order to restore the patient's health even if that includes to go so far as to take this decision out of the hands of the patient?

I would like use Rule utilitarianism and Kantian deontology to help determine what course of action could be morally justifiable in this case. Rule utilitarianism says "A person ought to act in accordance with the rule that, if generally followed, would produce the greatest balance of good over evil, everyone considered." (Mappes & Degrazia, 13) So according to rule utilitarianism, when one faces a moral dilemma one should map out the consequences of one's action and then act in so as to produce the greatest net amount of utility or happiness. So if I was faced with a moral dilemma concerning whether or not I should cheat on an exam, I should follow the rule that creates maximum happiness, which in this case would be that I should not cheat because if every one in the world cheated on every exam then there wouldn't be a need to take or give exams. There would no longer be a dependable system to gauge a student's knowledge on a subject. Kantian deontology however follows a different path. According to this moral theory, consequences are of no matter and duty is what is important. (Lecture, 01/27) Just as in rule utilitarianism, Kant says that an act can be considered morally right when it is in observance with a rule. This rule, however, must satisfy the conditions of what he calls the categorical imperative. There are three formulations of the categorical imperative (Lecture 01/27) that each maxim or rule must adhere to. Firstly, "Act only according to that maxim by which you can at the same time will that it should become a universal law." The second formulation says that "Act so that you treat humanity, whether in your own person or in that of another, always as an end and never only as a means." The third formulation says that "Treat others as autonomous agents, capable of self directed action." So an act would require fulfilling all these three formulations for it to be morally justified. In a case where there is debate about the morality of whether or not one should lie, the theory outlines the maxim that one should never lie. This maxim fulfils all three requirements of the categorical imperative; one can consistently will this maxim as a universal law, it does not treat others or oneself only as a means and it does not violate anyone's autonomy, including oneself.

Applying rule utilitarianism to the case of Dr. Lowell and Mrs. Jackson: the theory says that the rule that would afford the maximum utility would be one that said that a patient must follow that course of treatment that the doctor deems most effective. Any other rule that allowed the opposite to happen, one that said the patient always has the final word regarding what the treatment should be applied, would result in overall disutility as patients might chose not to take courses of treatment that might be painful but beneficial. Such behaviour might result in either prolonging of the disease or further complications, all consequences that would result in overall increased disutility. The emphasis in diagnosis would shift to a system wherein a doctor's knowledgeable opinion comes secondary to a patient's wishes about what course of treatment to follow. After all it is not likely that a doctor would intentionally try and do a patient harm. A rule that undermines a doctor's authority would only result in net disutility as it would produce a devaluation of doctors and courses of treatment based on scientific knowledge and understanding. Therefore rule utilitarianism would say that the doctor is morally correct in trying to undermine her patient's wishes. However, another consequence of applying this rule would be that it would disregard a patient's wishes especially in those cases where individuals have wishes grounded in religious or personal beliefs. Such disregard for a patient's autonomy might also produce disutility. Generally speaking, most patients tend to follow the suggestions offered by their physicians. The disutility suffered by the few odd patients who experience an infringement upon their autonomy by a disregard for their personal wishes surely would be far less than the general good that is produced by people heeding the words of advice given by their doctors. After all, not listening to a doctor's advice could lead to, in this case, death that produces a great of unhappiness for all the family and friends involved versus having to endure a course of treatment that one dislikes producing unhappiness only to oneself.

A Kantian approach to this problem might go along the following lines: a maxim that would pass the tests posed by the categorical imperatives might be that a patient always has a right to decide what course of treatment is most suitable for him/her self because any course of action that does not take into account a patient's wishes would violate his/her autonomy. This maxim passes the test of universal application and does not result in the use of others or oneself merely as means to an end. The maxim also undoubtedly agrees with the third maxim of conserving the autonomy of all parties involved. Therefore according to Kant's philosophy the ethically correct thing to do would be to respect the patient's wishes and allow Mrs. Jackson to try and fight the cancer by following a dietary regime comprising of high-fiber and lots of water. The maxim's universal applicability however could be called into question for the reasons stated in the previous paragraph, of taking the risk of not adhering to a course of treatment based on scientific grounds. But as mentioned, the utilitarian course of actions would cause an impingement upon an individual's autonomy, which is an acceptable consequence for the rule utilitarian but not for a deontologist. In a similar manner, loss of overall utility is an unacceptable consequence for the utilitarian but an acceptable one for the deontologist so long as autonomy is conserved. Since both theories seem to contradict each other, I think that more factors need to be taken into consideration in order