Aurelio, Lyca Mae M.

BSN II-D

Prenatal Diagnosis and Abortion

Activity 1

1. Do you agree with Naoko’s decision? What will you do if you were in Naoko’s situation?

I’m not against abortion but I admire Naoko for knowingly welcomes a baby with Down syndrome
into her life. I will definitely do the same as long as I am morally supported and financially capable
to raise the child but if not, I have no choice but to give up the life of the baby. Not because I
don’t want to save the baby but actually I want to save the baby from suffering that he/she is
made to endure.

2. What are your general impressions and the value of prenatal diagnosis in your culture and
religion?

Our culture and religion permit prenatal diagnosis so long as the expected benefit to the fetus is
greater than the foreseen risks. To make things more morally accepted, interventions must focus
on developing skills to foster a patient-centered, shared decision-making process and cultural
competency skills to discuss issues related to disability and termination in a culturally sensitive
fashion.

3. How the prenatal diagnosis useful? Is prenatal diagnosis always necessary for expected
mothers?

Prenatal diagnosis is essential to check on the health of the developing baby. During pregnancy,
mothers are often very anxious about their babies worrying that they may develop problems.
While prenatal testing is not a must, it is very important as it helps you to identify common
genetic disorders for better planning. It helps you make cognizant decisions for the baby pre and
post-birth.
 4. Should the hospital tell all the results including congenital disorders they find through the
prenatal diagnosis to the parents?

Hospital should tell all the results including congenital disorders they find through the prenatal
diagnosis to make the parents access counseling earlier and make informed decisions on what to
do. It allows them to arrange for procedures during and after birth of their baby. Dealing with
the disorder is a serious matter and needs a lot of attention and preparation.

5. Do you agree with abortion in general, or is it acceptable with certain reasons or not?

I believe abortion is a personal choice. Under no circumstances should someone be allowed to

force any individual to make particular decisions about reproduction, including forcing them to
become a parent against their will, depriving them of the ability to become a parent, or
interrogating their own decisions about pregnancy. The choice over when and whether to have
children is central to a parent’s independence and ability to determine their future.
Aurelio, Lyca Mae M. BSN II-D

Angela Carder – Maternal Fetal Issues

Activity 2

1. Should the treatment wishes of terminally ill or dying pregnant women be respected any
less stringently than those of non-terminal patients or non-terminally ill pregnant women?

During this 21st century, we are now free to choose all kinds of things in life from who we marry
to what kind of work we do and I think when one comes to treatments, whether you have a
terminal illness, you should have a choice about what happens to you and should always be
respected in regards of any situation. Compassionate care must be integrated in respect for the
patient’s autonomy.

2. If a pregnant woman’s decisional capacity is at question, who should act as her surrogate?
Are there limitations to this authority?

In the case pregnant woman’s decisional capacity is at question, the consent of legal
representative is required such as her immediate family members or spouse. Provided however,
that she must still be involved in the decision-making process to the fullest extent allowed by her
mental capacity.

3. If a pregnant woman, her designated surrogate, and her attending physician all agree to
forgo intervention intended to benefit her fetus, under what circumstances, if any, should
the health care providing organization intervene?

Health care providing organization should intervene the procedure when the foreseen risks is
greater than the expected benefit to the fetus. The risk taken by the mother should be
proportionate to the good resulting to the fetus.

4. If a dying pregnant woman’s surrogate does not give permission for interventions on
behalf of the fetus, does the state have “interests”?

The state has no right to decide on behalf of the mother because to be legally correct, so far as
possible decisions must be made by her surrogate. However, if the physician thinks that the
surrogate’s decision is in contrary to the patient’s best interest, he may challenge this decision
on the court.

If you’re Ms. Angela, what will be your decision? Make a decision by applying the ethical decision-
making process.

If I were Ms. Angela, I shouldn’t have listened and agreed to judge because calling a judge was a
counterproductive panic reaction. The judge treated the live woman as though she were already
dead, forced her to undergo an abortion, and then justified their brutal and unprincipled opinion
on the basis that she was almost dead and her fetus’s interests in life outweighed any interest
she might have in her own life or health. Direct communication with the patient is almost always
the most useful and constructive response to solve the problems.
Aurelio, Lyca Mae M. BSN II-D

The Case of George: DNR for an Adult with Down-Syndrome

Activity 3

1. The conflict in this case is between law and ethics. Address first what is the ethical thing
to do here.

When healing is no longer possible, when death is imminent and George’s suffering is
unbearable, then the physician’s role should shift from healing to relieving suffering in accord
with the parent’s wishes.

2. Is it ethically appropriate to remove the feeding tube? What is your argument?

Yes because George, unless an absolute miracle happens, will die eventually regardless of how
many interventions it takes to prolong his life expectancy. George already faces a long, slow,
painful death, surely it is much kinder to spare him this kind of suffering and allow him to end his
life comfortably.

3. Should the parents ask Stan and the other boys at the group home if George has ever
expressed an opinion on the subject of end-of-life?

Yes because it can greatly influence their decision since George did not talk about dying to them
ever before.

4. Is the ideal here that the parents use a substituted judgment or a best interest judgment?

The parents must ideally use a substituted judgment, needing to make a decision that reflected
the knowledge of the patient however George did not talk about dying to them ever before so
there is a need for them to consider more the context of their child’s current situation which
leads now to best interest judgment.

5. Distinguish between competency and decisional capacity. Even if George has been
declared incompetent, could he still have decisional capacity to make out an advance
directive?
Surrogate decisions are necessary if no directives are available however if George is conscious,
his interests must still be respected even if he is mentally incompetent as conveyed in advance
directives or living wills. Thus, the primary care physician is thrust into the conflict of rendering
care for the patient while looking after the patient's interests and wishes.

6. What kind of ethical reasoning are you using-virtue, principles, consequences?

I’m using consequential reasoning because it involves systematic steps to arrive at a morally right
or just decision or action.

If you are going to advise the family, what will be your decision? Make a decision utilizing the
ethical decision-making process.

I will advise the family to give up the life of their son already because unless an absolute miracle
happens, George will die eventually regardless of how many interventions it takes to prolong his
life expectancy. George already faces a long, slow, painful death, surely it is much kinder to spare
him this kind of suffering and allow him to end his life comfortably. It is not as if he is really ‘living’
during this time; he is merely waiting to die. George should has the right to avoid this kind of
torturous existence and be allowed to die in a humane way where his life ends with dignity.
Aurelio, Lyca Mae M. BSN II-D

A Family Divided

Activity 4

1. The judgment of futility should be a conclusion of a communications process, not a

beginning. How would you propose beginning the communication?

Who should be present?

 Patient’s wife and children and the attending physician and the rest of the treatment
team.

What information should be shared?

 Ethical consideration on the patient’s condition.

What alternatives are on the table?

 Agree to the tube placement in order to prolong the patient’s life.

 Disagree to the tube placement because the patient did not want to be sustained by
artificial means and in order to end his sufferings.

What is your goal in participating in the discussion?

 Choosing an alternative that have better results or consequences by outweighing the

possible options available using ethical decision making.

2. The family is divided over whether or not their husband/father should be placed on a
feeding tube. What are the points you need to consider and what you are going to discuss
with the family?

Most of us want to live as long as we possibly can, but l also believes that it is acceptable to let
anyone with some severe medical condition which is causing unbearable symptoms to have an
assisted suicide. Plus, the attending physician and the rest of the treatment team are opposed to
placing the feeding tube because their argument is that the patient has “minimal consciousness”
and will not improve. This means that the patient will die eventually regardless of how many
interventions it takes to prolong his life.

3. How will you advise the family and the healthcare providers? If not, what is to be done
now?

I will advise the family to disagree to the tube placement because their burden is huge and cuts
across various domains such as financial, emotional, time, physical, mental and social, knowing
that there is no longer an assurance that the patient will be able survive. When healing is no
longer possible, when death is imminent and patients find their suffering unbearable, then the
physician’s role should shift from healing to relieving suffering. It must be a choice for both family
and medical staffs.

4. How would this case have been different if the attending physician had been the one
asking for a consultation?

The family’s freedom to make rational and unconstrained decision using substituted judgment
(what the patient would choose if he could) shall always be respected by the physician. If the
family chooses to decline the tube feeding, the physician’s compassionate care must be
integrated in respect for the patient and his family to makes patient’s life ends with dignity.

If you are going to advise the family, what will be your decision? Make a decision utilizing the
ethical decision-making process.

Most of us want to live as long as we possibly can, but l also believes that it is acceptable to let
anyone with some severe medical condition which is causing unbearable symptoms to have an
assisted suicide. Plus, the attending physician and the rest of the treatment team are opposed to
placing the feeding tube because their argument is that the patient has “minimal consciousness”
and will not improve. This means that the patient will die eventually regardless of how many
interventions it takes to prolong his life. Family’s burden will just grow and cuts across various
domains such as financial, emotional, time, physical, mental and social, knowing that there is no
longer an assurance that the patient will be able survive.