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Ethics in nursing is very vital. The foundational objective of this essay is to explore a case that has the potential of rising ethical questions. This is with the aim of familiarizing ourselves with such situations and to know how to apply the knowledge we have acquired from learning and experience in practicing. We will see how the basic principles of ethics and moral theories are applied to solve such problems as put people in deep dilemmas.
The conjoined twins
The critical case to study is that of Conjoined twins. They were born in Manchester in the year 2000. This was on 8th of August in Mary’s Hospital. The twins are known as Mary and Jodie. The doctors had done an ultra scan on the pregnancy at the age three months. This is when they found that they were conjoined.
The parents were residents of Gozo Island. This was a place that people upheld high catholic Christian morals. Abortion was a grave sin and so this was not an option for the parents. They remained apprehensive waiting for all the best. Medical facilities were also not enough in the island. In that case, they travelled to Britain for the medical services.
The seriousness of the health of the children was seen at birth. They were joined at the lower end of their spines. They seemed to have a single trunk with legs emerging from it. They also had their circulatory system fused. The twins shared a single bladder. The weaker twin Marry, had a heart that was not functioning effectively. Her lungs had not taken in air and her brain was primal. She was only surviving in the cost of Jodie, who had normal functioning.
The case’s dilemma lies in the fact that surgical operation would kill Mary and that her survival would strain Jodie’s heart and result to the death of both at the age of between three and six moths. Jodie needed nothing else but surgery to survive.
The doctors had the opinion that the surgery should go ahead. Their parents were opposed to this idea, giving reasons that they were devout Christians. They therefore entrusted the future of the twins to God’s care and will. In addition, they said nature should take its course, even if both girls would succumb to the problem. They also said they had equal love for their daughters and not one was to be favored beyond the other. They both had equal rights to live. If the operation had to take place, the parents would not imagine losing her life on behalf of the other. In addition, Jodie was to remain in the hands of the specialist. This meant that the parents would go home without her. They would not envision this. Finally, the girl would be a handicap for a long time thereafter. The parents could not take this in as they thought about it. After the parents had become completely adamant about this, they applied to the high Court for a permission to go ahead with the surgery. This was in the family division.
On 25 August, the judge ruled that the operation should go on. This was in favor of the doctoral team. Though the judge had taken a serious consideration on the rights of the parents, he still was forced to rule that that the operation goes on because of the fact that they would both die. To the judge it would be better if we let the stronger twin live. He also considered the feeling of the parents. Conversely, the medical facts presented to him that one of the twins was living in the expense of the other, and would result to death of both, made him decide that the operation should go on.
This decision was a shock to the parents and was highly criticized in the media. It also caused a sharp divide on the public opinion. People saw that doctors would turn to court if they have not agreed with parents. This is with the aim of undermining the rights of the parents and their concern. People considered the act to be a thing that sparked serious ethical and legal discrepancy. The life of one child should not be sacrificed for the life of the other.
This halted the operation for further deliberation. By September, Jodie had stopped growing normally even if Mary had become bigger. This was a great signal that there was trouble. Prolife Alliance came up with an offer to take care of the issue and pushed its case through the Vatican. This made the parents to fight even harder. They went to the Court of appeal. After a long deliberation, the courts decision was still the same with the first court. The Catholic Church did not side with this decision. They damned it. The parents reportedly accepted the process and the operation took place in November. In the operation, Mary did not survive. Jodie lived but had to go through specialized care. This was in the reconstruction of her body parts and skin surgery. This was to go on for a number of years in her life.
By July 2003, she was approaching her third birthday. Her brain is normal and her life expectancy was average.
The ethical issues
The case shows a wide rage of ethical considerations and critical analysis. This will show us how we may reason on many other cases that draw from the same principles applied in this case. It is not put forward to convince someone to take a particular decision but to think critically and make a sound decision.
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Value and rights of life
To resolve the dilemma basing on the rights idea will be very difficult. The opinion appeals to the moral status off the two girls and is highly divided. It is therefore hard to reach the conclusion that Jodie or Mary has a right to life. According to the Church, life is sacred and is worth respect from conception. To the Church, the rights are conferred to the conceived babies because it is at this point that they gain full moral status (David et-al, 1996). On the other hand, we have people who hold an opposite opinion of this. They say that rights are not conferred to conceived children because they have not yet comprehended any right (Archard, 2006). In this case, the people cannot wrong the young children by putting them to death.
If we reason basing on those arguments in turn, we may come up with three conclusions, all different. Either, both girls have a right to live, either girl do not have any right to live, or Jodie has the right to live and not Mary. If we are to say both have equal rights to life as the parents, then we should analyze the rights of each girl independently. In that case, Mary will be found to depriving Jodie her personal rights of the body.
All parents have a right to seek medical treatment for all their children. It is the parent’s duty to look for and provide medical care equally for his or her children. This must all be in the good interest of the children. The impasse comes up if the parents’ resolution is in contrast with the doctors’ view and the well-being of the child.
The other difficult thing is to decide if to respect the parents’ decision to prevent surgery of the twins pegged on their religious belief, on the expense of the life of the children. This is such a hard decision to make. However, basing on the previous argument on rights one can reach a conclusion.
The other thing is the criteria, which the court used to decide to rule in favor of the medical decision. This one thing brings dilemma in deciding whether to go in the direction of the court or by the belief of the parents. The underlying part is not the belief but to respect their right as having the capacity to make a decision for their children. What about the differing concerns of Mary and Jodie? Whose should we use to come up with a sound decision?
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Again, we know that the Law highly upholds the interests of children. Ironically, the same custodians of law decide otherwise as concerns the life of Mary. It is therefore hard to know which way to go because Mary and Jodie’s interest are conflicting.
Another question would be concerning the future of Jodie. Is she supposed to live because Mary died? If so, is it ethical that this happened? These are also some of the question that are hard to answer.
Looking the condition of Mary, her life will be full of pain and suffering and she would eventually die. She does not have a perfect brain and she depends on her sister to live. In that case, she does not have any thing substantial that she calls her right. Separating her through surgery and her death is denying her nothing.
Sacrificing an innocent child for the benefit of another
A group of people views life as the end in itself. They therefore consider killing as an acceptable despite all other reasons that people may come up with to justify it. On the other hand, others see the end as to justify the means. If the result of killing the one is beneficial then there is no problem with such a death. Mary’s fate is known. She will die even if she remains joined with her sister. For Jodie, she will die if she remains joined with Mary. However, she will live if she is separated from her sister, even though with some defect but with normal life and an average life expectancy.
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Mary is a parasite to Jodie
Even though Mary is innocently intruding on Jodie’s life, she is parasite that is draining her of her livelihood. The destiny of Jodie with Mary joined on her is death. Jodie therefore has a right that the person who is draining her life be removed.
Paternalism and Patients Autonomy
We know always that every specialist in any field is the expert in that field. Doctors likewise know best in their field (Paternalism). In this case, we are bound to take the doctors advice even if it spells doom for Mary. On the other hand, the patients have the right to decide treatment they want (Autonomy). Infringing the parents rights to decide, is clashing with this ethical principle. What would we decide in that case? If the operation were to go ahead because the doctors know best, the surgeons would be liable of offence, of acting on Mary’s body without the parents’ consent. In that case, the conflict between the parents’ interest and the doctors’ view stalled everything, especially when the facts had professionally challenged them (Smith, 2000). This became intense when they faced sharp criticism from the media.
Deliberate killing and discontinuing life due to predictable dire consequence
Is there a difference between the two? Some people may maintain the fact that there is no difference. They will term both cases as killing and would say it is an ethical. Some would think through the situation before making a conclusion. Consider Mary and Jodie’s case. Jodie would die if Mary were not separated from her. Mary however, would die in either case. Therefore, to save at least one of the lives, it would be fair that one of them die to let one of them survive. Furthermore, the life of Mary was almost totally dependant on Jodie. Remember that her heart was not functioning; for that case, Mary’s used Jodie’s circulatory system. It was just right therefore that her life was terminated for the good of Jodie. The act should be taken as immoral but the moral value should be determined from the resultant product.
State sanctioned murder
Did the Court ruling imply state sanctioned murder? This is another fundamental question. This is where ethics once again questions legal decision. This action pictured a situation where people put aside moral and legal restraints. Going round the same reasoning, one would be forced to look at the result of the action. This is after rigorous analysis of the whole issue, leading to the knowledge of the disadvantages of not taking such an action. In this case, we will still that the separation of the twins would be more profitable. It would be better to loose one of them than to loose both. Therefore, at the end the state did not sanction murder.
Many more situations that are complex bring such dilemmas. Nurses and doctors should be able to weigh all options before settling on a solution. Considering all ethical principles, they should always be ready to come up with consensus with all patients before acting on an issue. They should also be ready to make very clear explanations to patients and show them the importance of some actions they would like to execute. Clear explanations make it easy for them to convince the patients to consent in several situations.
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