DENNIS’ DECISION
Dennis Lindberg had already survived more than most young people by the time he reached the age of 14. Born to drug-addicted parents, Dennis tried to ignore the needles in the toilet and his mom’s pale skin and strangely constricted pupils. He was too scared to ask her if she did drugs. Throughout his childhood, Dennis moved constantly and rarely attended school, often being left with neighbors while his parents were getting high.
He had the chance to make a fresh start, however, after his dad was jailed for drug possession. In an effort to save him from suffering while they got their lives back on track, Dennis’s parents sent Dennis to live with his aunt and gave her guardianship of the boy. Over the next four years, Dennis flourished in his aunt’s home. He began attending school regularly, made friends, and found comfort in regular meetings of the religious community to which his aunt belonged. Dennis soon expressed interest in joining the congregation and did so. He participated fully in the life of the congregation and spent many Saturdays witnessing door-to-door about the evils of drugs—the effects of which had touched him personally.
Then, at the age of 14, Dennis received grim news. He had leukemia and would need immediate treatment to survive. Dennis was diagnosed with acute lymphocytic leukemia (ALL), a type of cancer that affects blood or bone marrow. ALL is the most common type of leukemia in children under age 15, and doctors gave Dennis a 70% chance of full recovery if he underwent chemotherapy and repeated blood transfusions over the course of three years. In chemotherapy, patients are treated with drugs to kill the affected cells. Because bone marrow produces blood cells, chemotherapy causes a dramatic decrease in the number of blood cells the patient has. To make up for the lost blood cells, the patient is given blood transfusions. Without the transfusions, the patient will die. Dennis was prepared to begin chemotherapy immediately but recognized that blood transfusions conflicted with his faith.
Dennis’s religious faith teaches that blood is sacred in God’s eyes, that the soul or life is in the blood. Because of this, members of Dennis’s faith believe it is wrong to eat blood or to eat any animal that has not been properly bled. Likewise, they believe blood transfusions are wrong and that if they receive blood they are breaking God’s laws. Although blood transfusions are prohibited, the faith is not anti-medicine.
Dennis was clear with his doctors when they began chemotherapy that he would refuse blood transfusions. He even threatened to pull out the IV if they attempted to give him blood, which meant that physical force would be required, not once, but repeatedly, as Dennis received ongoing treatment. His aunt agreed with his decision, as did members of his congregation. When his biological parents found out, however, they were stunned—not members of that religion themselves, they wanted doctors to do everything possible to save their son. Since giving up custody of Dennis, his parents had completed drug treatment and were now sober. They felt they should have a say in this life or death decision. As Dennis’s blood count dipped dangerously low, his doctors struggled with what they should do, and an ethics board from the hospital was engaged. (This case comes from the Northwest Association for Biomedical Ethics Links to an external site..)
INITIAL POST INSTRUCTIONS
Imagine you are a member of the hospital ethics board and you have been called in to consult on this complex case. prepare a brief (i.e. a forum post!) to present to your colleagues that includes the following information:
What are the relevant facts of this case? What facts are not known?
What individuals and groups have an important stake in the outcome? Are some concerns more important? Why?
What are the options for acting? Consider the following:
Which option will produce the most good and do the least harm? (The Utilitarian Approach)
Which option best respects the rights of all who have a stake? (The Rights Approach)
Which option treats people equally or proportionately? (The Justice Approach)
Which option best serves the community as a whole, not just some members? (The Common Good Approach)
Which option leads me to act as the sort of person I want to be? (The Virtue Approach)
Considering all of the above, what recommendation would you make to your fellow committee members?
