When it comes to the case of Baby Boy Doe, many people have an initial reaction of shock, disgust, and contempt for all of those who were involved in the death of the infant. Those viewed “at fault” were not only the parents, but the family’s physician, the hospital staff, state family social services and the hospital organization. Today, we have the luxury of saying, “How could that many people have failed the infant? or, all of those involved would be locked up today.” However, at the time there was only one law in effect for self-determination that took place prior to 1970, but the catch was that the law only covered autonomous adults, not minors, and especially not minors with disabilities. In this assignment, I will be discussing my point of view on: what made the Baby Boy Doe case an ethical dilemma, the implications of the case, and finally what I think that the hospital could have done in that situation and whether or not the hospital acted appropriately.
In order to discuss what makes the Baby Boy Doe case an ethical dilemma, we must first be able to understand what an ethical dilemma is. According to the book, Ethics in Health Services Management it explains: “Ethical dilemmas occur when decision makers are drawn in two directions by competing courses of action that are based on differing moral frameworks, varying or inconsistent elements of the organizational philosophy, conflicting duties or moral principles, or an ill-defined sense of right and wrong.” What this means is that, when thinking about the process in which led to a loss of a life, the physician, the state family social services or any number of hospital staff may have wanted to save the infant’s life but because there was a lack of hospital policy or law protecting their ability to act on the infant’s behalf, they then abided by the parents’ wishes. It could be said that acting on the behalf of the infant could have costed them their livelihoods thus impacting their future or the future of their families.
As for the implications of this case, I think that it could be said that the hospital/physicians did allow the parents to be autonomous in their decision making. The parents essentially were not acting in the child’s best interest but in their own interest of what they decided as a life unworthy of their standards. There was no evidence of paternalism on behalf of the physicians because after informing the parents of their choices they left the choice up to the parents. When applying the moral principles of beneficence, nonmaleficence, and justice I think the hospital did not act beneficently because prior to the 1984 Child Abuse Amendments, hospitals were not yet legally able to go against the parents’ wishes. In an article by Alzheimer Europe they are defined as, “Beneficence involves balancing the benefits of treatment against the risks and costs involved, whereas non-maleficence means avoiding the causation of harm.” With that being said for nonmaleficence, I think that in order to do what is least harming to the patient, the hospital could have either: fixed the baby’s atresia and prepared for a legal battle or euthanizing the baby so that he would have had passed away in a more humane way rather than how he died. Considering the era that this took place, I will have to say that the hospital was acting in a “just” way. However, I do think that there is more the hospital could have done to give the baby a chance to live.
As stated above, I think that the hospital did not act appropriately as there were still more that they could have done. For instance, the hospital could have tried harder by getting another physician and/or family (with a child who has down syndrome) to come talk to and help convince the parents that a child with disabilities has a chance to live their life to the fullest. Another option the hospital could have presented would be to talk the parents into getting the infant’s atresia fixed and having the parents’ giving away their rights so that the child could be adopted into a family who would raise him. Lastly, the hospital could’ve recommended euthanasia for a more peaceful death rather than the horrible way the infant suffered prior to dying. Unfortunately, the fact remains that the infant’s parents simply just did not want the child to live at all and did not care for how the child would die.
In conclusion, this is why I think it is so critically important for health care organizations to have a philosophy, moral principles, and policies to protect the staff, and the patients alike. After the death of Baby Boy Doe this was not the last time a child with disabilities were to be at the center of an ethical dilemma. Later, there would be another case that would flag the attention of even the President Reagan himself. In the case of Baby Jane Doe, “The infant suffered from and incomplete development of the spinal cord, and abnormally small head, a buildup of fluid in the cranium, and kidney damage.” “…The parents opted against corrective surgery and decided to provide the infant with palliative care consisting of antibiotics and dressing of the exposed spinal sac.” It was after this case in which the 1984 Child Abuse Amendments were able to lay the groundwork for nonautonomous children, and especially children with disabilities. This also made a way for health service organizations to create policies to protect and provide the quality of care each human being deserves without dampening the rights of both the autonomous and nonautonomous patients/staff alike.
References
- Darr, Kurt. Ethics in Health Services Management, Fifth Edition, Health Professions Press, Inc., 2011. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/apus/detail.action?docID=4816403.
- Alzheimer Europe. (2009, May 09). Beneficence and non-maleficence. The four common bioethical principles. Referenced from https://www.alzheimer-europe.org/Ethics/Definitions-and-approaches/The-four-common-bioethical-principles/Beneficence-and-non-maleficence.
- Resnik, J. (2011, May 12). The Baby Doe Rules (1984). The Embryo Project Encyclopedia. Referenced from https://embryo.asu.edu/pages/baby-doe-rules-1984.
