A husband having sex with his now mentally and physically incapacitated wife: Is it ethical and is it even legal?

The 29 year old wife, 5 years ago, suffered a very severe traumatic brain injury from an automobile accident and despite long attempts at rehabilitation now lives at home under the attention and care of her husband who must also attend to the care of their own sons from earlier in their marriage. The wife is apparently alert sufficiently to show some response to visual, auditory and tactile stimulation but is unable to talk or communicate any decisions. She is paralyzed, unable to walk or move on her own, incontinent and unable to attend to her own personal care and has required tube feedings.

A few months ago, the wife became pregnant and the pregnancy was terminated by her physicians in her health interest. Despite the husband arguing that he and his wife were in a loving sexual relationship throughout their marriage, that he never divorced and abandoned her after her accident and that he believed based on his experience with her in the past and her current responses that she wanted the loving sexual relationship to continue despite her handicaps, the wife’s family considered the acts of having sex with the incapacitated wife as rape. They notified the police and started legal guardianship proceedings.

You are the ethicist and you are the judge. Were the husband’s sexual actions ethical? Were they, in fact, legal? What facts and what issues would be important to know and consider in answering these questions?

This scenario, as written here, was adapted from a case study “Sexuality and a Severely Brain-Injured Spouse” in the ethics journal “The Hastings Center Report” May-June 2010.http://www.thehastingscenter.org/Publications/HCR/Detail.aspx?id=4656 There are three separate commentaries by ethicists there but I hope my visitors would answer my question here before looking at their responses. ..Maurice.

Branding Patients: Beneficial or a Violation of Privacy?

Branding is an identification of a subject by applying a marker on that subject which can remain for the time it will be useful. Cattle are branded. Should patients be branded for one reason or another thought to be in the patient’s best interest? For example, a common hospital branding is to have a colored wrist band on a patient to identify the patient who does not wish to have cardio-pulmonary resuscitation in the event the heart stops beating. This branding is to identify those patients with that emergency when a decision has to be made about whether or not to resuscitate particularly if the patient’s chart is not readily available. But there are many other cautions that could be made easily apparent to the hospital staff by affixing some sign to the patient with a visible sticker such as allergy, prone to falling, need for isolation related to infections and others. In recent years there has been developed policies to have symmetrical sided part of the body that is to be operated upon to be branded to avoid mistaken operation on the wrong sided part. And what about privacy? It might not be unusual for others not involved in the patient’s care to become aware of the branding code (perhaps from their own personal experience) and then be able to identify the branding of another patient. For what conditions or issues would you think it would be inappropriate to brand the patient?

If a person has a problem for which others should be aware for the medical benefit of that person or for the safety of others, is it ethical for such a person to be identified? Or because of the way such branding was carried out in the Nazi era on Jews and others, branding is a troublesome consideration for its application to persons? ..Maurice.

Graphic: Photograph of a street sign in Europe branding a neighborhood that the elderly and infirm are present alerting drivers to be aware and cautious.

A True Bioethical Dilemma: Questionable Best Interest for Birds or Known Best Interest for Humans

With the current oil spill in the Gulf of Mexico and the reactive response, there is a true bioethical dilemma that is arising. It has to do with the use of resources to rehabilitate and support those who are injured or will be injured as the oil spill continues or after the spill is stopped.

The issue of the cleaning of the birds contaminated with oil was brought up in a June 14 2010 presentation on National Public Radio. The debated issue is regarding the outcome of those birds rescued and cleaned and whether they are saved from death, can live and reproduce normally into the future. The research evidence seems to be equivocal. A nurse ethicist writing on a bioethics listserv today wrote the following which sets the ethical issue:

“I … heard the NPR piece about the oily gulf birds. And I was perplexed about defining our moral obligation to clean the birds. Being a nurse, I'd start by looking at the scientific research. If I remember correctly, NPR said that the research on cleaning the birds varies widely. The birds may survive being scrubbed of the oil only to die a few days or weeks later because of the oil they ingested. The studies that followed the birds for longer periods also varied widely with some birds surviving for months, but then not reproducing. So the science may not be helpful. I'd have to look into it much more deeply.... and not being a biologist, I might not be a good consumer of the research. However, birds are birds. People will be suffering from this oil spill as well. Should scarce resources be focused on the current bird problem or should we prepare for the future and help the tourist industry or the fishing industry? The financial circumstances for families could be devastating - through no fault of their own. Does our moral obligation change depending upon the funds distributed by BP to various people/industries? Just first thoughts about something that will play out for all of us, especially those near the gulf.”

So the issue is clear: Do the American people and government focus on using all the limited resources available for a known benefit to aid the rehabilitation of humans or continuing to use part of these resources for a scientifically as yet unproven benefit to rehabilitate birds? Any answers? ..Maurice.

Graphic: Widely distributed AP photo modified by me using ArtRage 3

Discarding Praise and Preserving Criticism in Medical Practice

Commenting in the September 6, 2008 “One Big Umbrella” blog, Newfoundland playwright Robert Chafe responded to a question “How do you deal with praise? With criticism? “with “I'd like to be able to ignore both. I've gotten great at discarding praise, but criticism? I can still quote bad reviews and negative feedback for years afterwards. not healthy, that.”

I have a feeling that most playwrights would agree with Mr. Chafe. This led me to wonder whether this might be even a more common response, applicable to all professions including medicine. If so, then what is the difference in the longer term significance between praise and criticism? Could it be that praise is generally given more as just “words” or (perhaps my cynical appraisal) a method for secondary gain by the ones who deliver the praise? But criticism, on the other hand, may contain many fragments of truth and meaning which for the benefit of the receiver and others should be considered and retained. Could it be that praise is generally less constructive than criticism in promoting professional improvement?

I wonder what my blog visitors think about how physicians should manage, if they could, the discard vs retention as applied to praise vs criticism issue. Unfortunately, criticism is rarely directly delivered by the physician’s patients or even from the physician’s own colleagues and, from my own experience; the criticism is mostly delivered by one’s self. That self-criticism is, fortunately or unfortunately, rarely easily discarded. ..Maurice.

Graphic: Discarded awards, photographed by me 6-8-2010 in a neighborhood yard.

Empathy for All in the Bioethics Universe

Bioethics represents the ethics involved with all living things. Empathy means understanding and concern for others. Shouldn't those of us, people, animals and all living together on this single planet have empathy for all? You may find the video presentation of Jeremy Rifkin on YouTube regarding his concept of an empathetic civilization interesting. After all, this is what bioethics, in its fullest sense, is all about. After you have watched the graphic presentation, return and write about what you think of the concept. ..Maurice.