Chapter Three: Sample Essays

Sample Essay 2: Megahed’s Dilemma (Jury Model)

Step One:

            Lisa Belkin’s “First, Do No Harm” focuses on several life or death cases that take place in Houston’s Hermann Hospital. One such case is about a sixty-five year old man named Mr. Hardy who broke his neck in a car crash and was completely paralyzed with no hope of recovery. Dr. Megahed, his physician, refused the request from family members to have him removed from a respirator before he became conscious of his new situation. The reason of Dr. Megahed was both incoherent and thoughtless. In this essay I plan to discuss the details of his reasoning in order to show that his reasoning is not only poor, but difficult to formulate in any plausible form. After clarifying Dr. Megahed’s reasoning and showing that it is lacking in logical thought, I will attempt a reconstruction. The reconstructed argument will centre on the key claim that life ought to be preserved at all times. Some people argue that human life is sacred and precious, and therefore should not be violated, while others hold the view that extreme pain and suffering must be taken into consideration and, in some cases, outweighs other beliefs about the sanctity of life. I will argue that the claim that we should preserve life at all times is implausible.

Step Two:

            Mr. Hardy was sixty-five when a car crash left him completely paralyzed with no hope of recovery.  Under heavy sedation, he was unaware of his fate. The family requested that he be disconnected from the respirator before he could become aware of his new situation (152-153). His physician, Dr. Megahed, refused this request because he had to follow the instructions of his father, which were to “try to preserve life at all times.” He asserted that, in this situation, he was uncertain what the right course of action was, if even if there was a ‘right’ decision. Therefore he had to follow the basic rule of preserving human life at all time. To the family he said, “It is not your place to decide whether he lives or dies” (153), denying the family the right to take part in this decision. His claim was that the family’s wishes for Mr. Hardy were akin to murder, saying, “I can’t turn off the machine on someone who is alive like this. That would be murder. (153). Dr. Megahed so truly believed this last statement that when Mr. Hardy wakes up and asks on his own behalf to be removed from the respirator, he excuses himself from the case entirely. He is committed to the principle that if a patient is ‘alive’ then it would be murder to disconnect any machinery supporting the continuation of this state (like a respirator).  Even if a patient is competent and requests it, he will not violate his own principle. The hospital Ethics Committee later decided that Mr. Hardy should be awakened and his choice respected (153). Their decision was based on the belief that a patient has a right to choose whether or not to be kept on life-sustaining machines. Their decision was also based on the fact that family wishes are irrelevant in situations where the patient is competent enough to make their own decisions. Though I will not explicitly defend the decisions of the hospital’s Ethics Committee in this essay, I will state now that the committee did uphold an important principle governing medical ethics: the principle of autonomy. That principle insists that a competent patient has the right to refuse any medical treatment.

Step Three:

            A critic might challenge the claim that Dr. Megahed doesn’t interfere with decisions like these because there is no clear answer. Despite the fact that his explicit reasoning is clearly inconsistent, the deeper analysis must focus on the core of his reasoning: his claim that there are no answers to questions like these. We can reconstruct his reasoning in the following manner:

  1. Try to preserve life at all times.
  2. It is not the patient’s family’s right to decide if he lives or dies.
  3. Turning off a life-sustaining machine would be murder.
  4. Do not turn off the machine.

But there are flaws with this reconstruction. The second claim might mean the family does not have the right to make medical decisions because it is only the patient who has such rights. That view would uphold a principle of autonomy. But Dr. Megahed rejected the principle of autonomy when he objected to Mr. Hardy’s request to have the machine turned off. And if the second claim is not about patient autonomy, then what is it about? Nothing. The real claim of the physician is that we should try and preserve life at all times. But how plausible is this claim? If at one time in human existence this claim was self-evident, it is no longer a sustained belief. It is difficult to find a person today who thinks that preserving life is an absolute good that overrides all other claims. The claim might not be inherently false, of course, just that it is a controversial claim that needs to be defended. Dr. Megahed treats it as self-evident in a situation where it is questionable. He is, therefore, asserting something without reasons. In other words, he is ‘begging the question.’ He needs to provide a defence for his principle, but does not. The question that remains is: Could that defence be supplied?

Step Four:

            One might, in response, argue against the claim that it once was self-evident that we should try and preserve life at all times but now is no longer a sustained belief. Death is really the worst thing that can happen to a person so, therefore, it should be avoided at all costs. Everyone who is rational seeks to avoid death. Everyone thinks that death, due to a car crash or other means, is a tragic mishap. Not only that, but people do not seriously think that they can come back to life if they die or, if they do believe, they understand it is not always possible. Moral confusion and value disagreements of contemporary life should not distract from this obvious truth.

Step Five:

            But the claim that death is the worst thing that can happen to a person is not convincing. Being in pain is a horrible fate, as is being permanently incapacitated. Also, there is no scale of ‘evil fates’ that we can use to judge whether dying is worse than being incapacitated. Reasonable people disagree about these issues- which prove that not all rational people seek to avoid death in every case. Under normal circumstances humans do so, but there are circumstances where we, as rational beings, think that the great evil of death can be eclipsed by other great evils. If this claim is correct, then Dr. Megahed confuses normal circumstances with abnormal circumstances, where priorities and choices about the preservation of life change. I have argued that Dr. Megahed’s key claim, that life should be preserved at all times, is implausible. I have done so by showing that it is a premise which, in some cases, reasonable people would reject. Any plausibility the claim has comes from what normal people would desire under normal circumstances. Therefore the premise cannot be put forth as an absolute principle. There are exceptions to the rule. So the claim that we should preserve life at all times is implausible.

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