Chapter 5 Abortion 273 DECISION SCENARIO 9 Whose Life? Daniel Bocker was worried. The message his secre- tary had taken merely said “Go to see Dr. Tai at 3:30 today.” He hadn't been asked if 3:30 was convenient for him, and he hadn't been given a reason for coming in. Mr. Bocker knew it would have to do with his wife, Mary. She had been suffering a lot of pain during her pregnancy, and the preceding week she had been examined by a specialist that Dr. Tai, her gynecologist, had sent her to see. The specialist had performed a thorough examination and taken blood, tissue, and urine samples, but he had told Mary nothing. “Thank you for coming in,” Dr. Tai said. “I want to talk to you before I talk to your wife, because I need your help." "The tests showed something bad, didn't they?" Mr. Bocker said. "Something is wrong with the baby." "The baby is fine, but there is something wrong with your wife, something very seriously wrong. She has what we call uterine neoplasia." "Is that cancer?" “Yes it is,” said Dr. Tai. “But I don't want either of you to panic about it. It's not at a very advanced stage, and at the moment it's localized. If an operation is performed very soon, then she has a good chance to make a full re- covery. The standard figures show about 80% success." “But what about the baby?" “The pregnancy will have to be terminated,” Dr. Tai said. “And I should tell you that your wife will not be able to have children after the operation." Mr. Bocker sat quietly for a moment. He had always wanted children; for him, a family without children was not a family at all. He and Mary had talked about having at least three, and the one she was pregnant with now was the first. “Is it possible to save the baby?" he asked Dr. Tai. “Mrs. Bocker is only in her fourth month; there is no chance that the child could survive outside her body.” "But what if she didn't have the operation? Would the baby be normal?" "Probably so, but the longer we wait to perform the operation, the worse your wife's chances become. I don't want to seem to tell you what to do, but my advice is for your wife to have an abortion and to un- dergo the operation as soon as it is reasonably possible." “But she might recover, even if she had the child and then had the operation, mightn't she?" “It's possible, but her chances of recovery are much less. I don't know what the exact figures would be, but she would be running a terrible risk.” Mr. Bocker understood what Dr. Tai was saying, but he also understood what he wanted. “I'm not going to encourage Mary to have an abor- tion," he said. “I want her to have a child, and I think she wants that, too." “What if she wants to have a better chance to live? I think the decision is really hers. After all, it's her life that is at stake." "But it's not just her decision," Mr. Bocker said. "It's a family decision, hers and mine. I'm not going to agree to an abortion, even if she does want one. I'm going to try to get her to take the extra risk and have the child before she has the operation." 1. Would the doctrine of double effect justify taking steps to treat Mrs. Bocker's illness, even at the cost of terminating her pregnancy? 2. Would both Noonan and Thomson see the situa- tion as one in which considerations of self-defense are relevant? 3. It is sometimes said that the father of a child also has a right to decide whether an abortion is to be performed. Would Daniel Bocker be justified in urging his wife to take the risk of having the child? Copyright 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. 332 Part III Terminations illegal in New York to assist someone in committing suicide, the grand jury decided not to indict Dr. Quill on the charge. Dr. Quill's actions were later reviewed by the three-member New York State Board for Professional Medical Conduct to consider whether he should be charged with professional misconduct. The board arrived at the unanimous decision that “no charge of misconduct was warranted.” The board, in its report, distinguished between Dr. Quill's actions and those of Dr. Jack Kevorkian. (See the Case Presentation “Jack Kevorkian: Moral Leader or Dr. Death?" in this chapter.) The board pointed to Dr. Quill's long-term involvement in caring for Ms. Trumbull and contrasted it with Dr. Kevorkian's lack of any prior involvement with those whom he assisted in killing themselves. Moreoever, the board pointed out that Dr. Quill "did not directly participate in any taking of life," and this, too, made his actions different from those of Dr. Kevorkian.“One is legal and ethically appro- priate, and the other, as reported, is not,” the board concluded. 1. Does Dr. Quill's action fall within the scope of a physician's legitimate role? 2. Why might one view Dr. Quill's action as justifiable? 3. Was the action a case of active euthanasia? DECISION SCENARIO 2 What Would He Want? Jeffry Box was eighty-one years old when he was brought to Doctor's Hospital. His right side was para- lyzed, he spoke in a garbled way, and he had trouble understanding even the simplest matters. His only known relative was a sister four years younger, and she lived half a continent away. When a hospital social worker called to tell her about her brother's condi- tion, she was quite uninterested. “I haven't seen him in fifteen years," she said. “I thought he might already be dead. Just do whatever you think best for him. I'm too old to worry about him.” Neurological tests and X-ray studies showed that Mr. Box was suffering from a brain hemorrhage caused by a ruptured blood vessel. “Can you fix it?" asked Dr. Hollins. She was the resident responsible for Mr. Box's primary care. The man she addressed was Dr. Carl Oceana, the staff's only neurosurgeon. “Sure,” said Dr. Oceana. “I can repair the vessel and clean out the mess. But it won't do much good, you know." “You mean he'll still be paralyzed?" "And he'll still be mentally incoherent. After the operation he'll have to be put in a chronic-care place, because he won't be able to see to his own needs." “And if you don't operate?" Dr. Hollins asked. Dr. Oceana shrugged. “He'll be dead by tomorrow. Maybe sooner, depending on how long it takes for the pressure in his skull to build up.” “What would you do?" “I know what I would want done to me if I were the patient," said Dr. Oceana. “I'd want people to keep their knives out of my head and let me die a nice, peaceful death.” “But we don't know what he would want,” Dr. Hollins said. "He's never been our patient before, and the social worker hasn't been able to find any friends who might tell us what he'd want done." “Let's just put ourselves in his place,” said Dr. Oceana.“Let's do unto others what we would want done unto us." “That means letting Mr. Box die." "Exactly." 1. On what grounds might one object to Dr. Oceana's view? 2. Would active euthanasia be justified? 3. Would the natural law view make the operation discussed a moral mandate? Copyright 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Chapter 8 Organ Transplants and Scarce Medical Resources 363 “Medicaid will pay for the surgery, but not for an organ, and that's the only way we can get one." “How much does a liver cost?" "I've got a family right now that says it wants $15,000 for the liver of their baby. She died this morning." “I can't get money like that,” Clarissa said. “I can ask them to come up and talk to you. Maybe they would take less, or maybe you could work out some kind of deferred payment with them.” “What if I can't?" Dr. Amatin shook his head. “I can't arrange for a transplant without an organ that size, and I sus- pect they will try to find somebody else to sell it to." “That's not fair,” Clarissa said. “Just because I haven't got the money, my baby is going to die." 1. Does the possibility of such situations demonstrate that the present policy of relying on donated or- gans is a superior one? 2. Why might one object to selling organs? Do these ob- jections apply to all kinds of organ sales-for example, to a government-regulated market with set prices as well as to a free market? If it's all right to give away organs, why should it be thought wrong to sell them? 3. What other organ-procurement policy, besides vol- untary donation and organ sales, might be worth considering as a means to increase the number of transplant organs available? 4. Is Ms. Austin correct in saying that it would be unfair for her child not to have the organ because she cannot afford to pay the asking price? After all, surely it is not unfair for her child not to have, say, a silver drinking cup because she cannot afford to pay the asking price. 5. Some critics claim that organ sales will promote the "commodification” of the human body. What, if anything, is wrong with that? DECISION SCENARIO 5 Selling a Kidney Colin Benton, a British citizen, died of renal disease in the summer of 1988 after a kidney transplant failed. Benton's widow later revealed that the donor kidney had been ob- tained from a Turkish citizen who traveled to London for the surgery. The kidney donor was paid the equivalent of around $4400. When asked why he had sold the organ, the man explained that he needed the money to pay for medical treatment for his daughter. It was this case that led the British Parliament to outlaw organ sales. 1. On what grounds might one claim that it is wrong for society to allow people to sell organs? 2. Is there a moral distinction between donating a kidney out of benevolence and selling one for financial gain? 3. If a father has no other way to raise money for surgery necessary to preserve the life of his child, would it be morally permissible for him to sell a kidney? Should we hold him morally blameworthy if, given the opportunity, he refused to do so? 4. Is selling one's kidney different in any morally rele- vant way from selling one's labor under potentially hazardous conditions (e.g., mining coal)? DECISION SCENARIO 6 Lifestyle Factors Dr. Sarah Brandywine hurried into Dr. Kline's inner of- fice. Dr. Kline was transplant coordinator at Midwestern General Hospital, and he was expecting her. She had called him for an appointment as soon as she realized the dimension of the problem with Mr. Wardell. “So tell me about Mr. Wardell,” Dr. Kline said, nod- ding toward the chair beside his desk. “He's a fifty-one-year-old man who came to the hospital two days ago because he was frightened by the jaundice and ascites he developed over the course of the last week," Dr. Brandywine said. “He had been experiencing fatigue and loss of appetite several weeks prior to the jaundice. His liver is swollen and lumpy." “Sounds like cirrhosis,” Dr. Kline said. “I'm sure you did liver function tests, but what about a biopsy?". Copyright 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. 363 口 A^ AI Chapter 10 Women and Medicine 415 DECISION SCENARIO 5 Tabita Bricci Is Taken to Court In early December 1993, twenty-two-year-old Tabita Bricci, pregnant with her first child, went to St. Joseph Hospital in Chicago for a checkup. She was eager to do all she could to make sure that she had a healthy baby. The doctors at St. Joseph gave her bad news, how- ever. The thirty-six-week-old fetus was not getting enough oxygen and nutrients through the placenta to develop normally. The baby might die or suffer severe impairments, including brain damage. The good news, the doctors said, was that at 36 weeks the fetus could do well outside her body. They recommended an im- mediate caesarean section. Tabita and her husband Mircea, a twenty-three- year-old bank worker, were Pentecostal Christians, and they prayed for guidance in making a decision. According to their reading of the Bible, however, they thought the pregnancy should not be ended until the full term. Tabita told the doctors she didn't want to have the recommended surgery. St. Joseph Hospital referred the case to the Cook County state's attorney's office. The public guardian went to court to seek an order requiring that Tabita Bricci have a caesarean section potentially to save the life of her fetus. The court refused to issue the order, and Patrick Murphy, the public guardian, appealed the decision. “As lawyers for the fetus," Murphy said, "we have to do everything possible to maximize his life.” Murphy told a panel of the Illinois Appellate Court that it had to decide whether the fetus, close to full term, was“just a mass of human cells or a real life- form being kept prisoner in a mother's womb."Were it not“for the mother's primitive beliefs, he'd be outside the womb." An attorney for the state said that the hospital did not want to force the woman into the hospital, but it wanted her to have a caesarean once she naturally began labor. What if she refuses, one of the justices asked? Should she be strapped down and operated on? The attorney replied that once the patient was given an anesthetic in a routine way, the surgery would then be performed. (Caesarean deliveries are from two to five times more likely to result in the death of the mother than vaginal deliveries.) A public defender representing Tabita Bricci said, “This is absolutely Orwellian." On December 14, the appellate court unanimously upheld the lower court decision. The next day, Murphy filed an expedited appeal to the U.S. Supreme Court, but the court refused to take the case. Tabita Bricci gave birth vaginally to a four-pound, twelve-ounce, boy on December 30 at Northwestern Memorial Hospital. The baby was about three pounds under the usual birth weight, but he appeared to have suffered no defects from the placental problem. Even so, doctors said it would take months or years to be sure. 1. Who should get to say whether a fetus is protected from the risk of harm or death, the pregnant woman or the state? 2. Should a fetus be recognized as having rights that should be compared or "balanced" with those of the pregnant woman? 3. How does the question of the status of the fetus as a person relate to the issues raised by cases like that of Tabita Bricci? [Note: Compare the Bricci case with the one discussed in the Case Presentation"Angela Carder's Ordeal," in this chapter. See the Readings in Section 1 of the chapter also.] Copyright 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.