Describe the context of the case. What is going on?

Who are the moral agents?

What is the moral problem in this case? What is at stake? Please relate it to one or more bioethical principles

What is the moral question in this case? If you there think there are different moral questions describe why.

Make a moral argument of what you recommend the doctor should do. Don't just give your opinion: make an argument that reflects on the bioethical principles and attempt to justify your answer.

Mr. J had a slow-growing facial tumor, which had rendered him essentially housebound: the tumor was fungating, rotting from the inside out, and causing a terrible odor and unrelenting pain. He was becoming increasingly unable to go out in public. His doctors had told him that the tumor could not be removed in its entirety due to its involvement in his carotid artery and the proximity of the tumor to his brain; cure, therefore, was impossible. Nevertheless, at each clinic visit, Mr. J pressed his surgeon, Dr. G, to cut out as much of the tumor as he safely could. Mr. J had already undergone maximal "noninvasive" therapy with radiation, but the tumor continued to grow. Eventually, he was told that the tumor would kill himby eroding a major vessel and causing a life-ending bleed or by compressing his brainstem and causing him to stop breathingbut that the tumor's growth was slow, and nobody could tell him how much time he had left.

Every few weeks, Mr. J was hospitalized for pain or bleeding from the tumor, and each time he saw Dr. G, he was more and more depressed. This time, he was at his wit's end, all but begging for surgery. "Please," he said, "All I want is to visit my mother before I die. She cannot travel. I can't get on a plane like this. Please, please take the tumor away. Please help me."

Dr. G was troubled. Mr. J was in a terrible state, and there was a real possibility that surgery would make his condition worse. To help his pain and the appearance of his wound, surgery would require debulking the tumor and then covering the wound with a free flapharvesting skin, an artery, and a vein from a healthy area of the body to cover the hole caused by the resection. In the best-case scenario, the case would take at least 8 hours in the operating room, and the patient would require at least a 7-day hospitalization thereafter for monitoring and rehabilitationif there were no unforeseen complications. Worse, there was no guarantee that the surgical wound would healthe free flap would essentially be lying on a bed of tumor. There was scant medical literature on the subject, and any predictions for success or failure were basically guesswork. But if Mr. J survived the operation and if the wound healed, there was a chance that he would be able to achieve his goal of flying to say goodbye to his mother. Surgery was a lot of investment for a lot of uncertainty.

After many frank conversations with Mr. J, Dr. G felt that his duty to help Mr. J outweighed the risks of the surgery and that Mr. J understood the risks of the procedure and wanted to proceed. Dr. G decided to offer surgery. Dr. G's colleague, Dr. N, learned about the operation and could not hide his dismay: "You're going to do a free flap on that patient? Do you know how much that will cost the hospital? Will his insurance even pay for it? And what about the patients that have curable diseases whose care you're postponing caring for him? What if he never gets out of the hospital? You are making a big mistake."