In the Module Two Project Proposal, you chose your case study and professional code of ethics. In the Module Three Project Draft, you chose the ethical frame

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Project Proposal: Fetal Rights and Guardianship in the Case of J.D.S.

The J.D.S. case raises ethical problems about reproductive rights, individual autonomy, and governmental responsibilities to protect vulnerable individuals. J.D.S., a state-run facility resident with severe intellectual and physical disabilities, was sexually assaulted and became pregnant (Pierce, 2013). Florida's state attorneys tried to select a new guardian for the unborn child, under Governor Jeb Bush's directive, arguing that J.D.S.'s present guardian would put abortion ahead of the fetus's best interests. (Pierce, 2013). This ruling raised questions about handicapped people's rights, reproductive choice, and fetal personhood.

In this case, the American Medical Association's (AMA) Code of Ethics is relevant. When patients cannot make decisions for themselves, this code emphasises navigating medical decision-making complexity while respecting patient autonomy and placing patient welfare first (Rondinelli et al., 2023). Given J.D.S.'s incapacity, the AMA Code's surrogate decision-making and vulnerable patient treatment guidelines must be considered by healthcare practitioners.

The AMA Code of Ethics outlines justice, compassion, and respect to guide doctors and other healthcare workers. It emphasises putting patients' needs first, respecting their autonomy, and protecting those who cannot make good decisions (Rondinelli et al., 2023). Surrogate decision-making is covered by the AMA Code of Ethics for vulnerable patients. The code would likely prioritise J.D.S.'s rights and well-being above fetal guardianship, emphasizing patient autonomy and ethical medical procedures. The American Medical Association's 1847 code of ethics has been modified to suit modern healthcare (Rondinelli et al., 2023). AMA Code of ethics guides healthcare providers on ethical issues cases like J.D.S. based on beneficence, nonmaleficence, and patient autonomy.

Key ethical principles of AMA include:

1. Autonomy: This principle underscores the importance of respecting J.D.S.'s rights and her ability to have a guardian advocate for her best interests.

2. Beneficence: Medical professionals must prioritize the well-being of J.D.S., who, as a vulnerable individual, requires special considerations to ensure her health and safety.

3. Justice: This principle calls for fairness in treatment and equality before the law, which opposes the potential for imposing disproportionate state control over her reproductive rights.

Principlism, an ethical framework that relies on the four ethical principles (autonomy, beneficence, nonmaleficence, and justice), is particularly suited to this case (O'Rourke et al., 2019). This paradigm gives equal weight to each approach to assist practitioners balance state intervention and J.D.S. autonomy. J.D.S.'s wellbeing should come first, according the AMA Code's guidelines for vulnerable patients. In the J.D.S. case, individual rights and state interests conflict in healthcare, creating ethical issues. The AMA Code of Ethics and principlism framework support prioritizing J.D.S.'s welfare. They prioritize patient autonomy, protection, and respect for vulnerable people like her.

References

O'Rourke, D. J., Thompson, G. N., & McMillan, D. E. (2019). Ethical and moral considerations of (patient) centredness in nursing and healthcare: Navigating uncharted waters.  Nursing Inquiry,  26(3), e12284.

Pierce, J. (2013).  Morality play: Case studies in ethics. Waveland Press.

Rondinelli, R. D., Genovese, E., Katz, R. T., Mayer, T. G., Mueller, K. L., Ranavaya, M. I., & Brigham, C. R. (2023). AMA Guides® to the Evaluation of Permanent Impairment, 2023. In  AMA Guides® to the Evaluation of Permanent Impairment, Sixth Edition, 2023. American Medical Association.

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Case Analysis of Fetal Rights and Guardianship in the Case of J.D.S.

Background of the Case

J.D.S., who had cerebral palsy, autism, and cognitive disability, was in a state-run facility. She was raped while in the facility. However, she could not identify her assailant, talk coherently, or make treatment decisions due to her mental ability. After her pregnancy was discovered, a guardian was assigned to make medical choices for her. Florida state attorneys attempted to choose a new guardian for the unborn child under Governor Jeb Bush's directive. The decision sparked controversy. Their major argument was that J.D.S.'s guardian may put her interests above the unborn child, possibly leading to an abortion. This prompted support from anti-abortion advocates who saw the move as a protective measure for fetal rights. However, pro-choice groups like the American Civil Liberties Union (ACLU) opposed it, arguing that a separate guardian would violate J.D.S.'s autonomy. The case raised questions about disability rights, reproductive autonomy, and state intervention in private health matters, but the court rejected the idea of a separate fetal guardian (Pierce, 2013).

Ethical Issues of the Case

This challenging ethical issue involves individual rights, disability activism, and the state's involvement in reproductive health. J.D.S. cannot make her own decisions, thus her guardian must do what is best for her. This presents major autonomy and guardianship problems. However, the state's attempt to appoint another guardian for the unborn child introduced the concern that that her guardian might violate the fetus’s rights, which is against surrogate decision-making. Individual rights vs unborn child rights is also at stake. Proposing a fetal guardian would mean the state recognizes the unborn' legal rights as distinct from J.D.S.'s, which could mean fetuses are granted personhood, an unprecedented concept (Pierce, 2013). This new development upset abortion rights campaigners since it would set a legal precedent for fetal rights to trump pregnant women's rights, which would disproportionately affect seriously handicapped persons. The apparent overreach of state attorneys and Governor Bush's effort have raised ethical questions about state jurisdiction in private health matters. Political or ideological issues may influence health decisions.

Ethical Principles from Principlism that Apply to the Case

Principlism's four pillars—justice, nonmaleficence, autonomy, and beneficence—provides a framework for interpreting the J.D.S. case's ethical implications. Healthcare ethics emphasizes autonomy, or the right to make body decisions. J.D.S.'s guardian should respect her rights, protect her interests, and minimize state intrusion, even though she cannot enjoy autonomy in the traditional sense. J.D.S.'s health and interests must be prioritized when making care decisions, taking into consideration pregnancy-related mental and physical health concerns. The notion of beneficence necessitates actions that benefit the patient (Allen et al., 2024). In the case of J.D.S., and other vulnerable patients, nonmaleficence, which is the principle that states that harm should not be done to the patient, is key to treatment. Based on this concept, health and legal decisions should shield vulnerable persons from the psychological and physiological consequences of an unwanted pregnancy. Justice requires treating everyone fairly. Therefore, J.D.S should be treated fairly, and having a different guardian for the fetus may infringe on her rights. Combined, these principles give a well-balanced approach for deciding on the ethical obligations of the involved persons in the case of J.D.S.

Application of the Professional Code of Ethics

This circumstance requires American Medical Association's (AMA) Code of Ethics compliance. This guideline emphasizes respecting patient autonomy and placing patient welfare first when patients cannot make decisions for themselves to navigate medical decision-making (Rondinelli et al., 2023). Due to J.D.S.'s mental incapacity, healthcare practitioners must follow the AMA Code's surrogate decision-making and vulnerable patient treatment guidelines. Doctors and other healthcare professionals are guided by the AMA of Ethics, which delineates the principles of justice, compassion, and respect. It protects those unable to make informed decisions, prioritizes patients' needs, and respects their autonomy (Rondinelli et al., 2023). AMA Code of Ethics covers making decisions for incapacitated patients. The code would likely prioritise J.D.S.'s rights and wellbeing above fetal guardianship by emphasizing patient autonomy and ethical medical practices.

Use of the Ethical Framework to Examine Ethical Issues

Principlism can illuminate the J.D.S. case's ethical issues. J.D.S. cannot make decisions for herself, yet autonomy supports the idea that her guardian should protect her interests while limiting state interference in her private health care. When applied together, beneficence and nonmaleficence stress that J.D.S.'s guardian and healthcare experts must put her health and safety first and avoid doing anything that may harm her (Allen et al., 2024). Justice requires equality and fair treatment in all medical and legal decisions, therefore giving the fetus's rights more weight than J.D.S.'s may unfairly treat her, especially because she is handicapped and receiving state aid. By applying Principlism, guardians and healthcare practitioners can balance their ethical obligations to J.D.S.

Conclusion

In conclusion, the AMA Code of Ethics and the principlism framework provide valuable ethical guidance in prioritizing the welfare and rights of J.D.S. within a complex legal and moral context. These frameworks promote careful decision-making that prioritizes J.D.S. interests without limiting her autonomy by extending fetal personhood. The frameworks emphasize respect for autonomy, protection of vulnerable individuals, and adherence to principles of justice. Principlism and the AMA Code together advocate for an ethical approach that respects individual rights.

References

Allen, L. R., Adams, N., Ashley, F., Dodd, C., Ehrensaft, D., Fraser, L., … & Veale, J. (2024). Principlism and contemporary ethical considerations for providers of transgender health care.  International Journal of Transgender Health, 1-19.

Pierce, J. (2013).  Morality play: Case studies in ethics. Waveland Press.

Rondinelli, R. D., Genovese, E., Katz, R. T., Mayer, T. G., Mueller, K. L., Ranavaya, M. I., & Brigham, C. R. (2023). AMA Guides® to the Evaluation of Permanent Impairment, 2023. In  AMA Guides® to the Evaluation of Permanent Impairment, Sixth Edition, 2023. American Medical Association.

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