Consider Ethics: Theory, Readings, and Contemporary Issues - Assignment Example

 First we define ETHICS. Ethics is a branch of philosophy that deals with the questions involving morality, or what is good and bad, right and wrong. 1. There are major branches of ethics which include meta-ethics, or the study of ethics as to where they started, or how they came into being, normative ethics, which deals with the practical use of ethics as applied to daily living in terms of what is right and wrong, and applied ethics, or the ethics that is involved in handling ethical issues like abortion, euthanasia, organ transplantation, environmental issues, and others. 2 In this paper, we will deal mostly with the application of ethics in terms of the types of ethical issues that can occur. Using the case scenario given below, we are going to tackle the impact and the boundaries of social workers in the ethical decision-making for another individual. CASE SCENARIO We are given a case of Mr. M, a fifty- six year old man who lives in a residential home, who was placed in the care of the institution by his family. Unlike most elderly, Mr. M is special in the sense that he had been born with the congenital disorder called Trisomy 21, which is otherwise known as Down Syndrome. This is a chromosomal dysgenesis syndrome consisting of a variable constellation of abnormalities caused by triplication or translocation of chromosome 21. The abnormalities include mental retardation, retarded growth, flat hypoplastic face with short nose, prominent epicanthic skin folds, small, low-set ears with prominent antihelix, fissured and thickened tongue, laxness of joint ligaments, pelvic dysplasia, broad hands and feet, stubby fingers, and transverse palmar crease. Lenticular opacities and heart disease are common. The incidence of leukemia is increased and Alzheimer disease is almost inevitable by age 40. 3 In this respect, Mr. M is often not able to take care of himself, and has trouble remembering many things, and has had to take maintenance medications for years. When at his best behavior, he will take the medicine without any problems. When he is not in a very good mood, he would often refuse the medications. When this occurs, the caregivers would decide to hide the medications in Mr. M’s food and he would unknowingly be able to take his medications for that day. We will now try to see whether these actions present ethical dilemmas. First, we would have to understand that in his current condition, Mr. M is obviously challenged in many respects, but the most prominent of these is his mental retardation. At the age of fifty-six, Mr. M’s mental capacity is that of a ten-year-old. Having said thus, we are now faced with a problem of a man who is by age, legally allowed to make decisions that pertain to his well-being. On the other hand, his limited mental capacity would mean that he is more often than not, unable to fully understand the impact of any decisions he makes on his well-being and on his health. On examination of the case, we will try to look at it from several points of view. First, we will look at the case based on the deontological argument and we then contrast it with the teleological approach to ethics. We can also look at the perspectives of moral objectivism, utilitarianism and psychological egoism. Lastly, we examine the options and motivations we have under Kant’s theory regarding the good will as a driving force in our ethical decisions. Deontological ethics or deontology is an approach to ethics that judges the morality of an action based on the action's adherence to a rule or rules. Deontologists look at rules and duties. It is sometimes described as "duty" or "obligation" or "rule" based ethics, because rules "bind you to your duty"4 In our case, we can consider the situation in terms of its setting. In a residential setting, the duty of the service providers is to make sure that the welfare of the subjects, such as Mr. M, is not compromised by any misbehaviors on the part of the subjects. By establishing the ground rules for acceptance to the said institution, the subject therefore must obey a set of regulations in order to make himself a part of that institution and to maintain the flow of activity and service. However, if we look at Mr. M in all his limitations, any misconduct on his part, for example, by refusing to agree to the management of his disease without solid evidence of rational backgrounds for the said refusal, we can assume that he is not acting in his proper mental capacity, and we may choose perhaps to dismiss his refusal as a result of his inability to comprehend what is going on with his health. Having recognized this dilemma, we can now try to find ways to resolve the issue of “disobedience”. We can opt to explain to him why he has to take the medications, or we can deceive him by giving him the medication in other forms that he would normally tolerate like food, or we can practice some form of force and make him obey. The least of our options would be to not give him the medications at all if he refuses it. And simply ask him to sign a waiver. This being the least amenable because it would not be beneficial to him as he needs these medications as maintenance for his illness, and it is not part of the obligations to care for the patient’s health. As service providers however, the duty one has towards his fellowmen who are recipients may include occasionally having to find ways to provide a well-meaning service even when it is unwanted. In this regard, we should also ask whether by sticking to our duties, we are also stepping over the rights of our fellowmen to refuse what he does not want, and when he does not want the service. By applying the deontological ethics, we would say that we are morally obliged to follow our rules because we are bound to them as our duty. There are cases wherein individual rights and welfare become the point of an ethical issue. Assumptions are often made in order to begin arguing for a moral standard to follow for us to be able to handle issues that involve individuals who society label as “incompetent” decision-makers. Occasions of this include those who are still assumed to be below the legal age, individuals who are mentally challenged, psychologically challenged and those who are under the influence of chemicals that arguably affect reasoning. These are just a few possibilities where we can assume that decision-making may be delegated to other individuals, preferably those who have the intellectual, emotional, psychological, spiritual and moral capacity to be able to decide and take responsibility for someone else’s life choices, and this would include the use of certain services, and the decisions involved in providing care for these individuals who are unable to make “rational” decisions for themselves. One problem we can encounter on this part is that we really have no specific tests that have been proven to be perfectly sensitive and specific enough to tell us whether one person is more morally responsible and more rational than another. But that would be a different dilemma altogether. For now, let us assume for the sake of argument that the people surrounding Mr. M and who are the service providers in the residential home he is living in are mentally, psychologically, emotionally, spiritually and morally equipped at a higher level than our index person, Mr. M. In this respect, we can also assume that they, as human beings, have their own motivations and reasons for certain acts, either good or bad, toward our person, Mr. M. We then proceed to study these acts according to different ethical views, and try to measure them according to the terms provided by each ethical theory to see whether we can really claim that in the process of caring for Mr. M, we are committing acts that are unethical, or that in some way or another, these acts can be justifiable. Before we begin to claim that we have the right to choose certain services for the benefit of other people, we have to ask ourselves if these claims are ethically sound. We open the idea of informed consent, wherein, if we are given a case of someone needing medical intervention, unless that individual gives his informed consent, we cannot give any interventions to him, even if we as adequate decision-makers deem it necessary for that individual. The decision is his to make, and if he does not agree to certain medications and procedures, we cannot override his free will except for special instances. By definition, an informed consent is a legal document in all 50 states. It is an agreement for a proposed medical treatment or non-treatment, or for a proposed invasive procedure. It requires physicians to disclose the benefits, risks, and alternatives to the proposed treatment, non-treatment, or procedure. It is the method by which fully informed, rational persons may be involved in choices about their health care.,5,6,7,8 The rights of an individual, regardless of who she/he is involves the liberty to choose how to live his life, how to advance it to his benefit and how to take care of it. If for an instance, like Mr. M, had he not been mentally challenged, knowing that he is ill, he would, rationally, do something to ease the illness like take medications. Since in this case, Mr. M is incapable of making the decision for himself, and since informed consent cannot be given in a case of a mentally challenged patient because of the assumption that he is unable to grasp the entire impact of a decision, thus he falls short of our definition of an individual capable of giving his informed consent. We can claim then that another individual with the capacity to understand the situation can make the decision on Mr. M’s behalf could be an option. We can actually look towards other sources for decision-making, for instance, we can ask Mr. M’s family to decide for him. We can also take into account how society would react to such measures that need to be taken in order to manage Mr. M’s case. Often, there are certain views of society that result from the lack of information they get regarding the situation of persons such as Mr. M. With this lack of information, we cannot expect them to have good perspective of what goes on behind the doors of a residential home. If a social worker recognizes that the people like Mr. M, though handicapped, still have his rights, then decision-making options would be broader. If the family would also be informed that such a situation is occurring in the residential home, perhaps they can also practice and participate in ethical decision-making in behalf of their particular subjects. We have to take into consideration whether it is ethical to decide for Mr. M, and to what extent one can safely intervene in behalf of someone who may no longer be aware that he can refuse or agree to any interventions being placed on his person, even if it is already proven necessary for his health and well-being. In the event that Mr. M says “no” and refuses any of the claimed “beneficial” interventions and medications, do we admit these refusals as valid, or does the social worker or caregiver have the right to overrule his judgment by claiming that due to his disease, he is by default unable to practice rational decision- making, or to give informed consent. And with this notion in mind, the caregiver then hides the medications in the patient’s food. This action can be justified as ethical teleologically, because of the view that the rightness of an action is justified by its consequences, in this case that which is beneficial to the recipient of the act. By claiming that these medications are necessary for the health of Mr. M, we can do whatever is necessary to ensure that he receives them, even if we act “deceitfully” like concealing them in his meals, or coercing him into taking them. However, if we look at the case through the eyes of moral objectivism, we can say that some actions are inherently good or bad. By acting deceitfully towards Mr. M, we are involved in an act of immorality, regardless if the consequences are beneficial or not to the recipient of the act. L.P. Pojman gives us the definition of moral objectivism as…“There is a fact of the matter as to whether any given action is morally permissible or impermissible: a fact of the matter that does not depend solely on social custom or individual acceptance.”10 Here he is saying simply that the nature of the action taken actually matters, and it is not something that is relative, it is something that holds true across cultures and despite of individual beliefs. If an act is wrong because it is in itself wrong, then it is an act considered to be unethical. And since deceit is in itself not right, this would make the act of deceiving Mr. M unethical in itself, despite of its good consequences on his welfare. If, by caring for Mr. M, the service providers are benefitting in the sense that they get to feel that they have fulfilled their obligations towards a fellowman in need, or selfish desires like a sense of having power over Mr. M, we can say that their actions are motivated by egoistic reasons. Psychological egoists propose that there really are no actions that are motivated by goodness; that whatever reasons the service providers give for caring for their patients will always stem from selfish desires, that self-oriented interests ultimately motivate all human actions. Perhaps then we can propose to examine our motivations in any action we do towards our patients, especially if these patients are inherently unable to rationalize their actions. We can also examine any proposed action from a utilitarian point of view. Utilitarianism (Totalitarianism) by definition means that an action is morally right if the consequences of that action are more favorable than unfavorable to everyone. Taking into consideration the benefits of a certain decision made for Mr. M’s improvement, we can say that this will also result in favorable consequences for the service providers, as they would have done their obligations to provide for the subject and for the family who are dependent on the idea that their member is in good hands. As for its impact on society, we can perhaps look at it as beneficial in terms of the overall health and wellness status of their people in general, because if each and every member are at their functional best, it would create a positive overall picture for the society itself, that it is able to take care of its members and provide well for each of them. We re-evaluate our dealings with these individuals who have been enrolled in our care in the first place, because they are mostly unable to care for themselves already. We review our actions because we should be driven towards a goal that follows the “do no harm” principle towards our fellowmen. What would be the boundaries that family, friends and social workers within which he can say that he is doing his job in relation to Mr. M’s well-being. To what extent can these people and other service providers decide for Mr. M without stepping over lines of ethical duties towards a fellow human being to outright violation of that human being’s rights? Mr. M, if at his rational best cannot comprehend that his body needs certain medications as maintenance, would it have been to his benefit if for instance, the caregivers would hide his medications in his food, or force him to take his medication, or treat him in unethical ways simply because they are driven by the sense of duty to provide for Mr. M the best care possible, if by this we mean that he is physically well? By Kant’s deontological argument, the rules that surround Mr. M and how to manage a case similar to this, would be the basis for any intervention the caregivers provide. If it is part of the moral obligation of the caregivers to give medications to the patient according to his needs, then Mr. M’s right to refuse may be revoked for each instance that it is proven that his taking his medicines are part of the rules on how to provide the best care for him as a service user. However, we can also look at it in terms of teleological approaches to what is ethically sound. By looking at the consequences of an action, we can differentiate what is morally sound and unsound. If, in our case, hiding medications in patient’s foods is a way to make them take the medicines that would benefit them, then we can say that what the caregivers are doing can pass ethical confrontations. Another thing to consider would be that any action can never be intrinsically good based on Kantian theory unless it is based on a sense of duty towards our fellowmen. He also stated that any action can only be done in a morally right way if it is good in itself, and good without qualification. Nothing in the world—indeed nothing even beyond the world—can possibly be conceived which could be called good without qualification except a good will.11 So, we ask, do we have good will towards these people who are at an inherent disadvantage because of their learning disabilities, acquired through no fault of their own? Or are we simply acting towards these individuals impersonally, without care for what they really need from us rather than our claims to duties and obligations as service providers, and nothing more? By placing the situation in different platforms and examining actions taken towards any individual, we can see from several perspectives that each action may have several consequences, both good and bad. Knowing also that each action, despite of its consequences can be inherently unethical, we can therefore validate first whether the actions we take in an attempt to fulfill our duties end up in more damage towards the violation of an individual’s rights, despite of the presence of any handicap on his part. As a service provider, we can claim to have an obligation towards the care of our patient. Also, we have to think of how much the benefits would outweigh the risks for any plan of action we decide to take towards our patients. We can always choose what is best according to what we deem, but we should also act as one human being towards another human being. If at the level of a friend or counselor towards Mr. M, we can be kinder and as much as possible, consider making him understand, at his level of intelligence, the necessity of certain actions towards his person, and the necessity of taking his medications, perhaps we would have fulfilled our obligations at a higher level than most. And if we follow the divine command stand of ethics, we know already whenever we decide to take one action over another, that there is delineation between what is right and what is wrong. And if we provide services as we are obliged to do, and yet use deceit or coercion or force in order to provide these services where they are due, then we should also understand that despite the consequences being generally good for the recipient, we would have done an act that is unethical to some extent. If there is a way to go through the situation as complicated as Mr. M in an ethical manner, then that would be a good option to follow. Sometimes we have to go beyond what we see and provide more than what we are duty-bound to do. Often, we have to bend beyond our comforts in order to be ethically responsible and to make decisions that are not going to make the recipient feel treated like he is less than a human being simply because he has certain disabilities he cannot control. Ethical theories are good and well as ways of studying each action before it occurs, but the real evaluation must be done with the person as a whole in mind—beyond the handicaps. This a statement that would perhaps sum up all these proposed actions based on different ethical theories. Hoy stated that "The ethical resistance of the powerless others to our capacity to exert power over them is therefore what imposes unenforceable obligations on us. The obligations are unenforceable precisely because of the other’s lack of power. That actions are at once obligatory and at the same time unenforceable is what put them in the category of the ethical. Obligations that were enforced would, by the virtue of the force behind them, not be freely undertaken and would not be in the realm of the ethical"12 Until there is a general moral framework with which we can pass our queries regarding ethics, these dilemmas will remain mostly unchanged. REFERENCES: 1. http://en.wikipedia.org/wiki/Ethics (January 25, 2010) 2. http://www.utm.edu/research/iep/e/ethics.htm. (January 25, 2010) 3. Stedman’s Concise Medical Dictionary for the Health professions. Illustrated 4th Edition. (p.286) 4. Waller, Bruce N. 2005. Consider Ethics: Theory, Readings, and Contemporary Issues. New York: Pearson Longman: 23. 5. Berg, J. W., C. W. Lidz, P. S. Appelbaum, and L. S. Parker. Informed Consent: Legal Theory and Clinical Practice, 2nd edition. London: Oxford University Press, 2001. 6. Donnelly, Mary. Consent. Crosses Green, Ireland: Cork University Press, 2002. 7. Jonsen, A. R., W. J. Winslade, and M. Siegler. Clinical Ethics:A Practical Approach to Ethical Decisions in Clinical Medicine, 5th edition. New York: McGraw-Hill, 2002. 8. Radford, Roger. Informed Consent. Bangor, Maine: Booklocker. com, 2002. 9. Flew, Antony. 1979. "Consequentialism". In A Dictionary of Philosophy, (2nd Ed.). New York: St Martins: 73. 10. Pojman, L. P. : A Defense of Ethical Objectivism (p. 50) 11. Kant, Immanuel. 1785. "First Section: Transition from the Common Rational Knowledge of Morals to the Philosophical", Groundwork of the Metaphysic of Morals 12. Hoy, D 2004, Critical resistance from poststructuralism to postcritique, Massachusetts Institute of Technology, Massachusetts Read More