Apply the John Rawls Theory or the Natural Law Theory Dr. Dobb is an emergency physician in a large urban hospital. One
Posted: Wed Apr 27, 2022 7:19 am
Apply the John Rawls Theory or the Natural Law
Theory
Dr. Dobb is an emergency physician in a large urban hospital.
One relatively quiet evening Mr. Rose, a 32-
year-old male, presents to the emergency department complaining of
shortness of breath. The problem, as it
develops, is a depressingly familiar one to Dr. Dobb. Mr. Rose,
known to be HIV positive, turns out to be
having his first episode of pneumocystis pneumonia, an often fatal
disease of AIDS patients. The episode,
fortunately, appears at present to be a relatively mild one; his
blood test shows his lung function is only
moderately impaired.
When Dr. Dobb begins to explain this, Mr. Rose insists that his
friend, Mr. Url, be brought into the
emergency department to listen to the doctor. Dr. Dobb goes over
the condition and describes the
appropriate treatment: IV antibiotics. When asked, Mr. Rose denies
any drug allergies.
As they grapple with the news that Mr. Rose has now changed from
being a patient with HIV to one with
AIDS, Mr. Rose and Mr. Url produce a living will and durable health
care proxy form designating Mr. Url
as responsible for decision making if Mr. Rose becomes incompetent.
The living will forbids
cardiopulmonary resuscitation and prohibits under any circumstances
endotracheal intubation and respirator
ventilation, along with numerous other measures.
Dr. Dobb believes strongly in patient autonomy. He therefore
assures Mr. Rose and Mr. Url that Mr. Rose's
wishes, as clearly expressed, will be respected. After arranging
for the papers to be copied and placed in the
chart, he goes to admit Mr. Rose and Mr. Url leaves.
While a bed is being readied, Dr. Dobb orders a dose of the
appropriate antibiotic to be given to Mr. Rose
and goes to see the next patient. Upon starting the antibiotic and
leaving the room for a few minutes, the
nurse returns to find Mr. Rose unresponsive, with a bright red rash
and severe trouble breathing.
Immediately recognizing a life-threatening allergic reaction, she
stops the antibiotic and calls for the doctor.
Mr. Rose is in anaphylactic shock. Quickly ordering the four
appropriate medications, Dr. Dobb opens his
mouth to ask for an endotracheal tube and respirator and realizes
he has a problem.
Mr. Rose will die as his airway closes up if patency is not
immediately ensured by placement of a tube.
Indeed, in a case like this, placement often requires cutting the
patient's throat to maintain the rapidly
narrowing airway. Seconds, quite literally, count. The good news is
that this is a time-limited condition.
With immediate aggressive action, only a few hours or days of
ventilator support should be necessary and
there should be absolutely no long-term effects. Of course, it is
possible that Mr. Rose's pneumonia will
acutely worsen. He might then be unable to be weaned off the
respirator. An emergency physician with no
experience in the long-term management of either pneumocystis
pneumonia or anaphylaxis, he is unsure of
the chances of that.
From Better-Jane Crigger, ed., Case in Bioethics, 2nd ed. New York:
St. Martin's Press, 1993
Choose either of these theories to apply to this case: John Rawls
Theory or Natural Law
Theory
Dr. Dobb is an emergency physician in a large urban hospital.
One relatively quiet evening Mr. Rose, a 32-
year-old male, presents to the emergency department complaining of
shortness of breath. The problem, as it
develops, is a depressingly familiar one to Dr. Dobb. Mr. Rose,
known to be HIV positive, turns out to be
having his first episode of pneumocystis pneumonia, an often fatal
disease of AIDS patients. The episode,
fortunately, appears at present to be a relatively mild one; his
blood test shows his lung function is only
moderately impaired.
When Dr. Dobb begins to explain this, Mr. Rose insists that his
friend, Mr. Url, be brought into the
emergency department to listen to the doctor. Dr. Dobb goes over
the condition and describes the
appropriate treatment: IV antibiotics. When asked, Mr. Rose denies
any drug allergies.
As they grapple with the news that Mr. Rose has now changed from
being a patient with HIV to one with
AIDS, Mr. Rose and Mr. Url produce a living will and durable health
care proxy form designating Mr. Url
as responsible for decision making if Mr. Rose becomes incompetent.
The living will forbids
cardiopulmonary resuscitation and prohibits under any circumstances
endotracheal intubation and respirator
ventilation, along with numerous other measures.
Dr. Dobb believes strongly in patient autonomy. He therefore
assures Mr. Rose and Mr. Url that Mr. Rose's
wishes, as clearly expressed, will be respected. After arranging
for the papers to be copied and placed in the
chart, he goes to admit Mr. Rose and Mr. Url leaves.
While a bed is being readied, Dr. Dobb orders a dose of the
appropriate antibiotic to be given to Mr. Rose
and goes to see the next patient. Upon starting the antibiotic and
leaving the room for a few minutes, the
nurse returns to find Mr. Rose unresponsive, with a bright red rash
and severe trouble breathing.
Immediately recognizing a life-threatening allergic reaction, she
stops the antibiotic and calls for the doctor.
Mr. Rose is in anaphylactic shock. Quickly ordering the four
appropriate medications, Dr. Dobb opens his
mouth to ask for an endotracheal tube and respirator and realizes
he has a problem.
Mr. Rose will die as his airway closes up if patency is not
immediately ensured by placement of a tube.
Indeed, in a case like this, placement often requires cutting the
patient's throat to maintain the rapidly
narrowing airway. Seconds, quite literally, count. The good news is
that this is a time-limited condition.
With immediate aggressive action, only a few hours or days of
ventilator support should be necessary and
there should be absolutely no long-term effects. Of course, it is
possible that Mr. Rose's pneumonia will
acutely worsen. He might then be unable to be weaned off the
respirator. An emergency physician with no
experience in the long-term management of either pneumocystis
pneumonia or anaphylaxis, he is unsure of
the chances of that.
From Better-Jane Crigger, ed., Case in Bioethics, 2nd ed. New York:
St. Martin's Press, 1993
Choose either of these theories to apply to this case: John Rawls
Theory or Natural Law