I am a physician taking care of a woman with bad asthma who requires admission

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I am a physician taking care of a woman with bad asthma who requires admission to the hospital. She happens to be six months pregnant, which is clinically relevant because low oxygen levels in the blood will affect the fetus. I inform her that if she refuses treatment, her unborn child will suffer oxygen deprivation, and will likely be mentally retarded. She says that "God will take care of us, I'm going home."

The situation that you describes raises all sorts of interesting philosophical questions, I’m not sure which to address. I'll assume for the sake of this discussion that you’re not wondering whether your patient could possibly be right about God’s intentions. So, let’s assume that she’s wrong: God won’t take care of her and her fetus, and she’s placing her future child at significant risk of harm that would permanently and seriously restrict his (let’s give him a gender for the sake of this discussion) future life opportunities. There are then two questions that you might have in mind. One: “Is she doing something that is morally wrong?” Two: “What are my own moral obligations in this situation?” The answer to neither question is straightforward.

First question: The answer to the first question is complicated by two facts– (a) the individual who would be harmed by your patient’s lack of treatment is currently a fetus, and (b) your patient is apparently ignorant of the fact that she really is putting her future child at risk of harm.

While the rights of children are fairly uncontroversial, the rights of fetuses are highly contested. However, we can avoid this controversy by talking simply about your patient’s future child. If this future child were to be mentally handicapped because she now refuses to take treatment, then she would have made him much worse off than he otherwise would have been. As a result of her action, he would have a significantly more restricted range of reasonable life plans available to him than he would otherwise have had. Her action, then, puts her future child at significant risk of significant harm. From a moral point of view, it seems to me, it is irrelevant whether one’s actions causesomeone immediate harm or harm someone some time in the distant future.On these grounds alone, I would conclude that your patient’s refusal oftreatment is morally wrong.

However, some might argue that wecannot say that her action is morally wrong, since she is doing what she thinks is best for her future child– she just happens to be mistaken aboutwhat is best for her future child. Only if her ignorance is itself culpable,can we charge her with immorality.

Though many philosopherswould disagree with me, I would like to distinguish the conditionsunder which one counts as performing an action that is wrong and theconditions under which one counts as being a bad person or as doingsomething that is morally blameworthy. An action can be wrong, perhaps because it has terrible consequences. But the person who does the wrongaction might nonetheless be a good person because through no fault ofher own, she did not anticipate these bad consequences. To use afamiliar example, a Good Samaritan might go to some trouble to save thelife of a person who turns out to be a serial murderer. Was her actionmorally correct? I would want to say “no.” Had she not so acted, manyvaluable lives would not been shortened. No action with such bad (evenif indirect) consequences could be morally right. Other philosopherswould insist that what the Good Samaritan did was morally correct,since the direct result of her own action was the extending of the lifeof a fellow human being (who just happened to be a serial killer) andsince the shortening of the lives of his victims wasn't the directresult of her own action but instead was the direct result of theserial killer's actions. Despite this disagreement about the moralityof her action, all of us can agree that the Good Samaritan was a goodperson and that she could not be morally blamed for doing what she did.

Returningnow to your patient. I would say that her action is morally wrong.Others would say that her action is morally wrong only if she isculpably ignorant of the likely harmful consequences of her action.It’s an interesting question, which I can’t answer here, whethersomeone who lives in the 21st century who believes that God will takecare of her and her fetus is culpably ignorant and thus morallyblameworthy for the consequences of actions that are based on thisbelief.

Second question: What are your moral obligations? Onthe assumption that your patient’s behavior is morally wrong, whatfollows? Unfortunately, not much. The fact that one person’s potentialactions are immoral does not by itself imply that another person ismorally permitted to prevent her from acting immorally. Physicians playan important beneficial role within our society and their ability toplay that beneficial role could be jeopardized if they were to take itupon themselves (especially as a matter of professional obligation) toprevent their patients from acting immorally. Patients might refuse toget further treatment from those whom they regard as meddling doctors,and the health consequences for both patients and fetuses (and thefuture children they become) could be devastating.

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