Reference no: EM133914595

Question

PJ is the patient, and he is making his first visit to Doctor Ramirez, who is an oncologist, because of debilitating bone pain and severe constipation. For the past year, PJ has been treated for cancer of unknown origin by a state-licensed naturopathic physician whom he has seen extensively over the years for what he explains were a variety of autoimmune diseases and infections. PJ has sought care in this manner because he comes from a culture that believes in faith/mental healing that should only be augmented by nature-based interventions. Despite this therapy, the cancer has progressed to an advanced state with multiple vertebral metastases, including a large tumor in his cervical spine which required emergency surgical decompression 3 weeks prior to his visit to Doctor Ramirez Before the hospitalization for surgery, PJ was not under the care of a medical oncologist. PJ is aware that he may need additional therapy but does not trust medical science and is worried about the toxic effects of chemotherapy and radiation and the abandoning of his beliefs in faith/mental healing. PJ was told to see Doctor Ramirez by a close friend who explained that Dr. R "is the kind of doctor who treats the whole person." In his initial interview with a clinic nurse, he explains that he has suffered all his life from what he believes is heavy metal poisoning. His father was a dentist, and the family was exposed to large amounts of heavy metals which, PJ believes, weakened their immune systems and gave them cancer and neurological deficits. Two years earlier he had a large set of silver fillings removed by a dentist who botched the procedure, PJ says, exposing him to a high enough dose of silver to precipitated his current disease. To make matters worse, PJ has an adult son who has autism, which he believes was caused by heavy metal "poisons" that accompanied his childhood vaccinations. He believes that his faith and mental focus will bring his son back to health. He has received some support from a neighbor but has been mostly on his own throughout this illness. The nurse listens carefully and makes brief notes about PJ's medical and social history, but he becomes increasingly frustrated throughout the conversation, as though his view is not being heard. When Doctor Ramirez enters the room he finds an ill man who appears to be in marked discomfort, despite receiving moderate doses of narcotic analgesia. They begin by reviewing PJ's medical chart, including a CT scan of his spine that shows multiple large masses. There is no record of his treatment by the naturopath. Doctor Ramirez sits down, faces PJ, and begins by addressing his symptoms. He prescribes Miralax to relieve the constipation, but the patient refuses the prescription initially, saying he has read that it is toxic. The doctor explains that it is cancer that is killing him, not the drugs. Doctor Ramirez refers patient to a pain specialist and wants him to begin chemotherapy and radiation the following week. PJ tentatively agrees but pushes for a more naturopathic approach that is more in keeping with his beliefs, without allopathic or pharmacological interventions. Taking into account the parameters of the patient-physician relationship, and cultural differences, whose decision is the more ethically justifiable according to Mill?

1. Who are the moral community members in this case?

2. Explain the framework of Mill's theory and how it is applied to specific circumstances, i.e., what factors must be considered and what method must be used to objectively evaluate the various alternatives for action.

3. Should multiculturalism be incorporated into this case study and the resolution of the ethical issues?

4. Name the ethical issues.