Mrs. E (Kluge 2005, pp. 191).
This does not apply to this situation, however, as Jack's competency for decision making is only temporarily impaired, and he will still be caring for himself by and large for the foreseeable future. Thus, a consideration of his best interests must include a consideration of Jack's psychological, emotional, and religious/philosophical attitudes as well (Kluge 2005, pp. 191). Jill asserts that her husband feels very strongly that all individuals should contribute to the welfare and progress of the community, and she believes that medical progress through such things as successful drug trials are a part of this progress and contribution. It is from this stance that she decides to have Jack included in the trial.
There does not appear, at first glance, to be anything wrong with this assessment, yet it must be noted that it is Jill's opinion that medical testing and drug trials contribute to social welfare and progress, and this does not necessarily align with jack's values and beliefs. Love and trust do not necessarily indicate the appropriateness of proxy consent decisions with an individual's best personal interests at heart; Jill is including her own personal values and beliefs in the decision and the doctor is allowing her to do so. There is also an automatic conflict of interest in the doctor's ability to make an effective decision in jack's best interest, especially in a controlled and systematic trial. Though such trials are much safer than unsystematic uses of new treatments based on a "clinical hunch," there is a heightened symbolic importance to the informed consent of a patient in a controlled trial because "the patient is being used as a means to an end," and the patient's outcome is no longer the sole consideration of the physician in his or her treatment of the patient (Kluge 2005, pp. ).
These considerations being taken into account, it is still reasonable that Jill decided to have Jack included in the study. The physician should not be without some moral qualms, however, as there were certainly some pitfalls in the logic...
The knowledge that Jill used her own personal values, in however limited a fashion, in helping her render her decision, should serve as a reminder to the physician that few cases of ethical decision making are as simple as they may appear. In addition, many patients prefer to have increased input from the physician when making proxy decisions, and though the doctor in this case was right to step back, more information regarding the trial drug could have been provided (Kluge 2005).
Objections
There could be a major objection raised to these conclusion due to the fact that jack was not fully incompetent, but merely temporarily incapacitated. It could be suggested, for instance, that given a lack of certainty regarding Jack's values and personal beliefs, the decision should have been made solely on the basis of the medical best interests of the patient. Despite the reduced likelihood of side effects presented by the new drug, a purely medical decision based solely on Jack's case (i.e. not taking the welfare of future patients into account) would likely have resulted in his exclusion from the trial and his relegation to the standard treatment option, thus avoiding any unforeseen consequences and providing him with a proven and well-established treatment. This view does not account for Jack's values as stated by his wife, however, and is far less human and individualistic in its approach to the proxy decision making process in addition.
Conclusion
There are very few -- if any -- simple answers to ethical considerations in the provision of healthcare, especially when it comes to proxy decision making. This case illustrates the complexities that can arise even when a solid relationship exists between the patient and the person designated as their proxy decision maker. Jill attempted to make decision using appropriate standards for proxy care, even taking Jack's values into account, but the doctor should have been more attentive to the fact that she included her own values in this decision as well.
