Welcome to Ethics Consult — an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true, but anonymized, patient care case. You vote on your decision in the case and, next week, we’ll reveal how you all made the call. Bioethicist Jacob M. Appel, MD, JD, will also weigh in with an ethical framework to help you learn and prepare.
The following case is adapted from Appel’s 2019 book, Who Says You’re Dead? Medical & Ethical Dilemmas for the Curious & Concerned.
Frances is born with a severe terminal genetic disorder in which the skin and tissues form improperly. Her skin will eventually peel off, leaving the infant with wounds over large portions of her body. In all cases of the disorder, the baby’s internal organs suffer the same fate and break down. No child has ever survived more than 6 months with this disease.
Doctors wish to give Frances high doses of morphine to make certain that she is not in pain. However, the morphine needed to keep Frances pain-free also reduces respiration rates and increases the chance of a premature death. The infant’s parents, Eli and Delilah, vehemently object. They belong to a devout religious sect opposed to all forms of euthanasia. Victims of euthanasia and assisted suicide, they believe, will have to wait longer before their souls are permitted to enter heaven. For Eli and Delilah, giving morphine that may shorten the child’s life, even if that is not the doctors’ primary intention, is immoral. “We don’t want our child to suffer,” says Eli. “But we also want to make certain that there is a place for her in the afterlife.”
Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at the Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College.
Check out some of our past Ethics Consult cases:
Genetic Testing for Potential Employees?
Add Lithium to Town’s Drinking Water?
Fertilize Human Egg With Neanderthal Sperm?