JONATHAN PLASKETT

TAKE HOME #1

Please don’t feed him: Questions 1 and 3

Question 1: Does the nursing home staff have an ethically compelling

argument to refuse the family’s request?

Yes. While the family members are arguing for their fathers respect for

autonomy in that not being fed is what he would want, there is in fact, no way to

confirm or deny this. The patient has documents in place regarding his will in such

situations regarding artificial nutrition or hydration at the end of his life and so

arguments can be made regarding whether having someone feed you when unable

to feed yourself is “artificial”. As feeding infants and children who are unable to feed

themselves is not considered such it may be determined that it is not artificial. If

however, you look at the situation in the context of the anticipated future life

experience of the infants versus the elderly person, or in other words, feeding the

infant with the expectation that they will eventually be able to feed themselves

versus feeding the patient in question with the expectation that he will eventually

expire without regaining the ability to self-feed, it could be argued that one is

natural while the other is artificial. The argument for the respect for autonomy is

therefore ambiguous and not a strong case either for or against refusing the family’s

request.

The compelling arguments therefore lay within those of justice, non-

maleficence, and beneficence. As justice is determined by fairness for everyone it

should be argued that anyone else in a similar situation would want to either be fed

or not. As there would be ambiguity is determining what “anyone” would want it

requires the remaining two principles of non-maleficence and beneficence to

support decisions regarding justice in this case. As non-maleficence means to do no

harm the question arises, would actively not feeding someone be doing harm or in

other words would it be considered harm by omission? If having the power to defer

harm is within ones power and actively withholding that aid causes harm it should

be determined that harm was done. Beneficence also requires actively doing good

for individuals such as the patient in question and supports this argument as well.

With non-maleficence and beneficence ethically requiring action from the staff it can

be argued that it would be fair and just to feed anyone in his situation.

Question 3: If the staff and family cannot come to an agreement, what should
happen next?

As the both of the effected parties have moral sentiments (emotions) both

are making decisions based upon the empathy they feel towards the patient. The

family is making decisions for him based upon their past experiences and their

emotions regarding how he would feel stating “he would be mortified if he ‘could

see himself now’”. The staff at the facility have undoubtedly seen people suffer as

thy are unable to feed themselves and so don’t want to put the patient through such

agony. It becomes necessary for each party to evaluate the situation from an outside

perspective or from that of the “impartial spectator”. As both are unable to step back

and let their own “impartial spectator” make decisions, any ethical decision either

party makes is suspect. It therefore becomes necessary for a third party such as an
ethics committee take the role of the impartial spectator to reach an ethically sound

decision.

Limitless in the ER: Questions 2 and 3

Question 2: If a hospital allows its ER staff to take Drug A, should the public
be made aware of this?

No. When contemplating the principles of autonomy, justice, non-

maleficence, and beneficence, respect for autonomy comes to the forefront of

thought when considering this. As it is a basic principle, which highlights individual

liberty, and as the hospital is not requiring staff to take Drug A it then becomes the

individuals right to take or not take it as they determine fit. The argument that

hospitals do not require staff to divulge their use of any other prescription

medication and so should not require divulgence of Drug A use is tempting but as

taking Drug A does no harm to the individuals taking it nor to the patient

population, it is not applicable to debating the ethics of principles.

Question 3: Are there any compelling ethical reasons to forbid physicians

from using Drug A while working?

No. As determined in the previous question, in regards to respect for

autonomy the staff should have the individual right to determine use of Drug A. As
there are statistically significant benefits to patient outcome from staff use of Drug

A, and as there have been no determined adverse effects to the users, the principles

of non-maleficence and beneficence only support use of the drug. If any long-term

adverse effects exist there would be a compelling argument forbidding staff usage of

Drug A while working as the entity responsible for staff wellness would be under

the ethical obligation of non-maleficence to forbid such use. As there are not yet any

determined ill effects there should be no reason to disallow its use. The ethical

principle of justice and fair treatment to all only supports the argument regarding

autonomy of choice regarding the matter.