Medical ethics can be defined as the discipline of evaluating the merits, risks and social concerns of activities in the field of medicine.  Many in the healthcare field have suggested various methods to help evaluate the ethics of a medical situation.  These methods provide basic principles that doctors should consider when making decisions about care given to patients in regards to death and dying, reproductive medicine, medical research and alternative medicine.

These principles include:

• Beneficence- what is in the patient’s best interest
• Non-maleficence –“first, do no harm”
• Autonomy – patients have the right to refuse or choose their treatment
• Justice – scarce resources then who gets what treatment
• Dignity – the patient and practitioner have the right to be treated with dignity
• Truthfulness – patients deserve to know the whole truth about his/her illness and treatment options

In light of bioethical issues, some important questions need to be raised concerning the case of the women in Iowa whose guardianship has been awarded to her father, not her husband.  The patient is an adult female who has been unconscious since July 31, 2006 , when she collapsed because of a bad reaction to a diet drug.

Points about this case include:

1. Husband of patient is a Jehovah’s Witness.
2. Father of patient requested guardianship of daughter, so he can consent to a transfusion of blood if necessary.
3. Patient is “stable and improving”, but still unconscious.
4. Five years ago, the patient signed consent forms for “no blood transfusions.”
5. The patient has no Advance Directives formulated.

There are also some things that are alleged about the patient’s current thoughts about blood transfusions.  An Aunt has stated that the patient verbally acknowledged at some point in time that she would accept a transfusion for herself and her son.  The husband has stated that the patient allegedly signed a card identifying herself as one of Jehovah’s Witnesses, but the card has not been produced for review.  The patient has been affiliated with Jehovah’s Witnesses as an interested person or a Bible student.

The facts and the possibilities lead us to ask some interesting ethical questions about the determination of the courts to award guardianship to the father.

Questions to ponder:

• What is the patient’s blood count?  Why put the “cart before the horse” by considering ordering a procedure (blood transfusion) in advance of the fact that it might never be necessary?
• What is the principles in regards to the rights of relatives to make healthcare decisions for a patient?  Is their a “cascade” of qualified relative, who by law, should be able to make healthcare decisions for a patient?  Priority in most states reads this way:
  1. the patient’s spouse;
  2. the patient’s reasonably available adult children:
  3. the patient’s parents; or
  4. the patient’s nearest relative.
• Is the legal system, and as in the case of Terri Shiavo- the political system, taking precedence over the medical system who are the experts concerning medical interventions?