LESSON 8: REASON AND IMPARTIALITY

ETHICS: ETHICS
PROFESSOR: Prof. Concepcion G. Regalado
UST-AMV College of Accountancy First Semester | A.Y. 2023 - 2024

THE CASE OF BABY JANE DOE ■ The Benefit Argument

● Important case in history due to non-existing laws in ▣ If no one would benefit from the medical
the 1900s. treatment then the treatment will be pointless
● This case made it possible to define certain ethical and need not be performed.
issues in healthcare. ▣ Dr. Newman: Baby Jane Doe will not benefit
● Baby Jane Doe was diagnosed with spina bifida from the surgery.
(broken and protruding spine), hydrocephaly, ▣ Therefore, the surgery need not be performed.
(excessive fluid in the brain) and microcephaly (an ■ The Sanctity of Life Argument
abnormally small head, suggesting that a part of her ▣ Every human life is in is individually and uniquely
brain was missing). sacred.
● The surgery was needed for the spina bifida, for the ▣ Every individual regardless of age should be
main purpose of straightening or correcting her given medical treatment as needed to preserve
posture. However, doctors who examined the baby life.
disagreed about whether the operation should be ▣ Therefore, the surgery on Baby Jane Doe should
performed. have been performed.
○ Dr. Newman, for one, believed that the surgery is ■ The Argument from the Wrongness of
pointless because the baby could never have a Discriminating Against Handicapped
meaningful life anyway. ▣ It is wrong to discriminate against handicapped
○ Dr. Keuskamp believed that the baby's condition people.
was not hopeless and advocated for the immediate ▣ Baby Jane Doe is obviously a handicapped and
surgery. her parents with a support of Dr. Newman were
○ The parents decided to accept Dr. Newman's denying her treatment precisely because of her
recommendation and they agree that aggressive handicaps. If she was a normal child needing
treatment for the child is pointless. surgery it would surely have been provided.
● Lawrence Washburn, a lawyer associated with the ▣ Therefore the parents’ decision was wrong.
conservative right-to-life groups positioned the courts
to set aside at parents' wishes an order that the REASON AND IMPARTIALITY
surgery be performed. ● Reason is a faculty that is used by a man in dealing
● The New York State Supreme Court granted the with issues.
request, but a higher court quickly overturned the ● Moral judgments are not a matter of personal
order. The court was impressed by Dr. Newman's preferences or tastes.
testimony. ● In moral reasoning, we…
○ Newman's testimony states that the decision made ○ Identify the morally relevant aspect of the situation.
by the parents is that it would be unkind to have ○ Weigh these morally relevant aspects giving due
surgery performed on this child. On the basis of the considerations to the view of the persons concerned.
combination of malformations that are present in ○ Enumerate all possible actions that can be pursued.
this child, she's not likely to achieve any meaningful ○ Decide on a particular action reason to be the most
interaction with her environment nor ever achieve ethically justified.
any interpersonal relationships, the very qualities ● On impartiality
which we consider human. ○ Each individual's interests are equally important.
● After Mr. Washburn's suit was dismissed, the federal ○ Each must acknowledge that the other person's
government got into the act. The Department of welfare is equally important as our own.
Justice filed suit demanding access to the hospital's ○ Impartiality entails a prescription against
records in order to determine whether a handicapped arbitrariness in dealing with people.
person is being discriminated against. ○ Empathy is associated with being impartial.
● This suit was also dismissed when the judge declared ● The Minimum Conception of Morality
“that the parents decision was a reasonable one based ○ The effort to guide one’s conduct by reason while
on the consideration of the medical options available giving equal weight to the interests of each
and on the genuine concern for the best interests of individual who shall be affected by one’s conduct.
the child.”
● Was the parents’ decision correct?
○ The Underlyimg Arguments in the Case of Baby
Jande Doe

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 THE NEW FOUND USE OF THE PLACEBO EFFECT patients who need them and pay half the price. The
● To keep patients from being addicted to certain pain money is divided among those who are not involved.
medications like morphine, most doctors would ● These occurrences are not recorded because the nurse
prescribe alternate dosage of morphine and plain supervisor for that floor is no other than Lucky's
normal saline solution. brother, who's also involved in the case.
● Both will create cessation of pain sensation: Morphine ● And on the spot, inventory of expensive medicines
exerting its pharmacotherapeutic effect and the were conducted by hospital officials. Lucky was then
normal saline creating psychological effect to the on duty. Four vials of these expensive medicines were
patient thinking that it was morphine being injected. missing and yet not accounted for. The medicine
● In a surgical unit of a certain hospital, a nurse found a disembursed among the existing patients in the floor.
new application of the “placebo effect”. ● Lucky knew that CCTV would be reviewed for that
● Nurse Lucky was a newly hired registered nurse in the matter. He remembered that night when he found
surgical unit. He was hired immediately because his three vials of these medicines but eventually returned
brother who is a nursing supervisor in the said them where he saw them. This may spark
hospital. investigation and suspicion may turn on him.
● As he was being oriented by his senior nurse, he was
told that some patients will ask for pain medications a TOOLS FOR ETHICAL DECISION-MAKING
lot but these are not even liberally because of their ● Dilemma happens because good and evil are not
addictive properties. The senior nurse demonstrated apparent.
how placebo is carried out. He was instructed to do it ● Dilemma is about competing values, and not
only under the prescription of a doctor. competing options. We do not choose an action, in
● One night while he was on duty, Lucky decided to do fact, we choose a value.
an extra effort in cleaning the nurse's station in line ● How should we decide?
with the 5s (sort, straighten, shine, standardize, ○ Most often, we decide instinctively. Strictly speaking,
sustain) program of the hospital. As he began his task, nothing wrong with feelings, but feelings are always
he found vials of pain relievers and IV antibiotics under loaded – they are very biased and unless we use
the sink. The medicines were not expired. He also reason we will not see the full sum of the dilemma.
found out that these medicines cost 2000 pesos per ● Why Reasoned Process?
vial. He decided to place these vials back on the sink ○ Facts
and decided to ask his senior nurse about it later. ■ With a reasoned process, you will look at facts and
● One day, a patient's relative approached him and then you will evaluate; look at what are the values
asked where he can find Lucky's brother. Lucky asked and principles involved.
him why and introduced himself as his brother. The ○ Stakeholders
patient's relatives then said “Good that he is your ○ Values
brother. Will you kindly hand him over these three vials ○ Options
of medicine I bought from him at half the price? My ○ Consequences
sister, who is at the surgical unit died this morning and ● Steps in Decision-Making
will therefore not need these. Kindly ask him if I could ○ Know the facts
get a refund because I really need money to arrange ○ Gather the stakeholders
the interment." ○ Articulate the dilemmas
● Lucky was in shock when he heard about a patient's ■ Make a “dilemma statement”.
relative. He remembered the medicines he found the ■ Articulate the dilemma in a ___ vs. ___ vs. ___ vs. ___
other night. He looked for it under the sink and the ■ These values however are not really in opposition
medicine were no longer there. When he asked his as much as competing.
senior nurse about it, he replied: "Just pretend you did ○ List the alternatives
not see it. Everybody's doing it anyway. Welcome to ■ Should match the values and principles.
the club." ■ Two extreme alternatives in a dilemma.
● Lucky could not comprehend what his senior nurse ■ Think creatively: think of a third, middle option.
told him so he decided to investigate. ■ Make a 3-column matrix.
● He found out that some nurses do not administer ○ Compare the alternatives to the principles you have
these expensive medications as ordered. Instead, they identified.
administer a placebo even without doctor's ■ Weigh the consequences.
prescription. But they charge the patient with ○ Make a decision
medicine even though they administer a placebo. ● Being ethical is a character.
These extra vials are kept and later sold to other ● The will carries out your decision.

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