Case Study On Moral Status

Case Study: Fetal Abnormality

Jessica is a 30-year-old immigrant from Mexico City. She and her husband Marco have been in the United States for the last three years and have finally earned enough money to move out of their Aunt Maria’s home and into an apartment of their own. They are both hard workers. Jessica works 50 hours a week at a local restaurant and Marco has been contracting side jobs in construction. Six months before their move to an apartment, Jessica finds out she is pregnant.

Four months later, Jessica and Marco arrive at the county hospital, a large, public, nonteaching hospital. A preliminary ultrasound indicates a possible abnormality with the fetus. Further scans are conducted, and it is determined that the fetus has a rare condition in which it has not developed any arms and will not likely develop them. There is also a 25% chance that the fetus may have Down syndrome.

Dr. Wilson, the primary attending physician, is seeing Jessica for the first time, since she and Marco did not receive earlier prenatal care over concerns about finances. Marco insists that Dr. Wilson refrain from telling Jessica the scan results, assuring him that he will tell his wife himself when she is emotionally ready for the news. While Marco and Dr. Wilson are talking in another room, Aunt Maria walks into the room with a distressed look on her face. She can tell that something is wrong and inquires of Dr. Wilson. After hearing of the diagnosis, she walks out of the room wailing loudly and praying aloud.

Marco and Dr. Wilson continue their discussion, and Dr. Wilson insists that he has an obligation to Jessica as his patient and that she has a right to know the diagnosis of the fetus. He furthermore is intent on discussing all relevant factors and options regarding the next step, including abortion. Marco insists on taking some time to think of how to break the news to Jessica, but Dr. Wilson, frustrated with the direction of the conversation, informs the husband that such a choice is not his to make. Dr. Wilson proceeds back across the hall, where he walks in on Aunt Maria awkwardly praying with Jessica and phoning the priest. At that point, Dr. Wilson gently but briefly informs Jessica of the diagnosis and lays out the option for abortion as a responsible medical alternative, given the quality of life such a child would have. Jessica looks at him and struggles to hold back her tears.

Jessica is torn between her hopes of a better socioeconomic position and increased independence, along with her conviction that all life is sacred. Marco will support Jessica in whatever decision she makes but is finding it difficult not to view the pregnancy and the prospects of a disabled child as a burden and a barrier to their economic security and plans. Dr. Wilson lays out all of the options but clearly makes his view known that abortion is “scientifically” and medically a wise choice in this situation. Aunt Maria pleads with Jessica to follow through with the pregnancy and allow what “God intends” to take place and urges Jessica to think of her responsibility as a mother.

This week we’re examining Moral Status Theories. Everyone’s experience of illness and death is different and shadowed by their life and relationships. Moral status (who and how we allow dignity, honor and choice) become important especially during these times. It’s vital that we understand our own theory of moral status which tends to be unconscious. So I’m offering you some theories in the lengthy paragraphs that follow (forgive me, please). You’ll need these for your case study assignment this week. Please note that I’ve added 2 which are not in the book and have not mentioned 2 that are book (moral agency & relationships).

· HUMAN-NESS THEORY or SPECIES THEORY:This theory states that one has moral status by virtue of DNA; those who belong to the human race have moral status. In other words, one must be born of human parents and possess a genetic code. Therefore, embryos, fetuses, those who are brain-damaged or have a cognitive anomaly are all included. This would fit many Christian views. However, it has implications for abortion, stem cell research or use, unused embryos from in vitro fertilization, under-developed or cognitively impaired human beings (including Down syndrome, anacephalia or hydrocephia), pre-implantation genetic diagnosis and amniocentesis, medical advances that prolong life, euthanasia, those in a persistent vegetative state.

· RATIONALITY or COGNITIVE:theory of moral status is one of the most cited for determination of moral status and standing. It basically says that one must be able to reason, have a conscience and a free will in order to have moral status. At one point, Aristotle denied full moral standing to women and slaves because he believed their rational abilities were limited and not authoritative. That means, women, you don’t have the ability that men have, right? Hmmm. Aristotle argued that women have some rationality but that it was not as developed as that of men (Hancock, n.d.). Immanuel Kant also believed this to be the criteria for moral status. He argued “only a rational being has the power to act according to [moral] principles” (Kant, 1785).

· SENTIENCE THEORY:This theory states that moral status belongs to those who can experience both pain and pleasure and other subjective experiences. Some people claim that animals would have moral status because they experience pain and pleasure. Peter Singer states that one must include animals in moral status and cannot rule them out based on rational thinking or intelligence; otherwise, one would have to rule out those humans who are not capable of rational thinking due to lack of intelligence (Singer, 1985). There are problems with the Sentient Theory which would possibly rule out the moral status of embryos, fetuses, and those people who are unconscious. This theory “confuses harm with hurt and the experience of harm with the reality of harm (Feinberg, 1989, p. 307-315). This does not take into consideration that one may be harmed and be unaware of the pain that one experiences. For example, if a comatose person is turned and a limb is broken, he or she may not experience pain or hurt, but is indeed harmed.

· MULTI-CRITERIAL THEORY:This theory is not mentioned in the lecture but is worth noting and states that the degree of moral standing is proportionate to the degree the thing is capable of self-determination and degree of similarity determined by self-awareness, consciousness and sentience. Thus, all living organisms have moral standing but are ranked in order of greatest moral standing to least as follows: Those who can be moral agents and moral persons, i.e., human beings; Self-aware organisms but things or animals who are not moral agents or moral persons, e.g., primates, mammals or birds; Conscious and sentient organisms but those that are not self-aware, e.g., reptiles, amphibians, fish, and invertebrates; and, Non-conscious and non-sentient organisms, i.e., some species of animals, plants and microorganisms (Hancock, n.d.). There are several problems with this rank order theory. For instance, this means my dogs, Pepper & Baxter, are placed on the same rank order as that of the coyote out in the desert behind me. I must say that I think my dogs should earn higher moral status because of their meaningfulness to me (and cuteness). Another problem that arises with this theory pertains to those humans who are capable of being moral agents and moral persons. But what about those who are not capable? This again would be problematic when you consider embryos, fetuses, those with Down’s syndrome or other persons with mental disabilities, and those who are unconscious. It does mean that Pepper and Baxter have a higher moral status than the comatose patient. I really love my dogs but I’m not sure I can ethically support that they have a higher status than any human (but they ARE really cute).

· LIFE FORCE THEORY: This is another theory not mentioned in the lecture but states that moral status belongs to all living organisms that have a ‘life force’ or drive to live, and thus includes all humans, embryos, fetuses and stem cells. However, that theory would also include animals, living organisms, plants, ecosystems. The problem is then deciding whether some life forces are more valuable and have a higher moral status than other life forces. The most well-known advocate for this theory was Albert Schweitzer who viewed that all living things should have equal moral consideration and that there should be no hierarchy. Moral status belongs to all life because of the drive and will to live. However, Schweitzer did recognize that it’s impossible to avoid harming all living things and it becomes a matter of morality. It’s as wrong to kill a carrot as it is to kill a human (Hancock, n.d.). The problem with this theory is in determining what is the drive to live. What criteria can be used to determine the life force of any living thing? Warren accepts this uncertainty and doesn’t try to resolve them (Hancock, n.d.). However, she names some problems with this theory. First, the issue of will to live. Do all things have such a ‘will’? How can that be proven? Additionally, if all living things have equal moral standing, then that would mean that what happened in concentration camps was equal to deforestation (Warren, 1997). That’s problematic.

So are you getting more clear on the theories of moral status?

Dr. K

REFERENCES

Feinberg, J. (1989). Grounds for coercion. In Ethical theory and social issues. Holt, Rinehart, and Winston.

Hancock, N. (n.d.) Theories of moral standing. 

http://www.academia.edu/393647/Theories_of_Moral_Standing .

Kant, I. (1785). Grounding for the metaphysics of morals (J. W. Ellington,

Trans.). Hackett Publishing Company.

Warren, M.A. (1997). Moral status: Obligations to persons and other living things. Clarendon Press.

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