This case study is about a cancer patient who rejects chemotherapy. His competency is not in question. The issue is about whether or not pressure should be put on him, by his physician, in order to induce him to consent to treatment.
We will center on the two theories we studied, consequentialism and deontology. After reading the case, you will select one of these theories. When you proceed, answer all questions from the perspective of that theory. This will help you to understand how the theory could be used to examine a moral problem. You might want to start with the theory that most conforms to your own view, then go back and try the other theory to learn more about it.
Case Study
John is a 74 year-old patient with lung cancer. He is told that he will almost surely die within three months without chemotherapy. His physician, Dr. Samuels, believes that with chemotherapy his life could be significantly lengthened, possibly to a year. John rejects further treatment. He wants to prepare for a good death, one as symptom free and painless as possible. John’s wife, Iona, disagrees with his decision. She believes that John has an unreasonable fear of chemotherapy and that the quality of his remaining life will be better than he thinks it will be.
You will explore this case using the basic prospective of either consequentialism or deontology.
Please select the theory you will employ:
[1] Consequentialism
[2] Deontology
The issue in this case is whether to put additional pressure on John to get him to change his mind about chemotherapy. Are you ready to make a decision, or would you like additional information?
I would like additional information.
[Go forward to the additional information page.]
I am ready to decide.
[The following is for Consequentialism. Deontologist responses follow below.]
[Consequentialism and no further information is desired:]
This is unusual for a consequentialist. Consequentialists base their decisions on predictions about benefit and harm. Since additional information is available, you should check it out to determine whether it may influence your prediction about expected benefits and harms. After all, a consequentialist tries to predict the consequences of various actions and to select the course of action that is likely to produce the best results. Thus, it would be best to review that information. Would you like to change your answer?
I would like additional information.
[Go forward to the additional information page.]
No, I’m still ready to decide.
[Go to material directly below.]
What is your decision?
[1] Dr. Samuels should try to persuade John to consent to chemotherapy.
[2] Dr. Samuels should respect John’s decision not to reject chemotherapy.
[1 Dr. Samuels should try to persuade John to consent to chemotherapy.]
Among the following statements, select the paragraph that provides the reasons that a consequentialist would most likely offer.
[A] John is acting in a cowardly way. He should fight as hard as he can to live as long as he can, otherwise he does not show respect for his own life. His decision not to accept chemotherapy is much like committing suicide, something that is not morally permitted.
[A This is not the correct answer. A consequentialist is unlikely to appeal to a moral rule, the one against suicide. That sounds more like the view of a deontologist. Please try again.]
[B] If Dr. Samuels persuades John to accept chemotherapy then John is likely to live a longer life. Living longer is a good thing, better than almost anything. So it is the best to do whatever can be done to persuade John to consent.
[B This is the best of the choices. A consequentialist might reason in this way. After all, in most circumstances people do opt for life over death. But in John’s situation this is not so clear. After all, one way or the other he has a short life expectancy. And with chemotherapy the quality of his life might not be good. You should view additional information to be sure that you made a good decision.
[1] Yes, I’ll go on.
[1 Go forward to additional information page.]
[2] No, I’m sure that a consequentialist would reason in this way. Life is centrally important, more important than anything else. In fact, reasoning about quality of life is quite speculative, so I’ll stick with my opinion. I realize that most consequentialists would probably disagree with me, but I believe they are wrong. Please send me back to the home page for this case.
[2 Go back to initial page.]
[C] John will be happier if he accepts chemotherapy.
[C This is not a proper answer. We need a reason why John will be happier with chemotherapy. Please try again.]
[This ends the response to the consequentialist who does not want additional information and selects the first answer that John should be persuaded. Now we turn to the response to the second answer
[2 Dr. Samuels should respect John’s decision to reject chemotherapy.]
Among the following statements, select the paragraph that provides the reasons that a consequentialist would most likely offer.
[A] John has a right to decide himself whether he wants additional treatment.
[A This is not the correct answer. A consequentialist is unlikely to appeal to a right that is not dependent on consequences. This sounds more like the view of a deontologist. Please try again.]
[B] If Dr. Samuels persuades John to accept chemotherapy then John is likely to suffer a great deal. Chemotherapy is likely to weaken him, adversely affect vital systems, and make him extremely sick. Living longer is a good thing, but John knows that he will not live a quality life. He is better off with palliative care.
[B This is the best of the choices. A consequentialist might reason in this way. After all, chemotherapy does have bad side effects. But in John’s situation this is so clear. After all, many people face chemotherapy and do relatively well. A good consequentialist should balance the likely harm with the likely benefits. To do this properly you should view additional information.
[OK button], [OK: Go forward to additional information page.]
[C] John will be happier if he refuses to accept chemotherapy.
[C This is not the right answer. We need a reason why John will be happier. Please try again.]
[Deontologist response to those who want to make a decision now.]
You are right that a deontologist is less likely to want to view additional information. This is because there are some obligations that are so strong that little if anything can overcome them. In such cases viewing additional information will not be fruitful. But often deontologists need additional information in order to decide which moral obligations actually exist. So we hope you change your mind and seek more information. If not we will explore your decision and the likely reasoning supporting it.
I would like additional information.
[Go forward to the additional information page.]
No, I’m still ready to decide.
[Go to material directly below.]
What is your decision?
[1] Dr. Samuels should try to persuade John to consent to chemotherapy.
[1 Dr. Samuels should try to persuade John to consent to chemotherapy.]
Among the following statements, select the paragraph that provides the reasons that a deontologist would most likely offer.
[A] Human life is sacred. Preserving life is one of the main moral obligations. Allowing John to reject chemotherapy is more or less like watching him commit suicide without interfering.
[A A deontologist might argue in this way. Many deontologists put the preservation of life high on their list of obligations. So this is a good answer. But many deontologists value other things sometimes in an equally strong way. They may believe for example that people have a right to reject therapies that prolong life at the expense of quality living. John may have a right to decide that deontologists would support, even if it means that he will die earlier. To learn more about deontology, you should select a different answer.]
[B] John is an adult. He is making a very important decision, one affecting when he is likely to die. He needs all the feedback he can get. He wants to take a path that will shorten his life. He may be doing that without thinking everything through carefully enough. So it would be good to pressure him to be sure that this is really his best considered judgment. Not to do so might allow him to give way to his fears rather than giving him a chance to come to a fully reasoned decision.
[B. This is a good answer. It confronts issues about the proper way to respect a person’s decisions. But it might not be correct. Much might depend on the kind of pressure that would be put on John. It would be good to get further information to be sure that you answer is appropriate. OK. [OK sends the user to additional information.]
[C] Dr. Samuels agreed to give John good information when he took the case. By giving in to John’s desire not to have chemotherapy, Dr. Samuels is not living up to her professional obligations.
[C. This answer seems a little strained. Dr. Samuels has given good information to John, and even so he does not want chemotherapy. Physicians are required to respect the decisions of their patients. So it is hard to believe that part of a physician’s job is to persuade people to accept therapies they do not want. Please try again.
[2] Dr. Samuels should respect John’s decision not to reject chemotherapy.
Among the following statements, select the paragraph that provides the reasons that a deontologist would most likely offer.
[A] John can decide best whether he is better off with or without treatment.
[A This sounds more like the answer a consequentialist would offer. It says, in effect, that John is best off without additional treatment. It does not talk about moral obligations, the kind of reason a deontologist would offer. Please select another answer.]
[B] John is a competent adult. He has a right to make his own decisions about treatment, and physicians have an obligation to respect that decision. Iona also has an obligation to accept John’s decision. Failure to do so is disrespectful.
[B. This is a good answer. It asserts a right to informed consent, a right that many recognize. But it might not be correct. It might not be disrespectful to put some pressure on John. After all, he is an adult who can reason. Much might depend on the kind of pressure that would be put on John. It would be good to get further information to be sure that you answer is appropriate. OK. [OK sends the user to additional information.]
[C] Chemotherapy is a painful treatment. It isn’t worth it because it will only add a few months to John’s life, and those months will be lived in pain.
[C. This sounds more like the answer a consequentialist would offer. It says, in effect, that John is best off without additional treatment. It does not talk about moral obligations, the kind of reason a deontologist would offer. Also, it might be wrong. After all, you did not seek additional information. More information might indicate that John would be better off with chemotherapy. Please try again.
ADDITIONAL INFORMATION
The principals in this case are John, Dr. Samuels, and John’s wife, Iona. Click for additional information about each.
[Keep track of which information user looks at. Maybe have a small picture of each person to click on. When the picture is clicked go to a page with a larger picture and use sound clip of the narrator giving the information.]
John
John has been through both surgery and radiation therapy. He believes that both have prolonged his life. He is grateful for the additional time but he is now weak and is beginning to find life burdensome. He does enjoy being with his family, reading, and watching TV, especially sports. He fears chemotherapy, hearing accounts from his friends who went through it only to die several months later. He does not want to spend his last days sick and in pain. He wants hospice care so that he can enjoy his remaining days to the fullest extent possible.
Dr. Samuels
Dr. Samuel believes that John has about 2 months to live without chemotherapy. He thinks that he could live about eight months with it, and hopes that he could even live longer, maybe over a year. She understands that chemotherapy will mean that at least one of every four weeks will be difficult, even worse than difficult, but that leaves three weeks that will not be nearly as trying. There are medications that will help with the side effects of the chemotherapy, which she has explained to John. He will continue to grow weaker with the treatments, but still will be able to walk, read, visit with family, and enjoy sports on TV. John told Dr. Samuel that he doubts he would live extra months and that the quality of his life would be more seriously affected than Dr. Samuel believes. Dr. Samuel told him that he was wrong, but John remained adamant.
Dr. Samuel has provided John with information as objectively as she can. She believes that John would be much better off with the chemotherapy, but has not pressured him in any way. Dr. Samuel believes, from her past experience, that patients such as John can be pressured into agreeing to treatment even when first responses are negative. She could, for example, tell John that he simply doesn’t understand the situation, that his family is depending on him and does not want him to die without having done everything for him, and as a last resort, could challenge his courage. If she uses a very stern, aggressive, and authoritarian tone, Dr. Samuels believes she can convince John to agree to further life-saving treatment.
John’s wife