Case # 4 Autonomy

Autonomy essentially means “self rule,” and it is a patient’s most basic right. As such, it is a health care worker’s responsibility to respect the autonomy of her patients. However, at times this can be difficult because it can conflict with the paternalistic attitude of many health care professionals. The following two cases address patient autonomy. The first involves the rights of an individual to decide her own fate, even against her physicians’ judgments. The second case involves the rights of a parent to care for her child in the manner that she sees fit.
CASE # 4

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 inform her that time is of the essence, and that should the aneurysm burst, 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 time is of the essence, the surgeons decide to perform the procedure without consent. They anesthetize her and surgically repair the aneurysm. She survives, and sues the hospital for millions of dollars.

Questions for Case # 4
• Do you believe that the physician’s actions can be justified in any way?
• 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’ decisions ethical?)
• What would you do if you were one of the health care workers?
• Discuss the moral & empirical judgment
• Are there any moral dilemmas?
• What are the ethical implications?

Guidelines to Write the Responses to the Case Studies
In responding to the assigned case study, I expect you to assume the frames of mind of an ethicist as follows:
1. Be judicious: read the case at least twice and then ask yourself what is at stake in the context of the parties involved.

2. Be empathetic: think about the underlying assumptions which guide the parties who are involved in the case. Then try to draw out the erroneous and correct aspects of their positions on that basis.

3. Be sensitive to the religious and cultural differences of the parties involved and attempt to reconcile any such differences in a fair and equitable fashion.

4. In making recommendations to solve the dilemma of the given case, try to be realistic and sensible to current practices, norms, and beliefs.

5. Be aware of your own cultural, religious, and social background in order to prevent it from distorting your ethical judgment.

6. Do not allow religious norms to be the sole standard of your ethical judgment.

7. Apply the golden rule; treat the case, more specifically the interests of the parties involved as you would wish your own interests to be treated.

8. Answers all questions asked, also using your personal input. Please use the appropriate references