Ethical Problem(s)
Relevant Values
Stakeholders
Decision Making
Utilitarianism
Problems with Utilitarianism
Deontology
Ross’s Ethical Theory
Ethical Analysis
Scenario
A Pennsylvania hospital is faced with a non-U.S. born 5-year-old daughter of undocumented immigrants who has a life-threatening need for a 2 million dollar transplant. Using critical analysis and your ethics knowledge render and defend a decision about whether to provide the transplant.
Ethical problem(s)
One of the ethical problems present is the fact that the 5-year-old was born in undocumented immigrants parents. She also was a non-United States citizen. Another problem is the child has a life threatening disease that requires a transplant for a substantiate amount of money that is two million dollar to be spending on a non-U.S. citizen. The case that is being presented brings into focus a number of the most currently vital questions that occur in the gap of medicine and politics. If this case were one of only medicine, then both the questions and the answers would be relatively simple: Would the patient benefit in a substantial way from receiving the transplant? If the answer would be yes, then doctors could be free of political and economic constraints and would treat the child. However, the practice of medicine is most certainly not free of financial questions. And whenever money involves somewhere, politics is not too far behind because politics always follow the path of money.
Relevant Values
Several key ethical questions are raised by this scenario. More than anything, what one considers depends on the political perspective on things. And most of the time that is always considers being very important and obvious. This leads to the other major perspective on this issue, which is a laissez-faire or progressive one. A dispute would focus on the fact that a five-year-old girl has a potentially full life before her in which she can both contribute to society and enjoy the happiness that the people believed to have when living their lives. Medical care should not hold back when it comes to a situation like that when it comes to do the right thing as suppose to the political world. One needs to be realistic and acknowledge the obligation of this case. Then the society will eventually feel the obligation and the rationale of a child with life-threatening disease. People that are conservatives are likely to focus on the fact that the girl is not a U.S. citizen and therefore see the question not so much as one of medical care, but of immigration policy. The reality is that the little is a human being who needs care.
Information Needed
In this scenario, one asks to consider not simply whether the whole society should take on the medical costs of those who cannot provide for their own care but how much value different types of people have to our society. In America, a system in which health care has to be rationed, who will get how much becomes a politically charged issue. In the current atmosphere, in which anti-immigrant feelings run high, there would certainly be many people who would object to a non-U.S.-citizen receiving medical care. In addition, there would be many other people would stand out and defend the other side of the equation.
It would be critical to get information from the family, gather the little girl’s history of the disease and the all the information needed from the physician’s to assess and measure the amount of work and length of the whole case from the beginning to the treatment after the transplant. Furthermore, information from the pharmaceutical companies to see in what capacity they can help, either by donate medication for free or for a reducing price, information can be also obtain from outside charitable organizations that can help and that can make donations on the girl’s behalf. The information is needed to see how much would be needed for the entire ordeal.
Stakeholders
The stakeholders in this scenario are the family which includes the child’ parents, the doctors, state public health officials who are likely to have to serve as mediators between state and federal health law, as Kershaw (2007) describes in the case of the state of New York, in which state law requires that illegal immigrants be given certain medical care while federal law prohibits is. Also, there are the nurses, the specialists, the social worker, the physical therapist who eventually will be involved in the case. Another stakeholder that should not be forgotten is the little girl who is the patient and has to go through the entire political and medical ordeal.
Moreover, among the key stakeholders is the staff and administration hospital where treatment has been required and the ethics boards of the institution. One important issue that must be addressed in the assessment of the case of the little girl would be the real cost to the hospital of such a transplant: because there are, for example, the physicians’ fees, and are there physicians and other medical personnel who would be willing to donate their time? There are also other considered stakeholders, such as pharmaceutical companies who could be asked to reduce the cost of their drugs in such a case or if they could give away some of the drugs and charitable organizations that might be asked or might consider taking on some of the cost of the girl’s care. One could also include among the stakeholders the American nation as a whole.
Dwyer revealed an interesting assessment that neither totally conservative nor totally progressive perspective that helps one to address such ethical approach because it is very rough and complicated to deal with. In Dwyer’s assessment, he mentions that “I think both these answers are off the mark. The first focuses too narrowly on what we owe people based on legal rules and formal citizenship. The other answer focuses too broadly, on what we owe people qua human beings. We need a perspective that is in between, that adequately responds to the phenomenon of illegal immigration and adequately reflects the complexity of moral thought (Dwyer, 2004, p. 34). That kind of situation where everyone has mixed feelings about the subject, ethics is such ambivalence subject that an ethic committee in the hospitals is well placed to intervene. And such committee will have experienced qualified individuals to help make difficult decisions.
Decision Making
Every decision should be carefully made by everyone involved. That will include the patients’ parents and family, the physicians and staff involved in this case scenario. Because there is a lot of money involved, the institution itself is one of the main players. Arrangements need to be made before proceeding with any process. Mainly, meeting needs to be planned with the stakeholders in order to insure of the financial supports if there are going to be continued with the procedure. The medical professionals need to be there and help make a decision if they want to donate their time or to make any other arrangement. Other people who should make the decision in this case would be the people in the ethic committee and professional ethicists. Another important group of people who can be included in the decision making is the clergy group just in case the family would need such service. Having other organizations involved could be beneficial to this case because if everyone donates their time and money, the transplant and after the transplant treatment will go smoothly financially for the little and the parents. Even part of the money could alleviate the tension that exists within that case if outside help could be found.
Before any decision is taking, nevertheless, some questions ought to be asked. All this efforts that are being made, is the transplant going to be successful? What would be the percentage of the transplant being successful? Should they proceed with it? If the percentage is low, what other alternatives can be taken to alleviate the pain of the patient and the family?
It is extremely important to involve all the stakeholders in the decision making process and have a point-of-view from representatives of every party that is affected by this ethical issue. There is a huge amount of money involved in such cases, and the stakes are very high as it is an issue that will affect the future outcomes. The decision makers need to consider the political influences and the social consideration both at the same time.
The presence of medical experts is a must and the medical representatives should be neutral who are free from all kind of biasness and are able to make suggestions on ethical grounds. An ethical committee should be formed in order to make sure that whatever decision is taken should be in compliance with the ethical code of conduct established by governing authorities. The decision made should be on the basis of the various theories of ethics. The theory that must be taken into consideration with relevance to this case is discussed in detail.
Utilitarianism:
Jeremy Bentham was a brilliant man and his interest was in investigating different phenomenon. He had excellent analytical skills, he focused more on the reformation of justice system e.g. penal system of Britain and English legal code, and he termed it, “Demon of Chicane,” rather than facilitating the status quo system. This leads us to the conclusion that Jeremy Bentham was more of a philosopher of his time. He was continuously busy in finding new ways and theories to define the laws he had created. Secularism was popular in Jeremy Bentham’s time. Therefore, his ideas and beliefs were highly influenced by it. He looked for conclusions dependant on the material explanation of good and bad, right and wrong. Furthermore, he criticized Christianity and said that it was too much based on institutions. David Hume (1711-1776) and French philosopher Claude-Adrien Helvetius (1715-17710) were the driving forces behind his work. Jeremy highly appreciated the works by these two specific philosophers and his ideas were a continuation of their ideas as well. “True justice was synonymous with the good of the whole” was Jeremy Bentham’s motto. His philosophical ideas were based on this phenomenon.
Bentham knew that the British Parliament was run by some influential families. These families worked for their own self-interest. Bentham had once supported the demolition of monarchy and the rule of parliament. On the other hand, Bentham was not a big supporter of democracy; he supported parliament for the status quo as it was beneficial for all.
Bentham was a pioneer in the field of Utilitarianism. Without him, Utilitarianism might not have started. He gave birth to it and motivated other writers to expand his thought. Although the concept of greatest good for the greatest number was mentioned before Bentham as well, credit must be given to Bentham for bringing this in limelight.
Bentham had a follower who was known as James Mill who is responsible for supporting James’s ideas. Bentham had followers who wanted reforms. James was a priest and the leader of this specific group. The cause of creation of this group was dissatisfaction. Mill was no ordinary supporter. He coined the term ‘Benthamism’ which was related to Utilitarianism and spread Jeremy’s ideas. “Analysis of the Phenomenon of the Human Mind” was the most prominent work of James Mill. It was based on Bentham’s ideas. It was published in 1829. James in his analysis sought and evaluated the ‘pleasure-principle’ on which most of utilitarianism depended.
There are two types of Utilitarianism the first one is Act Utilitarianism and the second is Rule Utilitarianism. The distinction between two types of Utilitarianism are therefore on the grounds that one focuses on the actions that are suitable in specific case, while Rule Utilitarianism focuses on general rules that can be followed at all times, hence the case of this child’s treatment according to Rule Utilitarianism the case needs to be treated in the similar manner as it would have if the child was an American national. On the other hand Act Utilitarianism would suggest that the child’s treatment should be performed because it will cause more happiness than the problems and is morally right.
Problems with Utilitarianism:
Although Utilitarianism is a good and well celebrated theory, it has its drawbacks. First, we have to assign values to harms and benefits of our actions. Then we have to assign values to the implications that result from our actions. Then a trade-off is made between the two. However, the problem arises in this calculation. It is very difficult to give values to harms and benefits. This is because a benefit for you might be a benefit for me. Furthermore, how do we assign values to abstract ideas like life? And how can we make valid comparisons of money with life? Furthermore, we are not fully aware of the implications of our actions. This makes us give wrong calculated values to our implications. In the end, this will result in a wrong decision on the basis of wrong calculation of values.
The most criticized point about utilitarianism is that it does not consider justice and its system. This is because often times there are situations when certain actions will prove to be highly beneficial to society but they would be unjust and against the legal system. The apartheid movement is a very good example. This is because the rule which was supposed to be beneficial at first might have been claimed to be bad after the apartheid movement.
Therefore, it can be concluded that if the moral decision we take are based on justice, then utilitarianism is not the correct option for us. It can be vital in these decisions. Utilitarianism lets us evaluate the implications of our decisions; both overt and covert. However, it can be acclaimed as a good principle because it focuses on the benefit of a group of individuals rather than a specific individual.
Deontology:
Deontological ethics is an approach of ethics that establishes the rightness of an act after evaluating the correctness of the acts committed. This approach is completely opposite to the approach followed by the consequentialism, which judges the correctness of an act on the basis of the outcome of the act instead of judging it by the act itself. In the approach followed in deontology even if the outcome of the act produces a bad consequence, the act itself will not be unethical and would be considered right. This approach emphasis on our duty to act in an ethical manner without looking at the consequences, this approach is quite similar to that of Rule Utilitarianism. Immanuel Kant’s theory of ethics I considered to be the foundation of Deontological ethics. Kant has mentioned that the duty of a person is to act in an ethical manner and the consequences do not harm the moral intentions of the act. Kant has argued to act in a morally correct manner by acting in a responsible manner and has considered that the highest good is the good without qualification and the good in itself. By this Kant has highlighted the importance of the intrinsic good as well as the extrinsic good which comes from the consequences of the acts.
Applying the deontological ethics on this case, the intentions of the act or the decision needs to be evaluated. If the governing authorities decide not to treat the patient because of the political pressures, financial issues and future considerations, all these justifications are hinting towards bad intentions, on the other hand if the governing authorities decide to sustain all these pressures and go ahead with the treatment of the child, this seems to be the morally correct act, regardless of the fact that this decision can lead to bad consequences. Therefore the deontological ethics is also pointing in the same direction as Utilitarianism, which is to go ahead with the transplant of the 5-year-old child.
Rawlsian Ethics:
John Rawls is a contemporary philosopher that has put the concept of justice right at the centre of decision making. He considers that whatever we consider to be ethical or unethical in our social institutions and practices should be based on the principles of justice. Rawls coined a term “Original Position,” he considers that people would realize the fact that their own well being comes from the promotion of rules and institutions, therefore a social order should be based on the egalitarian form of justice. Rawls believes on the presence of the Original Position which means that everyone would agree with certain set of duties that one owes to oneself and the society. The duties include the duties of justice, helping others, not harming others and keeping promises.
John Rawls has immense contribution to this concept. He stated that ethical acts or decision are those that lead to equitable distribution of goods and services. He argues that we should always make decision as if we were under a “veil of ignorance.” The veil of ignorance would not let the benefits or burdens of an individual would be greater than the benefits or burdens of the other. Everyone would be treated equally under this “veil of ignorance.”
Rawls was also criticized. Rawls did not mention what exactly is to be included in his treatment. Rawls highlights that these decisions are made under the basic structure of society. However, what Rawls does not do, is explicitly define the boundaries of society and what institutions would come under the basic structure of society.
Rawls’ theory is applied in many ethical issues related to the healthcare system and policy making in the healthcare issues. The health issues in this approach are dealt with priorities given to the rights and liberties of individuals. In the same manner the question of natural duties can also be applied in this case. Rawls theory is based on giving dual considerations to both the consequences and the act itself which makes it a complex form of decision making.
Considering the case in hand and applying the leanings from the Rawls theory, the decision making would be of a complex nature. The consequences of the decisions and the moral implications of the act itself are both pointing in different directions. The Original Position would suggest that based on the human values and principles the treatment of the child should be carried out as it is a right of any individual to gain access to such emergency healthcare facilities.
Ross’s Ethical Theory:
W.D Ross had an intuitionist approach and his theory was based on the concept of moral truths. Ross’s ethical theory has completely rejected the theory of consequentionalism. Ross believed in maximizing the overall good that is the act which will bring about the good for most. Ross has mentioned 7 prima facie duties which are listed below:
Fidelity
Gratitude
Justice
Self-Improvement
Reparation
Non-malfeasance
Beneficence
Evaluating the case of the transplant on the basis of Ross’s ethical theory, all these 7 parameters are required to be analyzed. Fidelity, in this case would be evaluated for the loyalty of the medical profession which forces them to save human life without considering its consequences. Reparation, the consequences of this case might be beneficial for the authorities but the act certainly would not be if they decide not to go ahead with the transplant. Gratitude, the medical profession will uplift in its stature if the patient is treated. Non-malfeasance and beneficence, the treatment would be for the benefit of the medical profession. Justice, it is the responsibility of the state to provide healthcare facilities and everyone should be entitled to receive the treatment despite of the fact that in this case there is as immigrant involved.
Natural Law Theory:
The natural law theory is based on the concept that the system of law is determined by the universal laws and nature. The theory is based on the use of the natural laws in establishing the moral grounds of actions and consequences. The theory has clearly established a distinction between the natural right and natural justice.
In the modern era the common law theory is often mixed up with this natural law theory. There are certain morals and values that are universal across all over the world; these are the perfect examples of natural law theory. For example, not keeping promises in every culture would be considered a bad act no matter how different the society will be in practicing this moral duty. All the motives and the actions are driven by a sense of self preservation which is universal all over the world.
On the basis of natural law theory, it is clear that ethically the decision in this case should be of carrying out the transplant of the 5-year-old immigrant’s daughter. The basic human values teach the universe that a life of a human is far more important than any other thing in this world be it political or economic. The natural law of theory will not take the consequences into consideration because in this case a human life is at stake. In all the cultures the value of a human life will be given preference over any other harm that the consequences of going ahead with the transplant can cause.
Conclusion:
The decision has to be taken carefully understanding the dynamics of the case and the future consequences that it can cause. It is important to have a broader perspective while making this decision and take into consideration all the parties which are involved. All the stakeholders must be involved in the decision making process. A clear understanding of the ethical theories is required to make a decision on the basis of ethical considerations and for the benefit of the community as a whole.
The various theories of ethics after a detailed analysis are all pointing towards a common decision of going ahead with transplant of the 5-year-old daughter of the immigrant. However the method of implementation of this act is different if different ethical approaches are followed. Utilitarianism is a concept that can be said to have myopia. This is because it prefers short-term benefits to long-term benefits. The greatest good for the greatest number is better predicted when the time constraint is short. On a long time scale, the variable would be different and the answers would change. Thus, the long-term benefits are often ignored in Utilitarianism.
This case of having a transplant or not should be resolved by taking under the “veil of ignorance” concept, which states that everyone should have equal rights and hence if the transplant is not done then it is a completely unjust action. The impact of the consequences of the decision of having a transplant will not favor the governing authorities and for that they must now establish a new framework to deal with future such cases. However in this case the treatment is necessary.
References
Dwyer, J. (2004, February). Illegal immigrants, health care, and social responsibility. The Hastings Center Report, 34(1), 34-41. Retrieved from http://benedictine.learntoday.info/AngelUploads/Content/MPH-603-D3A3/_assoc/site/MM/WK5_Dwyer_Article.pdf
Kershaw, S. (2007). U.S. rule limits emergency care for immigrants. Retrieved from http://benedictine.learntoday.info/AngelUploads/Content/MPH-603-D3A3/_assoc/site/MM/WK5_NYTimes%20_%20No_Healthcare_for_Illegals.doc
Maximiano, J.M.B. (2003). Corporate social responsibility: Basic principles and best practices: Historico-philosophical issues in international business. Manila: DLSU University Press.
