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who might be threatened by the exercise of the rights of others. In the complicated legal and moral discussions about the case, it was still the care and protection of the individual human person that claimed Ford’s attention and care. Advising Radical Surgery In an article cowritten with J. E. Drew, “Advising Radical Surgery: A Problem in Medical Morality,” Ford discusses the moral dilemma of physicians advising seriously ill patients to consider an experimental medical procedure that might prolong life but would proceed at the cost of extensive mutilation of body organs. When mutilation and/or permanent incapacitation with excessive strain on family and finances can result from a therapeutic procedure, the surgeon frequently asks himself (or is asked) if such measures are morally defensible. . . . Every year new surgical techniques are developed and physicians are confronted with the question, “Shall I advise my patient to undergo this surgery?” or, in closer reality, “How shall I present the case to the patient?”; for, as all physicians know, the manner of presentation is frequently one of the, or even the, deciding influence as to whether the patient has the procedure carried out.72 A physician’s presentation of a new medical procedure could significantly influence a patient’s decision to agree to the procedure or not. Two different physicians could present the same procedure and give the same medical facts, but might emphasize either the positive or the negative aspects of the procedure. For example, the physician can stress the fact that the procedure is still somewhat in the experimental stage (and therefore new and relatively untried ); that it is mutilating; that it is risky; that it is costly not only in money but also in human stress; that the ultimate chance of complete success is statistically small; and, in short, that the price is very great. On the other hand, the physician could make it very difficult for the patient not to accept the program by stressing the desperate nature of the patient’s present condition; the fact that this program appears to the best and probably 186 Morality and Law the only means that offers any hope for a satisfactory outcome; and that, in spite of a considerable price, the possible great gains are worth it.73 The particular medical procedure that had prompted Ford’s consideration of the morality of advising radical surgery was the procedure known as pelvic exenteration, a radical attempt to treat cancer of the bladder which could not be treated by other means such as radiation therapy or a simple cystectomy (where the urinary bladder is removed). Pelvic exenteration would require the removal of all organs in the pelvis, leaving only bilateral openings on the skin to allow for waste disposal. At the time of the writing of the article, Ford claims that there were not enough data to evaluate the procedure’s overall effectiveness.74 Ford presents a hard case of pelvic exenteration in order to illustrate the physician’s problem of speaking about experimental radical surgery to seriously ill patients. This whole problem was brought to sharp relief in the case of a 7-monthold girl with a heretofore fatal type of sarcoma of the bladder. In such cases, simple cystectomy had been tried, but local recurrence in the pelvis had been the outcome. At the present state of knowledge, pelvic exenteration would seem to be the most likely procedure to rid the infant of cancer , although it had not actually been carried out before on an infant with this disease. Could one morally undertake pelvic exenteration on a child of this age? And if it was morally permissible, how should one present in all fairness the case to the parents? It might be strongly pointed out to the family that this demanding procedure would be the child’s only chance for survival. Or might it be presented to the family as a hopeless situation in which an experimental, untried, and mutilating procedure might be carried out if they, realizing the chance for success was at best quite small, wished. In the first instance, it would be difficult for the family to turn down the operation, but, in the second instance, they could have done so very easily.75 Ford admits that “hard cases make bad laws” and that those formulating guidelines for physicians should not let their attention be monopolized by one particular aspect of a hard case.76 The overall picture of the case must be considered. Among the many...

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