Withdrawing Treatment for Severely Deformed Infants
One of the most controversial questions in biomedical ethics today is whether severely deformed infants should be given access to the medical care they need or not. Advocates for the withdrawal of treatment for severely deformed infants base their arguments on the fact that treatment for severely deformed infants is futile. This means that severely deformed infants have no chance of surviving due to their medical condition. Consequently, there is no need to continue giving them medication (Jacobs & Taylor, 2005). However, some medical practitioners and human rights activists are against withdrawing treatment for severely deformed infants.
Their arguments are based on the value of human life (Porter, Johnson, & Warren, 2005). The ethical dilemma in deciding on whether treatment for severely deformed infants should be withdrawn or not is found on the justification of the decision made. This is because withdrawing the treatment could lead to the death of the infants. Consequently, there is a need to study the validity of the reasons that have been used to justify the withdrawal of such treatment. This will help medical practitioners to understand the basis of making decisions relating to the treatment of the severely deformed infants (American Nurses Association, 2001).
In order to achieve this objective, the validity of the concept of medical futility has to be tested. This paper argues for the premise that medical futility is a void concept and thus severely deformed infants should be given access to ordinary healthcare.
Reasons for Withdrawing Treatment for Severely Deformed Infants
To understand the ethical dilemma involved in this case, it is important to highlight the reasons used by the advocates of withdrawing treatment for severely deformed infants to justify their position on the issue.
Those who advocate for the withdrawal of the treatment use the concept of medical futility to justify their position. Medical futility refers to a situation in which the medication that is expected to improve the health of the patient is predicted to be ineffective based on the available evidence (Jacobs & Taylor, 2005). This means that the medical practitioners will use their past experiences with patients who had similar medical conditions to decide on whether to withdraw treatment or not. Thus if a given therapy did not succeed in benefiting the health of a given number of patients in the past, then such therapy will be considered to be futile (Jacobs & Taylor, 2005). Consequently, the therapy will be withdrawn as a treatment measure for patients in the future.
The concept is applied as follows in explaining the reasons why treatment for severely deformed infants should be withdrawn. First, some infants have severe deformation of vital organs such as the lungs, the heart, the nerve system and even the brain. Thus such infants have limited ability to interact with the environment on their own without the support of life-saving machines. This means that such infants cannot respond effectively to stimuli especially in cases where the brain is severely deformed. Due to these conditions, those who advocate for the withdrawal of treatment for severely deformed infants consider the infants to be incapacitated.
They believe that infants are as good as dead. Besides, they believe that no treatment can be used to reverse the infants’ conditions (Jacobs & Taylor, 2005). This implies that severely deformed infants are not persons due to their health conditions. Consequently, they do not have a right to medication and this informs the decision to withdraw the treatments given to them.
Second, the condition of most severely deformed infants cannot be treated or be reversed completely. This is due to the lack of appropriate medication or therapy that can help in solving the health problem of the infants. Thus the infants will have to live with the pain attributed to their health condition for the rest of their lives. Those who advocate for the withdrawal of treatment for severely deformed infants assume that the infants are not willing to live with their health conditions for long (Porter, Johnson, & Warren, 2005).
This means that the infants are not interested in continuing to live. Therefore, the infants do not have a right to any medication because they are not interested in continuing to live. The healthcare practitioners in this case will thus withdraw the treatment on the ground that it does not add any value to the health of the patient (Fry & Veatch, 2006). By withdrawing the treatment, the infant will have the opportunity to die. The death will therefore save them the pain that they would have suffered by continuing to live (Porter, Johnson, & Warren, 2005).
Finally, those who advocate for the withdrawal of treatment for severely deformed infants use the level of utility associated with the treatment of the infants to support their decisions (Jacobs & Taylor, 2005). In most cases, the treatment used in response to the health conditions of severely deformed infants has little effect or is slow in improving the conditions of the patients. Thus the patients are deriving little utility from the treatment and this might not be helpful for their well-being in the long term (Fry & Veatch, 2006).
The medical practitioners and healthcare providers are also deriving little utility by treating severely deformed infants. This is because they use a lot of resources in terms of cash and time to treat the patients. However, the outcome of their efforts to improve the health of severely deformed infants does not translate to the expected results. Consequently, the practitioners, in this case, deem it fit to withdraw the treatment to save on the scarce resources. The severely deformed infants are left to die as the resources are used to treat those whose health conditions can be reversed.
Analysis of the Reasons for Withdrawing Treatment
Those who are against withdrawing treatment for severely deformed infants identify several weaknesses in the concept of medical futility which forms the basis for withdrawing treatment. An analysis of the above reasons reveals the following weaknesses in the concept of medical futility. First, severely deformed infants are not considered persons due to their health conditions. This particularly happens in cases whereby the infant’s brain is severely deformed and the development of the infant’s personality is threatened. While this can be true, it is not easy to tell the extent of the infant’s brain deformation at early stages in life.
This is because most symptoms of brain malfunctioning are exhibited at later stages. This means that what might seem to be a severe deformation of the brain might not be the case when the infant grows up. Thus it will be a mistake to terminate the life of the infant by withdrawing the treatment they need to survive (Beauchamp & Childress, 2009). Today, the use of electroencephalography tests is used to determine whether a person is dead or not. According to this test, a person is dead if the test does not reveal any brain activity in 48 hours (Jacobs & Taylor, 2005). Thus the result of this test is used to withdraw the benefits of life support machines to the patients.
However, this definition of death is only limited to the brain. Medical research shows that even with lack of brain activity, the body of the patient can still maintain functions such as blood circulation, breathing, filtering of waste, and digesting food (Jacobs & Taylor, 2005). This shows that the body is not dead and can live longer if well maintained through medical support. Thus severely deformed infants are still human beings even if their brains are deformed. What they need is medical support to survive.
The concept of medical futility uses assumptions that if a particular medication did not succeed in improving the lives of a given number of patients in the past then such medication is futile (Jacobs & Taylor, 2005). Consequently, the use of the medication will be withdrawn for all patients. This reasoning fails to consider the fact that every patient is unique (Fry & Veatch, 2006). Thus it is not granted that the medication that has failed in some patients will fail in each and every individual.
Besides, patients respond to medication with varying levels of success. Consequently, there is no universal cut-off point for determining the success or failure of a given medication in improving the health of the patients. This means that withdrawing treatment for the infants is not justified simply because such treatments failed to help infants who had the same conditions in the past (Beauchamp & Childress, 2009). Instead of withdrawing treatment, the practitioners should consider alternative approaches to handling the infants’ conditions (American Nurses Association, 2001).
The other weakness of the concept of medical futility is found in the fact that the health practitioners have all the powers to make decisions regarding the lives of patients (Jacobs & Taylor, 2005). The advocates of the concept of medical futility argue that the practitioners are generally guided by the profession’s standards of care instead of a whim (American Nurses Association, 2001). However, personal prejudices and biases can interfere with the decisions of the practitioners regarding the lives of the infants (Fry & Veatch, 2006). When the responsibility to decide the life of the patient is fully given to the physician then the right of the patient to determine what they want for their lives is at risk (Porter, Johnson, & Warren, 2005). The law gives the patients the right to accept or decline treatment.
Thus the patients have to be involved in the making of decisions relating to withdrawal of treatment (Beauchamp & Childress, 2009). In the case of infants who cannot communicate, the decision can be made on their behalf by their parents. Consequently, the assumption that severely deformed infants do not have their lives at the best of their interest is nullified. This is because the opinion on the infants’ interests in their lives should come from the infants or their parents but not from the practitioners. Therefore, the infants should be given medication until at such a time when they are able to explicitly declare their lack of interest in their lives.
The concept of medical futility does not consider religious perspectives concerning life (Jacobs & Taylor, 2005). Every society subscribes to a religious ideology that upholds the dignity of life. Thus no one has a right to take the life of the other irrespective of the quality of the life in question (American Nurses Association, 2001). By withdrawing treatment for the severely deformed infants, the physicians are literally terminating the lives of the infants and this is against society’s moral standards. While religious ideologies should not interfere with the practice of medicine, practitioners cannot be effective without nurturing the values of society concerning life (American Nurses Association, 2001).
Religion gives physicians the best opportunity to understand the value of human life. This means that euthanasia is not allowed in society (Fry & Veatch, 2006). This is because for the physician to have authority to terminate the lives of the severely deformed infants at will by withdrawing treatment there has to be a law that gives them such authority (Porter, Johnson, & Warren, 2005). Currently there is no such law and this means that the severely deformed infants should be given all the necessary treatment that they require to live.
Severely deformed infants have always been denied medication since their treatment does not maximize utility (Jacobs & Taylor, 2005). However, the allocation of resources in healthcare cannot be based purely on utility. This is due to the fact that it is not possible to achieve maximum utility in treating all patients. Using utility as the basis for healthcare resource allocation will lead to inequality and alienation in the society. Besides, there are many options for addressing the low utilities associated with treating severely deformed infants. These options include improving the quality of compassionate care for the infants and the purchase of insurance cover to compensate for the financial resources used in the treatment (Porter, Johnson, & Warren, 2005). These options justify the need to offer treatment to severely deformed infants.
Finally, the general public is yet to understand the circumstances under which treatment should be withdrawn according to the concept of medical futility. While the proponents of the concept suggest that the information regarding withdrawal of medication should be available to the public, little progress has been achieved in implementing the suggestion (Jacobs & Taylor, 2005). Besides, the debate on withdrawal of treatment cannot be settled easily.
This is because a lot of funds and time will be needed to educate the public on the concept of medical futility. However, such education on the concept of medical futility will not be important if it is not possible to achieve consensus on the topic. Thus there will never be consensus on the topic even if more efforts are put into convincing the public to accept the concept of medical futility. Thus it will be more economical to focus on treating the severely deformed infants as compared to funding the debate on withdrawal of treatment.
Conclusion
The main dilemma in deciding whether to withdraw treatment for severely deformed infants is found in the justification of the decision made (Beauchamp & Childress, 2009). Those who advocate for the withdrawal of the treatment use the concept of medical futility to justify their arguments. Medical futility refers to the situation in which the treatment that is expected to improve the health condition of a patient is predicted to be ineffective based on available evidence. Severely deformed infants are denied treatment on the assumption that their health conditions cannot be reversed. Thus it is not important to make an effort to treat them.
However, medical research indicates that treating severely deformed infants can at least prolong their lives (Jacobs & Taylor, 2005). The main weakness of medical futility is that it relies on the assumption that treatment that failed on some patients in the past will fail in all subsequent patients (Jacobs & Taylor, 2005). This assumption does not hold in all circumstances as discussed above. Thus medical futility is a void concept and severely deformed infants should be given access to ordinary healthcare.
References
American Nurses Association. (2001). Code of ethics for nurses. Silver Spring,MD: American Nurses Association.
Beauchamp, L., & Childress, F. (2009). Principles of biomedical ethics. New York: Oxford Press.
Fry, J., & Veatch, M. (2006). Case studies in nursing ethics. Boston: Jones and Bartlett Publishers.
Jacobs, B., & Taylor, C. (2005). Medical Futility in the natural attitude. Advances in Nursing Science, vol. 28 (4) , 288-305.
Porter, T., Johnson, P., & Warren, N. (2005). Bioethical issues concerning death: death, dying and end-off life rights. Crit Care Nurs Q, vol. 28 (1) , 85-92.