Candura Case

ic74_pa_ethics

Instructional Designer: Steve Dahill

case_Candura

Copy and paste the text below into Dreamweaver below the HTML5 object where you want JAWS text to be read. Please make sure when copying the text you click and drag down to include ALL the text.

<p style="clip: rect(1px 1px 1px 1px); /* IE6, IE7 */
clip: rect(1px, 1px, 1px, 1px);
overflow: hidden;
position: absolute;
max-height:1px;">
The True Story of Mrs. Candura

In 1978 in Massachusetts, a true story occurred when a daughter (Mrs. Lane) petitioned the court for guardianship of her 77-year-old mother (Mrs. Candura) because she refused surgery to amputate her leg that was badly infected with gangrene. In fact, Mrs. Candura already had a toe amputated in 1974 when it was discovered that she had diabetes. In 1977, she had a portion of her right foot amputated because of an infection that turned gangrenous. By May 1978, she had once more developed gangrene in the right foot and a doctor who had known her for years persuaded her to have the leg amputated. At first she agreed, and then she changed her mind. Her reasons were that she didn’t want to become a burden to her children or have to give up her independent living for a nursing home. Her husband had died several years before and she was still grieving.

During the Appeals Court Hearing, Mrs. Candura repeated to the judge her reasons for not wanting her leg amputated. She said she wanted to get well, but was resigned to death. She was adamant in her refusal for surgery. Testimony from surgeons established the fact that without surgery, Mrs. Candura would undoubtedly die. The social service practitioner who had worked with Mrs. Candura stated that although Mrs. Candura could be difficult at times and sometimes her train of thought wandered she was mentally lucid. Psychiatric evaluations conflicted. The judge ultimately determined that she was mentally competent. “…What is lacking in this case is evidence that Mrs. Candura’s areas of forgetfulness and confusion cause or relate to impairment of her or ability to understand that in rejecting the amputation she is, in effect, choosing life over death.”

The court found Mrs. Candura competent, and the daughter’s petition for guardianship was denied.  Before the final decision was announced by the judge, Mrs. Candura agreed to surgery and on May 16, 1978 her leg was amputated. Mrs. Candura died in 1986. (Lane v Candura, 6 Mass. App.Ct. 377, 1978).

What was the main ethical principle at stake in this story?

Self-determination (autonomy)

In this case, had the courts ruled that Mrs. Candura was incompetent (unable to make her own decision because of mental incapacity), guardianship would have been given to her daughter. Once a guardianship is awarded by the courts, it is difficult and costly to rescind it (Kapp, 2005). The course of Mrs. Candura’s remaining years would have been determined by her daughter: all decisions regarding health, personal relationships, where she lived, and how her money was spent would be out of Mrs. Candura’s control.

As we can see from this example, self-determination is a complicated concept with potentially harmful repercussions when the person’s safety and wellbeing are at risk, but equally harmful if the person is deprived of choice. There is no doubt that Mrs. Candura’s daughter felt that the court’s decision would bring harm to her mother and that it was an unfair decision (justice). There is also no doubt that the physicians felt strongly that taking no action would bring harm to Mrs. Candura. However, both the worker and the judge believed that Mrs. Candura was able to make an informed decision about her health. As in many ethical dilemmas, good people with good motives operated from different sets of principles.

Finally we must be careful not to define self-determination too narrowly. It doesn’t have to be a “deep” decision. It may mean simply that a person in a long-term facility has the right to decide where he will sit in the dining room or a person with a mobility limitation has the right to decide what kind of wheelchair she wants to buy. Some of the everyday decisions we take for granted are life-affirming decisions for others.  People are empowered when they make decisions, and that is the goal you work toward in your practice. 
</p>