Connie Nugent MLS
Corresponding author: Connie Nugent
Contact Information: Connie.nugent1@gmail.com
DOI: 10.12746/swrccc.v7i30.565
Decision-making is an art. Most strategies involve a variant of the basic creative problem solving process: (1) Examine a situation; (2) Identify possible challenges; (3) Develop solutions; (4) Weigh alternative solutions according to criteria; (5) Explain/apply the final solution. This process can be time-consuming in a business environment—an advertising agency, for example, might spend months developing a specific ad campaign before reaching a final decision.
Physicians often don’t have the luxury of time for diagnoses and treatment plans. Critically ill patients need decisions made quickly. Sometimes decisions prove incorrect based on current symptoms; medical personnel adjust as new evidence becomes available. (Hence the value of case reports that discuss physicians’ decision-making processes when faced with difficult or unusual situations. Read and learn.)
Some decisions are made hastily, under duress, and have less than optimal outcomes. In Kim Edwards’s novel The Memory Keeper’s Daughter, set in 1964, orthopedic surgeon David Henry and his wife Norah brave blizzard conditions in their effort to reach the hospital for the birth of their first child. “’When we come back, we’ll have our baby with us,” she said. “Our world will never be the same.’” Prophetic words. They make it only as far as Dr. Henry’s clinic, where his nurse Caroline Gill awaits. The worsening weather keeps the ob/gyn away, so Dr. Henry is pressed into duty. “To the doctor, focused on what was immediately before him, she became not just herself but more than herself; a body like other bodies, a patient whose needs he must meet with every skill he had.”
The birth progresses without incident—a healthy baby boy. Then, unexpectedly, a second baby—a girl. With Down syndrome. Obviously shocked, “He held the infant, forgetting what he ought to do next.” As he goes through the mechanical motions of tending to his wife, Dr. Henry quickly considers the situation and weighs quality of life, remembering his own sister’s congenital heart defect. While his wife is sedated, he asks his nurse to take the newborn to a long-term care facility many miles away, and that he will tell his wife that the baby has died. “He did not imagine, as he would later that night, and in many nights to come, the ways in which he was jeopardizing everything.” Instead, the nurse takes the child to another city and raises her as her own daughter. Dr. Henry gradually becomes more and more reclusive, as “…the secret had worked its way through their marriage, an insidious vine, twisting…” He retreats into photography, “Photo after photo, as if he could stop time or make an image powerful enough to obscure the moment when he turned and handed his daughter to Caroline Gill.” Only after his death do Norah and their son Paul discover the truth.1
This issue of the Chronicles includes an article and two commentaries on ethical decision-making in physician-assisted dying. They discuss the legal and ethical considerations involved in a doctor’s either passively or actively helping a patient to take his/her own life. The Death of Socrates, by French painter Jacques Louis David in 1787, portrays the ancient philosopher Socrates immediately before his suicide.2 He has been on trial for “impiety” against the Athenian pantheon of gods and for corrupting the city’s youth by presenting them with “new” ideas. Judged guilty by “a popular court, or dikasterion, of some five hundred citizens, mostly of the less educated class,”3 he is sentenced to death. He chooses to end his own life by ingesting a fatal dose of poisonous hemlock.
Socrates sits upright on his bed surrounded by distraught supporters, including an elderly Plato, who slumps with his back turned in a chair at the end of the bed. Socrates raises a defiant left arm as if teaching a final lesson; his right hand reaches for the mortal draught. The man handing Socrates the cup turns away, his left hand cradling his lowered head. It is unknown if this person actually concocted the poisonous beverage or if he is simply conveying it; regardless, it is evident that he is grievously upset at assisting Socrates’s suicide. The artist conveys varying degrees of emotion not only in the poses of the onlookers, but in the use of color. Those who are more visibly shaken are robed in bold colors, while the stoic Socrates and the subdued Plato are in pale blue. Jacques Louis David’s neoclassical painting depicts Socrates’s final act with dignity and drama.
Jacques Louis David. The Death of Socrates, 1787. Metropolitan Museum of Art, New York.
Wikimedia Commons.
The decision-making process that condemned Dr. Henry to a life of regret was based on personal bias heightened by time pressure and duress. The decision made by Socrates’s jury may have been influenced by “groupthink,” peer pressure to support the opinions of the group and to avoid controversy. Regardless, ethical decision-making is a difficult task and should be approached thoughtfully.
Keywords: decision-making, ethical decisions, The Memory Keeper’s Daughter, The Death of Socrates
Submitted: 7/4/2019