Patients Making Bad Decisions Case Study

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Medical ethics and rules like the Hippocratic oath are fairly clear-cut when applying them to real-world solutions and situations. However, there are some situations where the "right answer" can be elusive and people will sometimes go against their own self-interest. Such seems to be the case with Mr. Simpson. He has weak lungs and his doctors and family morbidly fear that if/when he gets the flu again, it will literally kill him. However, even with this being the case, Mr. Simpson refuses to get the flu show under the auspices that he could end up getting the flu as a direct result of the shot despite assurances that this will not happen. Of course, this can absolutely happen in real life but that argument is not a factor in this case study as it is assumed he cannot possibly contract the virus. While Mr. Simpson is obviously not making the right long-term decision, it is his decision to make and nothing short of power of attorney or a medical condition that renders him unable to care for himself is going to enable the doctors or families to in any way ethically give him the shot.

Analysis

While it is an unfortunate truth that Mr. Simpson is making the wrong choice, it is his choice to make and no one should be allowed to counteract that by disobeying his wishes or lying to him. Basically every tenet of bioethics and the general right to live one's life the way they see fit suggest that forcing the shot on Mr. Simpson or deceiving him is the wrong way to go. The first reason for this is autonomy. Mr. Simpson is not a child and has indeed lived a long full life. The years of colds, bronchitis and such have taken their toll on Mr. Simpson's lungs and now he faces his mortality because of it. Even so, Mr. Simpson has been made aware of the risks of the shot but he feels that the risks of taking the shot are just as bad if not more. In a way, he does have a point in that even if he could get the flu again and die as a result, it might happen or it might not. Chances are he most certainly will unless he is a total hermit even from his family. Indeed, any random family member including child or grandchild could come in his personal space and give him the virus and the person may not even know they are sick at the time. However, there is only a chance and not a certainty of that happening. In the case of a shot, the risks (if they exist) are omnipresent no matter what so it would seem to many, including Mr. Simpson, that he is voluntarily inviting risk by taking the shot.

Another dimension of bioethics to look at is paternalism. This is something that the nurses and doctors are trying to force on Mr. Simpson but he knows that he cannot be forced to take the shot and he adamantly refuses to take the shot. The doctors and nurses are foisting their own view of the future based on a theory on Mr. Simpson and obviously Mr. Simpson is pushing back and recoiling in a major way. Put another way, the doctors and nurses are trying to implore and impress upon Mr. Simpson that they know best and Mr. Simpson clearly and completely disagrees. This paternalism manifests all over the place within the American healthcare system in the form of some drugs being allowed while others are banned. Different standards and recommendations are allowed to bubble up while others are forced down. While this can be a good thing, medical care and prevention is still an odds and probability game a lot of the time. It is a near certainty that Mr. Simpson will get the flu again and it is at least likely that he will die from it. However, he is of sound mind and he prefers not to get the shot. If he had a much more dangerous of contagious disease such as tuberculosis or something of that nature, it may not be up to him. However, the flu is relatively harmless, at least in the long-term, to the vast majority of the people that get it. While children and older people are the most susceptible, only the former and not the latter can be controlled by edict and rule all of the time while anyone at the age of majority is technically allowed to do what they wish. A sterling example of this would be the famous preacher who would tout and swing around venomous snakes to display his faith even though just one bite could kill him. Even after he was eventually bit, he refused the medical care he absolutely needed and he died.

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It is not hard to figure out why he died, but he may have been dead regardless and it was his choice to play Russian roulette with snakes. However, the case of Mr. Simpson is not nearly as simple but the overall point is the same. It is Mr. Simpson's life and he cannot be forced to get the flu shot so long as he is making his own medical decisions. Barring something like dementia or incapacitation, nothing will change that.

Next up for discussion is the topic of beneficence and/or non-maleficence, which for the purposes of this argument are basically the same thing but can manifest in a number of ways. The doctors and nurses are making their stand for good and offering the best-case scenario for Mr. Simpson, that being that he get a flu shot as his lungs will not be able to take another bout of influenza, in all likelihood. However, how one can define maleficence and beneficence can obviously vary. One example that some may pose while others not would be the idea of getting Mr. Simpson a shot to "boost his immune system" as a subterfuge to give him the flu shot without his knowing. When looking at it from the standpoint of Mr. Simpson's well-being, it may seem like the right move. However, from the perspective of informed consent and Mr. Simpson being allowed and able to make his own health decision, it is certainly maleficent to give him care without his permission and/or knowledge without an overarching reason for it such as incapacitation and/or loss of sound mind.

This leads to the next dimension, which is the aforementioned informed consent. While informed consent is not always possible as not everyone has their health directives and preferences mapped and documented ahead of time. An example of this would be a patient that does not want to be resuscitated but no one that knows of this preference is present when such resuscitation is necessary or called for. However, Mr. Simpson is not an incapacitated patient and is certainly awake and aware enough to make a decision about what could happen but might not. The doctors and nurses are focused on him getting the flu down the road and thus getting him killed while the patient (Mr. Simpson) is focused on what the shot could do for him or to him.

The last major issue to be discussed, and this has already been covered directly or indirectly, is competence, in the grand scheme of things Mr. Simpson is going to get the flu and it could quite possibly (or likely) kill him. However, he has been told that, ostensibly understands that and has decided that he is not willing to take risks (perceived or actual) that he associates with the flu vaccine. It matters not if he is wrong, and he probably is, for two major reasons. First, he might not get the flue and it might not kill him even if he does. However, even if he does get the flu and does die, he is taking a calculated risk. It is a more extreme version of medical and life decisions that people make every day. Some people go to the doctor every time they get a sniffle while others never go unless they are near death or at least feel like it. There are upsides and downsides to both approaches and the proper perspective is probably somewhere in the middle, but unless someone is a child or unable/incapable of making choices due to mental competence, it is his call to make. Second, he does not present a risk to just about anyone but himself as most people that would or could get the flu. As such, he and he alone bears the ultimate consequences of the choice he makes and why he makes it. As such, no one person or agency have the inherent right to override his decision regardless of what a third party may think, what medical professionals may think or what Mr. Simpson's friends and family may think. The overall takeaway from this case study is that Mr. Simpson was given….....

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