Ethics

Both the cases should be dealt with all the elements considered in mind. The question of resources, obligations to both citizens and government and service to the community must all be taken in to consideration in evaluating our course of action. We cannot just simply favor one in the expense of another.

The two cases are different in many respects. Primarily, its difference lies on their categorization to what degree of death assistance is going to happen or if its a case of death assistance in the first place.

The case of Dawson for example will be hard to categorize since we will really have no idea if whether he will be committing suicide the moment he get out of the hospital. Aside from the recommendation of the social worker, there are no concluding evidences that will fortify the claim.

However the case of the baby will be a clear example of death assisted suicide. In this report we are going to examine the necessary information, principles and ideas that are relevant in our recommendation.

Moral Justifications of the Actions
Let me just give a priority for the case of the day year old baby born with no arms, legs and have an anomaly in this mouth and throat that refrains the him from being nourished in the classical sense. This is because of the urgency of the situation when compared to Dawsons case. As stated in the report, the mothers chose not to nourish the child anymore and as we know it, this will lead to the death of the baby after some time. This implies the urgency of the situation so I propose to examine and decide to this issue as soon as possible.

With the condition and situation of the newly born baby, the bulk of the discussion will revolve on to whom decision must be considered in the first place. Definitely, there are only two parties that will be involved in this case, the mother and the hospital since the baby is unable to decide and communicate for his self.

First of all I would like to argue that this case is comparable to a case of abortion, an abortion due to the deficiency of the fetus. I believe in what Peter Singers statement that says, There is no sharp distinction between the fetus and the newborn baby. Even Helga Kuhse, one of the authors of the book Should the Baby Live, argued that a period of 28 days after birth must be covered for the infant to be considered as a normal human. In this case, the fetus and a newly born infant do not really make great differences.

If we all agree that it is legal and moral to abort a baby with known deficiency, there will be no problem to let the mother decide for her own baby. With this in mind, the law on abortion in Michigan will grant the permission to abort the baby under some necessary procedures.

The Case of Autonomy
The American College of Physician and the American Society of Internal Medicine acknowledge that in case that there is no statement or will regarding what must be done to the patient, someone else can decide for his or her treatment or condition. As stated by the ACP and ASIM, the following must guide the judgment of the person who will decide.

What would the person think is good or bad about a type of medical treatment
Does it prolong life
Does it ease suffering
Does it make quality of life better
What are the benefits, risks, and burdens of a treatment

With these guide questions in mind and the knowledge of the critical condition of the baby, it will be not hard to defend the decision of the mother.

For the Utilitarians
Aside from the arguments mentioned above, we must also take note the utility of the case. As we know the mother does not grant neither the operation of the baby nor his nourishment. From here, we should ask ourselves the following questions.  Are we going to shoulder the expenses of the operation and maintenance Can we ask for the assistance of the state or the federal government with this case If we are not willing to shoulder the costs of the operation and life support system, it would be better if we just let the mother decide for the fate of her baby.

The case of Dawson when evaluated in the utilitarian perspective will lead to a conclusion that we should argue the same way how we will argue as a communitarian. If Dawson has a mental and psychological problem, he could both harm his self and the people around him and as long as the utilitarian principle is concerned, the pain of greater number people must be avoided as much as we can. These will justify a recommendation for a psychological examination prior to the release.

For the Communitarians
The heart of the communitarian lies on the good of the community rather than the personal autonomy.
As Daneil Callahan (2000) mentioned, what is important to communitarians is asking whether the actions is conducive to a good society rather the question of the violation of ones autonomy.  With this respect, I believe that letting the deficient baby die will be the course of action for the communitarians.

Think of this scenario as a pigment of a bigger picture. If we let this single case in the favor of letting the child live what will happen if for every single future case, we shall act with the same decision. With the interest of community in mind, we would not want to live to a community wherein half of the population is deficient physically in one way or another. The demand for resources will increase without the supply coping with it due to the inability of the half of the population to be productive. Again, this will be counterproductive to the community. We would not want to live in a society wherein more than half of the population is depended on the other half.

In the communitarian analysis for the case of Dawson, it would be an inconsiderate act to release Dawson with the medical personnel suspicious of his mental and psychological capability. To release Dawson without the necessary procedures to prove his capability to decide is a careless act that can bring harm to Dawsons community. In case Dawson is suffering a psychological problem, it is possible that with his status he can harm a member of his community. When this happens, the administration of the hospital cannot plea for their innocence to what will happen.

The Case of the Vulnerable Population
In regards to the vulnerability of the both patients, Ill rather not consider this particular element. The argument of vulnerability of a particular population in my opinion leads to a very slippery slope.

Every one is vulnerable in one way or another. The history of questioning who is vulnerable or not had already branched out from few individuals to a group of people, even race for example. With this trend continuing, it is not hard to see in the future that someone will conclude that every human being is vulnerable regardless of age, gender, race, educational status etc. With this in mind, Id rather not to include this element in our evaluation of both cases.

The Legality of Both Cases
With the Michigans Informed Consent for Abortion Law or the Public Act 133 of 1993, we can argue that there is no legal violation for the mother to decide for her infant. With this law and the argument above saying that that there is no significant difference between a fetus and a newly born baby, it is easy to see the morality and legality of letting the mother decide for her infant. (DCH, n.d.)

In the case of Dawson however, I believe we already knew the efforts of the Michigan state in developing policies that will reduce the suicide rate in the state. In fact, the state already acknowledged that suicide is a rising public health problem and threat to the citizens of Michigan. In a recent report for example it was reported by the Michigan Suicide Prevention Coalition that in 2003 alone, there are 1018 deaths because of suicide. The number is larger than the deaths from to HIV, AIDS and homicides combined.

In this sense, we as a medical institution have an obligation to do something on this ongoing problem. We are obliged to act for us to know the real status of Dawson and prevent him if he is really intending to kill himself.

Recommendations

What should we do then If you understand the principles I cited earlier, it will not be difficult to assess what are our recommendations.

First in the case of the deficient baby, it would be better if we are to let the mother decide with the fate of her baby. With the evidences and principles cited above, I believe it would not be difficult for you to accept this course of action.

With the respect for the decision of the mother to refuse any treatment or surgical operation to the infant, it is necessary for us to prepare and ask her to sign a waiver saying her decision to the case and the hospital will not bear any responsibility for the death of the child.

The case of Dawson however is a tricky one. If the physicians and the social workers are right in the assessment that the patient is intending to kill himself, when the worst thing happened we cannot just wash our hands in the situation. If not, then good. However, of course we must at least take some measures to assess what is really taking place. He is our patient after all.  What we want to do is to recommend the patient to a commendable psychiatrist for the personnel to assess whether the patient is in the right condition to decide or not for his own good. If the result is positive to his ability to decide, of course we cannot detain him in the hospital. However if the result would show his inability to decide rightfully, necessary measures must be done like recommendation for a psychiatric treatment.