The case, whose decision is it, describes the ethical decision making scenario for case of Benito Agrela, a 15 year old boy who voluntarily decided for a painless death and was judicially granted the same (Munson 108). This case analysis is further focused on looking at various ethical health care imperatives from the discussed scenario. Also, there will be critical analysis of the rendered judgement and ethical derivatives from them. Finally, we will take a conclusive stand, either for or against the posed ethical dilemma in the case and justify the rationale behind our stand.
The given case describes a scenario in Florida, October 1993 and is based around 15 years old boy Benito Agrela. Agrela had an enlarged lever right since his birth and had undergone tow simultaneous liver transplants, in the course of attaining an age of 15 years (Munson 108). Owing to his medical then ongoing treatment, he was prescribed with the FK506 drug to evade a subsequent rejection of the lever by his body (Munson 108). However, intake of this toxic drug also resulted in suppressing his body’s immune prowess. The prescribed intake of drug, as a primary cure, made Agrela very weak and restless. With a voluntary acquired motif to end his miseries and to resort towards a peaceful death, Agrela decided to stop any further intake of FK 506(Munson 108).
When his decision of abstaining from his medication came into notice of government agencies, in June, the Florida Department of Health forcibly removed him from his parent’s home and was put in a Miami hospital (Munson 108). In spite of the official decision to keep him confined in the transplant floor of the hospital, he never gave up over his will and even denied giving blood samples for furthering his treatment. Finally, Judge Arthur Birken from Boward County court went into detailed discussion with Agrela and his physicians and consequently allowed him to go back to his parent’s house (Munson 108). Hence, in absence of any medication and its painful side effects, Agrela died a peaceful death on August 21.
Ethical dilemmas raised by the case
This case is evident of two crucial ethical health care dilemmas, faced by people involved in this case. First, accepting the decision of a minor to stop his life-saving medication just due to consequent pain and weakness is the toughest dilemma in this case. Second, as a medical facility in charge, the decision of concerned hospital to drag a critical patient out of his parent’s home and confine him in the hospital for further prognosis, is another stern dilemma in this case. Both the above mentioned dilemmas pinpoint the ethical concerns of beneficence over acceding to a minor’s resistive ability, against his own medication. We can also rephrase the cumulative impact of the above two issues as, whether to allow or deny a patient’s intake of a live saving drug which is abstained just because of its consequent pain and weakness, both of which are less fatal than the disease which it cures.
Three concepts of Ethics are blended in analyzing the ethical dilemmas in this case, viz. Beneficence, nonmaleficence, paternalism and autonomy. The ethical aspect of beneficence stands predominant in case of doctors and Agrela’s parents, whose first moral obligation is to provide a healthcare which should not cause any harm and be in sync with the physical well being of the patient. Similarly, the nonmaleficence is key driver of the medical healthcare ethics in this case, to ensure that the treatment should not result in any fatal consequences or traumatic after-effects for the patient. Paternalism ensures parental mindset and firm decision making to override Agrela’s decision of abstaining from his medication and instead forcing him to avail what is favourable for his life, although he was extremely resistive toward any further intake of the drug. Finally, autonomy is also equally applicable on behalf of Agrela, to vouch for a voluntarily decided regulation of proceedings in his life and abnegating any further intake of the immune suppressant and painful drug. Hence all above mentioned ethical aspects together define the dilemmatic scenarios evident in the case.
Other ethical issues in the case
There are some more ethical issues evident in this case. These issues pertain to different aspects of the case, focused on different stakeholders in Agrela’s life like himself, his parents, medical care authorities, his physicians and the judge who undertook the final decision in this case. The ethical issues in this case are:
The issue of letting a minor, aged 15 decide his future, subduing the medical considerations and prescribed medications. Also paternalism of his caretakers in medical facility and in his parent’s home was brought into question by his voluntary decisiveness.
The ethical issue is critical for validating the sovereignty of a decision to give up on most critical medication, by an extremely severe patient, just because of its impacts over immunity and weakness. There could have been some intermediary solutions to mitigate the worsening side effects of the prescribed medication.
On Agrela’s parent’s behalf, allowing him to deny any medication and still continue with his deteriorating health situations was ethically challenging. Similarly, allowing the hospital authorities to confine Agrela at transplant floor of the hospital was equally dilemmatic.
Last ethical issue is over the nonmaleficence of medical health facilities, that whether they should continue extremely painful medications, in spite of the fact that they erode patient’s immunity and cause weakness. Forced mediation for a resistive patient is also an equally deviating ethical issue.
Nonmaleficence and beneficence for health care professionals
The nonmaleficence principle of ethics states that healthcare professionals should not cause any harm of the patients, however a medical treatment resulting in extremely harmful consequences for a patient and patient’s subsequent denial of availing any such medication. Hence, we can clearly see the ethical dilemma as beneficence principal states that all the actions from doctors should be in favour of the customer’s well being.
My stand on the ethical dilemma: I am fully convinced by the judge’s decision of letting Agrela go back to his parent’s home and give up on his medication. His logic is very clear that in continuing the mediation, he was suffering more, in terms of pain, weakness and immunity suppression. We must not overlook the point that a patient knows more of his despair than the doctor or any other person. Hence in this case, the ethical aspect of autonomy for the patients treads over the paternalism and makes a genuine heed to address the patient’s regards for his painless and peaceful death.
Works Cited
Munson, R. Intervention and Reflection: Basic Issues in Bioethics. 9th Edition. Belmont, CA: Wadsworth, 2012.Print.
