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In the case of Mr. Johnson, a 60 year-old competent diabetic refusing a common sense

treatment that would prevent his situation from worsening, I would argue a principle of

beneficence ought to take precedence over a respect for his autonomy. In other words, looking

out for the patients own well-being should come before worrying about whether proceeding

with the treatment against his will is a morally wrong action since it would be attempting to

control [his] actions on the basis of a concern for [his] own welfare (Veatch, 115).

The short-sighted, but nonetheless correct, view is that preventing the infection from

worsening is the obvious thing to do considering the relative lack of risk as compared to the

overwhelming benefit. As Veatch points out, Mr. Johnson is the type of patient who seems to

incur risks and harms that far exceed any benefits that could be gained (Veatch, 125). This

lopsidedness in terms of the benefit-risk ratio should be Dr. Garcias first hint that something

isnt quite right. Furthermore, it doesnt seem all that invasive or even detrimental to Mr.

Johnsons autonomy to proceed with the treatment against his willin this case a Hippocratic

paternalism could be argued for quite easily all things considered.

Perhaps a longer view could be taken as well: the idea that Mr. Johnsons autonomy is

being violated for a relatively minor, non-life threatening procedure could be seen as

problematic, but, I contend, is the right thing to do considering the negative consequences for

Mr. Johnson, the hospital staff, and the healthcare system if treatment is not pursued. The whole

purpose of healthcare is to prevent worse things from happening. If Mr. Johnson refuses

treatment now, he will surely get his autonomy overridden at a later date in addition to losing a

toes or his entire foot.

One can determine, in other words, that Mr. Johnsons situation is likely to become an

emergency in the near future in which doctors will have no choice but to amputate or provide

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Adrian Rutt Bioethics 541

treatment against the patients will in order to save his life. This scenario not only has a high

probability of playing out, but will lead to unnecessary stress on both the hospital staff and the

healthcare system. Having no insurance and getting a relatively minor, non-invasive treatment

and having no insurance and undergoing an amputation should not be looked equally simply out

of respect for someones autonomy. What about the respect for the time and resources of the

hospital and its staff?

As Veatch points out, though, we generally accept peoples right to not only hold

whatever beliefs they want but act on them too, provided their actions do not have an

unacceptable impact on others (Veatch, 128). However, the case can be made that Mr.

Johnsons decision to refuse treatment is putting an unacceptable impact on others, albeit at an

inevitable later date, once again noting the imbalance between risk and reward. Had the

treatment Dr. Garcia wanted to give the patient increased the statistical risk by so much as a hair,

the case would have been more difficult. As it stands, the case is relatively straightforwardI

might even go as far to say that it is common sense. Dr. Garcia should sedate and treat Mr.

Johnson.

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