The Philosophical Approach to Be Used For the Case
The philosophical approach that seems to be appropriate for this case is Consequentialism/utilitarianism theory. This philosophical approach is concerned mainly with the outcomes of a particular action as the basis for judging whether the action is right or wrong. The consequentialist theory holds that the moral judgment about a given action can be determined from the consequences of the action (Consequentialism, n.d).
It has relation to utilitarianism, a theory that was popularized in the eighteenth and the nineteenth centuries by Jeremy Bentham (Mill, 2002, p.4). It emphasized on the resulting happiness of a given course of action. In respect of utilitarianism and consequentialism, a moral action will be one that produces the maximum good for all the subjects involved.
The given case involves a scenario in which different medical practitioners are in a state of dilemma on the best action to take following a medical conditions of two of their clients. An analysis of the possible consequences of the alternative actions to be taken by the practitioners can enable them make the appropriate decision.
In this particular case, there are two main concerns to be considered. There is need to preserve the privacy or confidentiality of an individual by not revealing her medical condition to the relatives. On the other hand, the revelation of this medical condition may be of help to another relative who suspects to have a similar problem. If the first medical condition is not revealed, the other victim is likely to undergo an operation.
The controversy here is that in the event that the operation is performed while the victim was not affected, then it would have been a waste. Besides, it is not guaranteed the operation will completely prevent the occurrences of the medical condition in the victim’s lifetime. The analysis of all these outcomes can provide the practitioners with the best approach to resolve the dilemma.
The Narrator of the Case
The narrator of this case is Anneke Lucassen, a clinical geneticist. The case comprises different stories that the clinical geneticist encountered in his profession while providing clinical services to different families. Anneke provides a collection of stories by different people all of which revolve around the same subject of breast cancer. There is a story by Jane, her other family members have suffered and died of breast cancer.
Jane is worried that the condition could be related to the genes in their lineage and that she may as well suffer the same. Her husband suggests that she seeks a medical intervention now that such thought disturbs her emotions. There is also the story by Phyllis, an aunt to Jane who apparently is suffering the same problem.
Phyllis is worried about the odds that she would encounter in the event that her condition is revealed to the other family members. In particular, she does not have good relation with Jane following a row with the latter’s mother before her death.
Phyllis laments that she is fed up of being blamed for anything that is not in order in their family. She detaches herself completely from the family members and holds that the other family members have no business knowing her test results.
The story by the general practitioner reveals Phyllis’s stance on her confidentiality. Coincidentally, Jane and Phyllis are attended to by close practitioners who can share ideas. The GP attending to Phyllis support her need for confidentiality even though this information can be of help to Jane.
The oncologist’s story provides the developments that are being registered on genetics and oncology, and illustrates how the advances will prevent future similar dilemmas. The author also gives a story by a geneticist from whom Jane sought for genetic test for breast cancer. The geneticist provides more details on such kinds of test and the information that Jane did not have concerning the test.
The narrator then provides his own evaluation of the case. Anneke observes that this particular case is typical of the different scenarios encountered in medical ethics. Situations of dilemma often occur in the field whereby the confidentiality of a victim is to be considered against the benefits of disclosing this information.
However, for this case, Anneke is submissive to the possible claim that the dilemma here results from lack of proper mechanisms for genetic tests. He admits that the problem arises because the technicalities of the genetic tests are still in their preliminary stages.
The narrator hopes that in the event that these mechanisms are developed properly, there will be no need to seek information from the relatives of a particular an individual in order to carry out a test for breast or ovarian cancer.
A moral subject in any given setting refers to an individual who is to receive ethical consideration (Peter, 2004). In such a case, the individual has his or her rights and duties. The individuals are also to be held responsible for the actions that they take in the event that the actions are conflicting with the rights of the others. In this respect, Jane, Phyllis and all the professionals involved here can be regarded as moral subjects in some sense.
All the moral subjects in this case are represented fairly. There is a concern to have Jane receive proper medical attention. The health specialists do not want to her to undergo unnecessary operation until the effectiveness of such operation is established. The right to privacy of Phyllis is also presented in the case.
She narrates how she feels about her family members and that she would not want to share her test results with the family members. The practitioners are, of course, in the central position for the ethical consideration as the ultimate decision-makers. They will be held responsible for the actions that they take. The case presents the views of the different practitioners as to the course of action that would be appropriate.
At the first encounter with this case, an instinct in us tells as that something needs to be done in order to help Jane in her situation. We tend to develop an assumption that life has meaning for some individuals more than it does for the others. The adverse health consequences that Phyllis may experience do not seem to appeal to our intuitions.
This is contrary to the natural perception that all individuals derive equal meaning out of life. The assumptions are supported by the emphasis put on the situation as involving a lot of dilemma. The position of the oncologist is that it is inappropriate to consider the effects that the tests will have on all the family members before performing them.
The Relationships Developed In This Case
Power relationship occurs where an individual has authority over the decisions that another individual can make. The latter is to be submissive to the requirements of the authority even if he were in a capacity to do otherwise. In the given case, Phyllis appears to have power over the general practitioners and subsequently to Jane.
The respect that the practitioners have for her confidentiality has presented them from proceeding with any tests on Jane even though they have very relevant information. The geneticist feels that Jane should be told the medical condition of Phyllis and then Phyllis be informed of this disclosure. However, they are still barred from this and they now wish for a restructure of the guidelines.
On the other hand, caring relationship often occur between healthcare specialist (nurse) and the clients. It involves provision of care to some ailing of individual by the nurses or by other family members in the case of home-based care. Individuals who have some ill health and are in dire need of help tend to develop this relationship quite rapidly (Bevis, p.127).
In this case, caring relationships are seen between Jane and Phyllis, and their respective general practitioners. Such a relationship is also seen when Phyllis cares for her mother and sister until the two die of breast cancer.
In the normal setting, the members of a given family may easily share information about a genetic situation. The members of the family have the mutual understanding sharing this information can be of help to all the members, whether they have been affected in some way or not. The situation is different when the members of a family are in conflict as provided in this case.
It should be noted that the proper predictive tests for this particular medical condition is effective if information is available about the genetic changes that have been observed in that family. Thus, there is need to seek other details from family members who are willing to reveal their conditions. The medical case does not focus on the lineage of Jane’s uncle.
Great Uncle Stan is still alive and he does not have bad relations with Jane. His side of the story is completely ignored and attention is focused onto Phyllis who proves to be of no help to Jane. Information from the medical condition of his daughters could be helpful in deciding whether Jane should undergo the predictive tests as well as the operation.
The Counter-Arguments and Ethical Principles Applicable In the Case
This case invokes a series of counter-arguments that involve ethical considerations. It would be argued that the practitioners had the ability to perform the tests and operations regardless of the effects that such move would have on the given subjects. To come to a better decision, the practitioners are to be guided by certain ethical principles. These include consequentialism and utilitarianism, approaches which have some relation.
Consequentialism involves examining the overall outcomes of a given action and asserts that the action with highest positive outcomes is the most ethical one. However, those opposed to this theory argue that it “undermines the integrity of the agent’s life” (Mulgan, 2005, p.15).
On their part, utilitarian hold that an action will be considered right if it produces more of pleasure and happiness while reducing pain and suffering (utilitarian.org, n.d; Scarre, 1996, p.2). It is seen as a form of consequentialism as it involves maximization of utility.
It does not discriminate against persons on whatever bases. Utilitarianism requires that the agents should be impartial as to whether the resulting happiness is for himself or for the others (Mill, 2006, p.28). In this case, utilitarianism is evidenced when the practitioners cannot deny Phyllis pleasure and happiness for Jane’s happiness, hence the dilemma.
Other philosophers also believed that consequentialism is not distinct from the deontological approach that emphasized on duty. They considered duty as the actions that produced overall good (Tully, 2006, p.13). The consequentialist approach can help resolve the dilemma through a cross-sectional analysis of the possible outcomes in this case.
There have been ethical codes that given the operations of medical practitioners for several centuries (Breen et al, 1997, p.3). The practitioners need to follow these codes. The general medical council (GMC) guidelines require that the practitioners break the confidentiality of their clients only in an event that it is very necessary.
The GP observes that there is no enough evidence to show that the prophylactic bilateral mastectomies will reduce Jane’s chance of dying form breast cancer (Case Study). Besides, the practitioner also observes that operation involves a kind of surgery that can be very harmful to the subject.
It would then be against the professional ethics to break this confidentiality. The possible outcomes would be that the medical practitioners face charges for violating the rights of their clients and breaching the provisions of the GMC. Perhaps, they would lose their jobs because of such a move. The client might also suffer the adverse consequences of unnecessary operations.
In order for Jane, to undergo the operation, it is necessary that the test results of Phyllis be revealed. Even if Jane were not informed of her aunt’s condition, carrying out the operations in her would enable her to conclude that her aunt suffers the disease.
She had been informed of the need to know health history of her affected relatives in order to have an effective operation. On her part, Phyllis is worried that in the event that her condition is revealed, more blames would be vested on her by her family members. This would give her more stress and negatively affect her poor health status.
The only possible positive consequence of performing the operation lies in the probability that this operation will prevent Jane from suffering the disease. However, there is lack of certainty for this possibility. Besides, the general practitioner suggests regular screening as a possible means of managing Jane’s case. Perhaps this would help until her ailing aunt succumbs to the disease, after which the condition might be revealed.
On the other had, the move has adverse negative effects to Phyllis and the medical practitioners. It threatens Phyllis’s life as well the professional careers of the practitioners.
Thus, the possible negative results seem to overweigh the positive outcomes should the test be carried out on Jane. The utilitarian economic justification is also evident since such a move may bring pain and suffering that are more pronounced than the associated pleasure and happiness.
The narrator has touched on other important individuals who will be affected in one way or the other by the actions to be taken in this case. Jane’s husband is more concerned on the emotional state of his wife. The decisions to be taken by the practitioners will also affect him due to this concern.
Jane’s daughters are significant stakeholders since their mother’s condition may reflect on their condition as well in the event she might test positive for the disease. However, none of these stakeholders can be advocated for in preference to the others. The stated principles will call for an equal consideration of their needs as long as they all amount to overall positive outcomes.
This final position tends to shift from an initial perception that attempted to advocate for one subject while breaching the rights of the other. This position, which is usually held by the majority at the first instinct, suffices to be challenged.
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