Intersection of Autonomy and Beneficence

Written by: Leah Jeunnette, Ph.D.(c)

Last week, Cnn.com highlighted the story of Elizabeth Joice.  After beating cancer in 2010, she became pregnant in 2013, but then also found out the cancer had returned. Suddenly, she had to choose whether to continue with her pregnancy or to receive treatment for her cancer.

Elizabeth’s story illustrates one of the most difficult intersections in bioethics, which is where the principle of autonomy and the principle of beneficence meet. In this case, Elizabeth chose autonomously to continue the pregnancy. At the same time, the principle of beneficence was in play.  While the tumors were removed from Elizabeth’s back, a more definitive full-body scan to search for more tumors could impact the fetus, not advisable if she planned to continue with the pregnancy. Elizabeth chose to move forward with no additional scans or treatment. The continuation of the pregnancy was her autonomous decision, and she did what she believed was most beneficial for the developing baby. Unfortunately, Elizabeth Joice passed away from her cancer less than two months after delivering her daughter Lily.

Did she make the right choice? I think that is a difficult question to ask and an impossible question to answer.  According to the principles, she made an autonomous choice; she chose to do what was best for the pregnancy, as opposed to what might be best for treating her cancer.  Principles often conflict and overlap.  There is no conclusive answer as to which principles are most important at a given time.  What is most important is that medicine allows for patients to act according to their own beliefs and values.  In the case of Elizabeth Joice, she was able to do exactly that.