Background and Purpose
These cases show complicated concerns that are related to decision-making and the intrusion of the government and family in the rights of a person. On the one hand, the idea of extracting the eggs of their daughter, might be considered by parents for creating a new child, but whether their daughter wanted this? On the other hand, care providers must follow the ethical principle of non-maleficence, but was it ethically-correct to continue sufferings of the women and go against her will? The purpose of this presentation is to critically discuss both cases, identify their impact, similarities, and differences in terms of law and ethics.
Impact of the Case with Ayash
The case with Ayash is the first legal and ethical precedent in Israel, when the eggs of a dead girl were extracted and fertilized. It means that further emerging cases would be decided looking at the outcomes of this issue. As stated by the chairman of the department of bioethics at University of Pennsylvania, Arthur Caplan, there is a need for formulating new policies that would identify whether parents are eligible to decide for their deceased children in terms of fertility. Accordingly, the impact of this case is related to the impetus to consider legal aspects. Among the ethical principles involved in this case, there are beneficence, non-maleficence, autonomy, and justice.
Impact of the Case with Bouvia
The case with Bouvia points to the movement for the legalization of euthanasia in the US. Since it happened in the 1980s, euthanasia was considered as suicide, which contradicted the ethical norms of healthcare provision. The right to die was reconsidered after the court’s decision to allow Bouvia to refuse force-feeding through the tube, even though she was not terminally ill. As the impact of the case, it informed policy and practice: Oregon and Washington adopted the Death with Dignity Acts that authorize assisted suicide for mentally-competent patients. The ethical considerations include beneficence and autonomy.
Involved Stakeholders
Both cases involve similar stakeholders, such as families, health care providers, courts, and public opinion. In both cases, care providers were confused to take action since there were no or limited precedents. In turn, the courts as the representatives of the governments acted according to the existing legal framework. In the US, euthanasia was partially legalized but only for terminally-ill individuals, but Israeli court made the first decision for the parents to decide for their daughter. Since these are the prominent and ground-breaking cases, they received great attention from the public.
Opposing Sides
In case of Ayash, one side (parents) was for fertilizing the girl’s eggs, the opposing side (care providers) was against such a solution. As for Bouvia, she wanted to starve to death to stop suffering, but the healthcare and legal systems were against it. The members of the interdisciplinary team included physicians, nurses, nurse managers, anesthetists, and others, each of which was involved in the ethical decision-making.
Autonomy and Beneficence
The main ethical issue of the first case is whether the underage girl wanted to become a mother after her death? In terms of the autonomy principle, each patient should be given a right to take medical decisions regarding their body and life. On the one hand, parents could decide for their daughter as she was underage, and they also faced her loss, wanting to create one more child. However, would this child bear emotional and psychological burden, knowing that he or she was conceived after the death of their mother? Although the deceased girl cannot give her consent, there is also no evidence that she would restrict her parents’ decision.
Compared to Ayash, Bouvia was not underage, which means that she was fully competent to make medical decisions. Autonomy is to be a paramount right to determine a patient’s health outcomes, as it is stated by bioethics. To follow the principle of autonomy meant that care providers must respect Bouvia’s perception of her life, choice of actions, and her values. In this case, the respect for autonomy contradicts care providers’ ethical norms and the attitudes to euthanasia of that time.
The bioethical dilemma is that autonomy opposes beneficence in both cases. The key purpose of the beneficence principle is to make good to patients and improve their lives, but how can these cases provide good? Is it good to fertilize the eggs of the underage girl to create another child? Is it appropriate to assist to commit suicide to the patient who has severe pain and paralysis? These questions cannot be answered with a certain argument as both sides have different interpretations.
Differences
The main difference of the discussed cases is that the case of Bouvia was rejected after the first appeal and approved only after the second appeal. In case of Ayash, the court requested the evidence, yet it decided in favor of parents based on their arguments. In terms of the legal framework, the first case had some related precedents when patients wanted euthanasia to be applied to her. On the contrary, the second case had no precedents as no one requested saving the eggs of the deceased female.
Conclusions
Both of the discussed cases are related to human rights to decide on one’s life. From the medical ethics, care providers must follow the principles of autonomy and beneficence, but they are opposed to each other in these cases. The ethical dilemma emerged around the considerations of what is good and bad for patients, one of which was dead, and the other one was paralyzed and wanted to die. The impact of both cases is that they informed both policies and health decision-making by serving as the hallmark examples of bioethics role in human life continuation and cessation.
Lessons Learned
The first lesson is that the expressions of a patient’s autonomy should be recognized and respected by care providers, if he or she is competent to decide. Even though autonomy contradicts beneficence, care providers should take a comprehensive view and pay attention to all possible outcomes, including the quality of patient’s life, burden of illness, and the value of life-sustaining treatment. The second lesson refers to the inability to identify the patient’s wishes likewise in case with Ayash. Considering that the girl was underage, her parents were given more attention to decide for their daughter. These cases show that new policies are needed to identify the conditions in which parents can make decisions for deceased children in medical terms. At the same time, ethical organizations should update their codes of ethics to guide care providers in their decision-making process.