3. Respect Hannah’s right of Autonomy? Autonomyrefers to the capacity of a rational individual to make an informed, un-coerced decision. http://en.wikipedia.org/wiki/Autonomy Hannah has decided she wants the CABG. She has made a autonomous decision, even after being explained the multiple risks of the surgery at her age (87 years old). prolonged ventilation time transient renal dysfunction atrial fibrillation sternal dehiscence respiratory infections leg wound infections neurocognitive impairment http://www.hindawi.com/journals/crm/2010/725173.html If Dr Nicely and the HMO do not respect her decision, they could be in direct violation of Hannah’s right of autonomy. Hannah is mentally lucid and able to understand her situation, and is capable of making rational decisions concerning her healthcare.
4. However… Is the surgery what’s best for Hannah? What quality of life would she have after the surgery? Would she still be semi-mobile, and be confined to a wheelchair the rest of her life? How do we know she would not die from complications of her recent CVA, and then thousands of dollars would have spent wastefully (in the eyes of the HMO)?
5. Thoughts to ponder….. Consider the risks of performing the surgery from Dr Nicely’s viewpoint. If he operates: Does he live with the guilt of agreeing to do the surgery an causing Hannah’s death? Do his surgery statistics go down, causing his malpractice insurance to go up and cost the hospital/HMO lost revenue later on, from declining CABG surgeries? That money could have been spent for other patients and surgeries. Examples: Open heart surgery of a 10 year old, suffering from a congenital defect Renal transplantation of a 28 year old married father of two Bone marrow transplantation of a 19 year old college student suffering from leukemia
6. Beneficence Beneficence is defined as the doing of good; active goodness or kindness; charity. http://dictionary.reference.com/browse/beneficence Is Dr. Nicely being beneficent by agreeing to do the surgery? That is, doing what is “most good” for Hannah? Or, would he be more beneficent, or “more good” by not operating, and preserving whatever quality of life she has at this point? Would Dr Nicely feel like he did the “right” thing if Hannah goes on to live another 10 years of a happy, however limited, life? Does Hannah feel that being dead (possible risk of surgery) is better than being semi-mobile? She should be asked about her quality of life now and what she will do with her life if the surgery is successful?
7. The Common good The common good consists of all the conditions of society and the goods secured by those conditions, which allow individuals to achieve human and spiritual flourishing. http://www.ascensionhealth.org/index.php?option=com_content&view=article&id=79:principle-of-the-common-good&Itemid=171 In this case, the common good would be to allow Hannah to have her surgery. To give her, in whatever capacity, the opportunity to flourish. This could be participating in the church choir, being a role model to others in wheelchairs, and being able to spend time with family members. Who says that a life spent in a wheelchair, semi-mobile, cannot be just as complete and fulfilling as one spent ambulating? If Hannah had the surgery, and felt better, whose to say she wouldn’t make great strides in physical therapy and one day be able to ambulate with the use of a cane?
8. Conclusion…. Hannah’s life is valuable. Even though it is limited and imperfect, it deserves consideration for surgery, to offer her a chance to flourish, both mentally and physically. Disbursement of healthcare services has got to be thoroughly considered, morally weighed, and the consequences considered. Tough decision, no matter how you view it.
