I was on the subway when another passenger passed out. The train made an emergency stop, and medical responders assisted the person, despite her screaming — after she came to — that she wanted to be left alone. If the woman was saying she did not want to be helped, even if in critical condition, is someone ethically allowed to obey her and let her suffer? Or would it be a crime to let her suffering continue? ELISABETH BUCHWALD, SCARSDALE, N.Y.
If an injured party is not acting reasonably, the seriousness of the medical condition cannot be deduced without professional assistance. Moreover, a person screaming in public might be mentally ill (and could be seen as a threat to other passengers). But things are different if the injured person remains calm. According to a standard E.M.T. training guide, a “mentally competent adult has the right to accept or refuse emergency medical care.”Let’s imagine the person in question coolly turned to the emergency responders and said: “Look, this has happened to me before. I know what’s going on here. I just need to get off this train at the next stop and go home. I apologize for the inconvenience this has caused the other passengers, but this is not an emergency.” Had this been the case, the emergency personnel could ask a few more questions and — assuming the answers were sufficient — leave the person alone. If someone can rationally justify the decision to refuse medical aid, he or she must be granted that privilege. But the key word here is “rationally.” This person has inadvertently caused a significant disruption to public transport; she should not be punished for doing so, but she does need to demonstrate that she is of sound enough mind to take care of herself — both for her own good, and for the good of the other passengers (who are now involuntarily involved with the situation simply by being on the same train).
This column is an interesting dilemma that tightens the tension between ethics and morals. In a case where a person with a serious medical condition screams and denies the help of medical responders, should we ethically be —and I love the word the asker uses— allowed to leave the women alone and let her suffer? The ethicists takes on the answer that I’d expected from most people: a solution that lies in the middle region of a spectrum of “interference” and “non-interference”. One may say that the critical information when considering the situation is the illness of the person, but I think that the real dilemma comes in exactly because we do not know the details the background regarding the illness of the person. While I certainly don’t blame the ethicist for choosing the middle path, I feel as if the issue hasn’t been fully addressed in the way s/he used their words. The reply to the question begins with, “If an injured party is not acting reasonably…” and s/he also writes, “If someone can rationally justify…” What is the boundary of reasonable and non-reasonable. How about rational and irrational? To me it seems as if the ethicist is almost avoiding, irking from the topic of what is reasonable. S/he leaves out that detail, either assuming that people can tell what that is or uncomfortable to draw lines for people. In the latter case, a simple acknowledgement may have been a more persuasive answer than overlooking the definition.
There seems to be a faulty logic in the first sentence, not only because of the vague premise, but also because of the weak link between the If and thens. S/he dismisses completely the inability of non-professionals to realize the seriousness of a medical situation. We, as non-professionals, may not know the symptom name, the curing methods and possible prescriptions, but if someone on the streets is screaming, lying on the floor short of breath (assuming that this constitutes as “not acting reasonably”), even the dullest of us would know something is not right. On second thought, this is even contradictory. The ethicists assumes that we can use our “common sense” to deduce what is “reasonable,” but we can’t use our “common sense” to realize a serious medical situation when we see one?
She also seems to have a bias, a stereotype than if one remains calm, he or she is alright. This may be true to some extent, as in this situation where we are dealing with strangers, but I think this is where difference cultural upbringings could divide people’s stance. The ethicist is not wrong to claim that and even quotes the standard E.M.T. training guide, but her argument definitely weakens when she doesn’t mention the delicacy of the issue, the illness, which is another detail she did not mention. There seems to be more weight on the side of “let’s trust the outward rational appearance of the patient.” By delicacy I mean that patients with some serious diseases still may need help even when when they seem calm. Should a person be dismissed just because their state of depression doesn’t necessarily show up violently in public?
Also, the ethicist limits the situation with an imagined response of a “mentally competent adult”, if it is at all possible to determine on the spot. There are so many components to the response of the patient that the omission of one phrase may flip situations. If the patient had said that this has had happened to them before, but does not say they “know what’s going on here,” that, to me, would not compel me to let the patient go.
Going back to the different cultures aspect, I would feel morally wrong and perhaps ethically as well to leave a suffering person alone. Being brought up in a Korean family and society where interest in others is not entirely weird or rude and where denial can actually mean a yes, I wouldn’t be able to “leave the person alone.” Those words just seemed too cold to me. Again, difference of perspectives and environments seem to shape the ethics and also the morals of individual. However, this is not a strictly cultural difference. I would think that this is not just ethics pertaining to certain cultures, but more of a universal ethics. Why, then, would people criticize and be upset when we see videos of people passing by a person near to death? Again, I, myself, may be generalizing as well.
While the ethical boundary here would be to intervene at a minimal level and offer one’s assistance to the suffering patient, I think it is morals, the individual guiding compass, that determines the level of interference in the face of some stranger who refuses help. It would be ethical to have compassion in the very least, which I feel derives from our way of living in groups and societies whereas to go against a refusal would have different cultural meaning to different people. While I understand the ethicist’s point of view to leave the person alone with rational justification, I would still think that this is not just a matter of morals but also of ethics whether or not to leave a person in pain.
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