Reference no: EM133527959

Sarah Jones is a 31-year-old woman. She was shot and is now in a coma. She is five and a half months pregnant. Because of the wound, one lung is collapsed and the other is functioning at a sub-optimal level. She is a single mother and has a five year old at home. Her mother, in consultation with her physicians, is currently making medical decisions for her.

Sarah has been in a coma for about three weeks (ever since the shooting). There is some speculation that it may have been her boyfriend who shot her. But, the police have been unable to locate him. At the time of the shooting Sarah was living at her mother's house along with her daughter. Her mother, Delores, is 58 years old. Delores is the only family Sarah has.

This morning, her pulmonologist and her obstetrician visited Sarah in the intensive care unit. She does not seem to be doing well, and her pulmonologist is particularly concerned. His view is that the pregnancy is putting a strain on her body, that things might very well get worse, and that she is much less likely to recover form the coma if the pregnancy is allowed to continue. She will have more of a chance to survive the wound, he claims, if she comes out of the coma. The pulmonologist suggests that it makes medical sense for Sarah to have an abortion.

The obstetrician is less comfortable with this. She is concerned because, in her view, Sarah has an almost viable baby. In addition, she says that no one knows what Sarah would want. Also, it is very possible that Sarah, even with the abortion, will not recover, and then there will be two deaths.

Delores, of course, is very worried about her daughter. She is very concerned with the question of whether Sarah will survive. She also says that she thinks she knows what Sarah would want, and that would be "to be at home taking care of her 5-year-old". Delores admits that she is also concerned about the fact that, if Sarah dies, she will have to assume full responsibility for her 5-year-old grand-daughter, and she is also concerned about suddenly having responsibility for the baby, should it survive as well.

Question: You are the ethics consultant on this case. What is your recommendation? Clearly explain and provide a justification for how you have arrived at that recommendation.

Analysis questions:

1) Describe the facts. Limit yourself to what is known. There is no speculation involved here. What is the person's medical situation, what is known of her life generally or in relation to / as relevant to this situation?

2) Describe uncertain or ambiguous aspects of the cases.

Identify aspects of case that cannot be presented as fact, which, instead, require some kind of interpretation because they involve uncertainty or ambiguity. This involves discussion of things that don't quite rise to the level of fact but may be features of the case that deserve discussion and possible interpretation.

EXAMPLES (not all of these are relevant to the case [perhaps none of them are relevant!]... I present them here merely as illustrative of the general type of things that one might consider for this step during the course of a general case analysis, not necessarily the case I've presented you with in particular): Is the person possibly clinically depressed? Is the family exerting pressure or pushing things to continue in a particular way? Is there conflict in the family that thereby puts the patient in a difficult place? Is the patient fearful? Would the patient become fearful if the case unfolds in one way yet not another? Is it possible, with some discussion, to identify the interests of the participants that should be recognized and articulated, interests that may be in conflict? Can we achieve informed consent? Do we have some way of discerning the patient's interests? What "default" position should we take and why? Is quality of life an important consideration? Who gets to make such quality of life determinations and why?

This section requires you to speculate, to interpret. What is important is that you provide a thoughtful explanation for the path that your interpretation takes... and that your interpretation is grounded in the facts of the case and makes logical inferences licensed by the scenario and the doctor's role in it.

3) Identify relevant principles (autonomy, beneficence, etc) and the point at which the relevant principles come into conflict or tension.

EXAMPLES (the same qualifiers as in the long parenthetical comment above apply here too): Is this a case that involves a conflict between concern for the patient's autonomy versus a desire that things will occur in a way that serves the patient's best interests (beneficence)? Is this a case that involves a conflict between autonomy and justice? Between autonomy and non-maleficence? Do the special duties of the doctor towards the patient become relevant in this situation? If so, in what way(s)?

You should identify the principles that are most at issue in the case, but also be clear about the specific way these principles are at issue. That is, it is not enough simply to name the principles. The question is how do the principles play out in this case. How you feel they interact with one another and which principles "trump" or otherwise "outweigh" others in guiding us to a resolution for the decision and why.

4) Determine possible case resolutions.

In this step, the point is to present alternatives. Do not argue for one alternative or another yet. Do not explain why one alternative is better than another yet. Simply list them. Keep your list of alternatives somewhat representative of reality (no outlandish alternatives that would allow you to evade the tough choices presented by the assignment such as "new medical technology is invented that lets us communicate with patients whose wishes we otherwise have no access to").

5) Choose a resolution, presenting a thoughtful defense of your choice. This section should also contain identification of and response to possible counter examples or possible counter arguments for different resolutions.