Ethical Analysis of the Famous Johns Hopkins Case
The Johns Hopkins Case: They Should Have Operated
Logically, the quality of life argument is less valid then the sanctity of life argument. This is simply because quality of life can only be assessed by a wide variety of subjective measures, such as health, happiness, intelligence, pain level, social stigma, financial strain, family stress, etc. The outcome of decisions based on quality of life are therefore determined by whichever subjective measure is used in the assessment. Decisions based on the sanctity of life however, offer an objective principle to use as a measure; Life is valuable and while it exists, it should be supported to the fullest extent possible. There are many arguments about when life begins but for the purpose of this paper I will assume that it is widely accepted that at birth, the baby is considered alive and is supported by the medical ethics which protect everyone. Medical ethical principles such as: respect for autonomy, beneficence, nonmaleficence and justice are based on the sanctity of life model.
There is no way for a newborn to express its own autonomy. Guardians, such as parents are given the right to make medical decisions which they feel are in the best interest of their child. Since parents love their children, usually a child's best interests are supported properly by parents. The parents of baby X however, did not sufficiently advocate for the best medical interests of their special needs baby. When baby X was born, the doctors noticed that he appeared to have down syndrome. Also it was discovered that the baby had an intestinal blockage which is a relatively easy condition to correct. The financially well off parents were presented with two options for their newborn. The first option was to consent to a normal risk surgery to remove the intestinal blockage from the infant. The outcome of choosing this option would be, the child could to eat, survive and grow up normally, still with mild retardation from down syndrome. The second option was to not consent to the surgery. The outcome of this would be, the baby could not eat and would therefore starve to death. With the knowledge of both outcomes, the parents of Baby X chose option two and decided not to consent to routine surgery to remove the intestinal blockage from their newborn. This choice was clearly based on a quality of life judgment. The parents argued that they did not think it was fair to their other normal children to be raised with a retarded one. This reason is obviously subjective as many families in their position are functional and happy with children who are both normal and disabled.
The subjective measures the parents used to make their quality of life judgment were based on their own convenience and fear of social stigma. They did not want to raise a child with special needs and they wanted to save themselves and their existing children from the burden and embarrassment of having a family member with down syndrome. While this may have served the interests of the parents, it certainly didn't take into account the best interests of the baby. If they would have used a different quality of life measure, namely the potential happiness of baby X, their decision may have been very different. To use the happiness measure, they may have considered what the doctors informed them; Children and adults with down syndrome are known to be very happy and can have long fulfilling lives. Instead of being given the chance to live, baby X suffered an excruciating death by starvation over an 11 day period in a side room at the hospital.
If the baby could have expressed autonomy it would have most likely chosen to live. If you ask a child or an adult with down syndrome if they would rather live or die they would likely choose life. Many would argue that if they were born with a disease like down syndrome they would rather not live. This again is a quality of life assertion, which is based on a subjective assumption that life is not rewarding or valuable unless it's normal. When making medical decisions for someone who can not make their own wishes known, it is important to consider what they would want from their perspective, instead of making assertions based on what you would want if you were in their position. We can take the perspective of Baby X by thinking about his immediate infantile drives. Starvation is not a pleasant or peaceful death. If not for any other reason but to ease his own discomfort and suffering, Baby X would have most likely elected for a quick surgery followed by a warm belly full of milk over the long process of starving to death.
A further concern is that doctors and medical staff are bound by the Hippocratic oath and other for mentioned ethical principles. Instead of making decisions within the bounds of medical ethics, the doctors refer to using “the American ethic” Which is, “a different standard... There is a tendency to value life on the basis of intelligence... It's a part of the American ethic” (John Hopkins Case). We don't have the medical field just to support the well being of normal healthy people. The medical field is there to explore, heal and ultimately cure the complex phenomenons of human physiology with all of its abnormal, disabled and diseased components. This is why medical ethics is charged with protecting the rights and interests of all people.
The doctors in this case could have taken administrative steps to bypass the parents decision and gain legal consent through the courts to preform the life saving surgery. They report that if the child had a normal IQ they would have pursued this course, but because the child had down syndrome they decided not to. If they would have taken these legal steps, regardless of the courts decision they would have been free of ethical fault. By neglecting these steps, the medical professionals violate the ethical principle of granting justice and fairness to all their patients.
Additionally, if the courts decision supported the medical rights of the baby, the doctors could have legally preformed the routine and normal risk surgery which could have prevented the prolonged suffering and otherwise inevitable death of baby X. In essence, allowing Baby X to suffer and die under their care, when they could have taken steps to prevent it, violates the ethical principles of beneficence and nonmaleficence because they did nothing to promote a good outcome and in fact caused unnecessary harm to the baby.
The decisions made in this case were based on the subjective quality of life way of thinking instead of the logical, objective, sanctity of life model. I have shown why the parents, doctors and medical staff were ethically wrong for choosing this method and why in most cases, it is more reasonable to use the sanctity of life model. Additionally, I have shown that in this case all four major medical ethical principles, autonomy, justice, beneficence and nonmaleficence were violated. Therefore by the standards of modern medical ethics, the child was a victim of negligence and suffered a wrongful death.
Logically, the quality of life argument is less valid then the sanctity of life argument. This is simply because quality of life can only be assessed by a wide variety of subjective measures, such as health, happiness, intelligence, pain level, social stigma, financial strain, family stress, etc. The outcome of decisions based on quality of life are therefore determined by whichever subjective measure is used in the assessment. Decisions based on the sanctity of life however, offer an objective principle to use as a measure; Life is valuable and while it exists, it should be supported to the fullest extent possible. There are many arguments about when life begins but for the purpose of this paper I will assume that it is widely accepted that at birth, the baby is considered alive and is supported by the medical ethics which protect everyone. Medical ethical principles such as: respect for autonomy, beneficence, nonmaleficence and justice are based on the sanctity of life model.
There is no way for a newborn to express its own autonomy. Guardians, such as parents are given the right to make medical decisions which they feel are in the best interest of their child. Since parents love their children, usually a child's best interests are supported properly by parents. The parents of baby X however, did not sufficiently advocate for the best medical interests of their special needs baby. When baby X was born, the doctors noticed that he appeared to have down syndrome. Also it was discovered that the baby had an intestinal blockage which is a relatively easy condition to correct. The financially well off parents were presented with two options for their newborn. The first option was to consent to a normal risk surgery to remove the intestinal blockage from the infant. The outcome of choosing this option would be, the child could to eat, survive and grow up normally, still with mild retardation from down syndrome. The second option was to not consent to the surgery. The outcome of this would be, the baby could not eat and would therefore starve to death. With the knowledge of both outcomes, the parents of Baby X chose option two and decided not to consent to routine surgery to remove the intestinal blockage from their newborn. This choice was clearly based on a quality of life judgment. The parents argued that they did not think it was fair to their other normal children to be raised with a retarded one. This reason is obviously subjective as many families in their position are functional and happy with children who are both normal and disabled.
The subjective measures the parents used to make their quality of life judgment were based on their own convenience and fear of social stigma. They did not want to raise a child with special needs and they wanted to save themselves and their existing children from the burden and embarrassment of having a family member with down syndrome. While this may have served the interests of the parents, it certainly didn't take into account the best interests of the baby. If they would have used a different quality of life measure, namely the potential happiness of baby X, their decision may have been very different. To use the happiness measure, they may have considered what the doctors informed them; Children and adults with down syndrome are known to be very happy and can have long fulfilling lives. Instead of being given the chance to live, baby X suffered an excruciating death by starvation over an 11 day period in a side room at the hospital.
If the baby could have expressed autonomy it would have most likely chosen to live. If you ask a child or an adult with down syndrome if they would rather live or die they would likely choose life. Many would argue that if they were born with a disease like down syndrome they would rather not live. This again is a quality of life assertion, which is based on a subjective assumption that life is not rewarding or valuable unless it's normal. When making medical decisions for someone who can not make their own wishes known, it is important to consider what they would want from their perspective, instead of making assertions based on what you would want if you were in their position. We can take the perspective of Baby X by thinking about his immediate infantile drives. Starvation is not a pleasant or peaceful death. If not for any other reason but to ease his own discomfort and suffering, Baby X would have most likely elected for a quick surgery followed by a warm belly full of milk over the long process of starving to death.
A further concern is that doctors and medical staff are bound by the Hippocratic oath and other for mentioned ethical principles. Instead of making decisions within the bounds of medical ethics, the doctors refer to using “the American ethic” Which is, “a different standard... There is a tendency to value life on the basis of intelligence... It's a part of the American ethic” (John Hopkins Case). We don't have the medical field just to support the well being of normal healthy people. The medical field is there to explore, heal and ultimately cure the complex phenomenons of human physiology with all of its abnormal, disabled and diseased components. This is why medical ethics is charged with protecting the rights and interests of all people.
The doctors in this case could have taken administrative steps to bypass the parents decision and gain legal consent through the courts to preform the life saving surgery. They report that if the child had a normal IQ they would have pursued this course, but because the child had down syndrome they decided not to. If they would have taken these legal steps, regardless of the courts decision they would have been free of ethical fault. By neglecting these steps, the medical professionals violate the ethical principle of granting justice and fairness to all their patients.
Additionally, if the courts decision supported the medical rights of the baby, the doctors could have legally preformed the routine and normal risk surgery which could have prevented the prolonged suffering and otherwise inevitable death of baby X. In essence, allowing Baby X to suffer and die under their care, when they could have taken steps to prevent it, violates the ethical principles of beneficence and nonmaleficence because they did nothing to promote a good outcome and in fact caused unnecessary harm to the baby.
The decisions made in this case were based on the subjective quality of life way of thinking instead of the logical, objective, sanctity of life model. I have shown why the parents, doctors and medical staff were ethically wrong for choosing this method and why in most cases, it is more reasonable to use the sanctity of life model. Additionally, I have shown that in this case all four major medical ethical principles, autonomy, justice, beneficence and nonmaleficence were violated. Therefore by the standards of modern medical ethics, the child was a victim of negligence and suffered a wrongful death.