CASE SCENARIO 1; MAKING DECISION BASED UPON THE SITUATION (Paternalism

and Utilitarianism)

Many years ago, as a junior nursing student, Mary was assigned to observe the labor and
delivery department of a small rural hospital. As frequently occurs in small towns, the nurses
and physicians were acquainted with many of the women – they knew their backgrounds, home
situations, and so forth. During her second day in the unit, Mary attended the delivery of a set
of premature twins. Unhappy that she was pregnant again , the 35 year old mother had 9 living
children and 2 previous miscarriages. After delivering the tiny babies, the physician walked to
the nearby room and placed them on a metal utility table. He turned and said to those in
attendance, “ Nobody is to touch them, she doesn’t need any more babies.”

Because these babies were very premature, it is unlikely they would have survived in the
best situations: nevertheless , the nurse struggled with moral implications. This example raises
many ethical questions , and illustrates a case of paternalism and utilitarianism taken to the
extreme.

 Utilitarianism holds that action is judged as good or bad in relation to the consequences
that are derived from it. If the physician is thinking in terms of utilitarianism, what would
be the argument to support his action.

- In utilitarianism, the action is judged whether it is wrong or not based on its

outcomes. It gives the notion that the end always justifies the means.
Sometimes there are situations when a person will do the wrong action to
achieve the right because, in utilitarianism, those producing the greatest
happiness are considered the only right action. In the given scenario, if the
physician is thinking based on the ethical theory of utilitarianism, one of the
arguments that will support his action is that the patient, even from the start
of her pregnancy, is not happy with it considering her current status. Also, in
weighing the outcome of the action, it will not achieve the greatest happiness
but only struggles physically, emotionally, and financially for the mother and
the premature twins since, based on the assessment, they are unlikely to
survive in the best situation.

 Assume that the twins are rescued. Name as many possible outcomes as you can imagine
 - Based on what I have learned in the past two years as a student nurse, there
are many possible outcomes that the family, especially the mother and the
premature twins, will experience, either positive or negative such as:

POSITIVE OUTCOME:
 The twins will experience life in this world.
 The twins will have the opportunity to have and explore their freedom
and fundamental rights as a human.
 If the mother decides not to raise the twins and chooses adoption, the
baby will experience the life, love, and care they deserve. They will
also bring joy to the family who will love them.

NEGATIVE OUTCOME:
 The family will experience more struggles financially, considering that
the babies are premature twins. It needed advanced care to
continuously support the life of the babies and knowing that the family
had nine more children to feed and considering their financial status.
 The mother might struggle to control her emotions, leading to anxiety
and depression. Since she has nine kids adding the two premature
babies, her mind and body will tire of taking care of her children and
responsibility for household chores. Additionally, since she has a
history of miscarriages, it can be a factor in triggering her emotions.
 Since the twin is born very premature, their body system is weak and
vulnerable because some organs are not fully developed or functional
to fight certain diseases and infections. They are prone to several
complications that might lead to sudden death. Adding that the care
that provided by small rural hospital is limited the possibilities that
they will survived is little.

 Name 4 arguments in support of and 4 arguments in opposition to the physician’s

decision?

Arguments that support physician decision:

1. The mother is unhappy with the pregnancy
2. The family is struggling financially it will only be hard for them to support their
other children
 3. The twins are premature baby with low rate of survival
4. The resources of the family are limited to provide advance care that the twins will
need.
Arguments in opposition to the physician decision:
1. It removes the autonomy of the mother to decide for the life of her babies
2. It deprives the freedom and fundamental rights of the twins to experience life
3. It violates the natural and divine law by letting the twins to die without providing
comfort and care.
It removes the opportunity and privilege of the twins to experience the love and
care they deserve and the chance to give joy to a family who needs it.

 Considering her position as student in the hospital, what were Mary’s options?

- Since Mary is only student nurse in the hospital, she has no authorization or
right to decide on the situation. The only thing that she can do is to accept,
follow, and respect the decision of the doctor or whoever is in charge.
However, she can ask the doctor or the higher person to her the basis,
evaluation, and moral principle that has been considered in coming up with
the decision. This will not only address the moral complication that she is
experiencing but also help and develop her decision-making in the future. 

 What thought would have gone into your mind if you were in the situation?

- In nursing school, we are taught that as a nurse, if we can’t redirect the

course of life of a patient, we still must provide the care they deserve. As a
person, I do not support the decision of the doctor to place the premature
babies on the metal utility table and leave it there without doing anything.
This action removes the right of the mother to decide for her baby’s life.
Although the twins are very premature and struggling to fight for their lives,
as professionals, we must still provide the care they deserve to the best of our
ability. According to Immanuel Kant, morality applies to all for all times,
and there is no exception. It means that the outcomes or consequences of the
action are unimportant as long as we provide the care that the patient
deserves and needs.