The Implementation of Modern Medical Ethics - Essay Example

? The case of Ruth Symonds as pertaining to the implementation of Modern Medical Ethics. CONTENTS Introduction 2 - Deontology 2-3 – Teleology 4-5 – Modern Examples 6-7 – Autonomy, Non-maleficence, Beneficence The case of Ruth Symonds as pertaining to the implementation of Modern Medical Ethics. INTRODUCTION Integral to a question of ultimate ethics as it pertains to the case of Ruth Symond and her nurses, or indeed anyone's ability to ultimately judge right and wrong must be an issue of intentions. Is the nurse correct in compelling the less comfortable pressure-bandages on her patient when the allegedly positive outcome can only be achieved via compulsory overrule of Ruth's expressed wishes? While the nurse has factual justification for the enforcement of her recommendation, is it possible that her apparent commitment to the health and welfare of the patient cannot be achieved by the disregard of her wishes? DEONTOLOGY One might argue that to care for the body in a way that yields emotional distress is self-defeating; What then, are the rules by which we can standardize the 'goodness' of an action or philosophy? Deontological ethics (deontology) is an obligation-centric ethical theory. Duty and rule-adherence are essential in that ethics, when anchored by rules and obligation connect the person with his or her duties. Deontologists may also follow a belief of moral absolutism, outcomes themselves become irrelevant; only duty, rule-adherence that can give us a basis for final moral arbitration. Combining these views, actions yielding positive outcomes but not resulting from strict adherence to a pre-existing code of conduct cannot be morally justifiable - regardless of how good it seems in retrospect. Ergo, if compelling the compression bandages is following a pre-ordained obligatory behavioral code, then the outcome of preventing swelling and sores is irrelevant, as is the outcome of the widow's displeasure. So long as the Nurse acts according to a protocol. The case of Ruth Symonds as pertaining to the implementation of Modern Medical Ethics. TELEOLOGY By contrast, Teleological beliefs and philosophies are outcome-based, or outcome justified. This principle can extend not only to philosophies as they inform decision making, but the natural sciences as well. Hanke, (2004) A tiger has stripes because stripes are needed for a tiger to live and hunt in the way that tigers live and hunt; therefore striped tigers are inevitable. But this does not inform the investigator as to the ultimate origins of behaviors or adaptations, and thus would not permit future investigators to extrapolate that observation into further predictions. It would then become necessary to devise an explanation whereby the root causes of the tigers' need for stripes and the consequences thereof are elucidated in terms of differential survival outcomes; before said stripes ever appeared. In the writings of Aristotle, the premise of teleology is expounded upon as a unifying meta-principle that he uses to apply holistic meaning to the forms seen within nature. All that exists must be whole and functional within the purvey of ultimate purpose; a purpose which he held to be human benefit. Schindler, (1986) But subsequent generations of scientific thinkers would be able to demonstrate the incompleteness of that presumption. While it is true that wheat may be very beneficial for human consumption, and that oxen may be advantageous as a source of cheap, brute force for human-guided industry, what of disease? The Smallpox virus is perfectly adapted to infect and proliferate amongst humans, and can only survive inside of a human being; does humankind exist solely for the benefit of the Smallpox virus? Broader considerations like this must be kept in mind for anyone that adopts a presumptuous, just-so opportunistic teleology. It is difficult to entirely purge this kind of circularity from the field of biology, but attempts are being made by some biologists to remove assumptive references to a 'blind watchmaker', that presupposes final purpose as a guiding force impelling all nature to be as it is. Reiss, (2009) The case of Ruth Symonds as pertaining to the implementation of Modern Medical Ethics. Under such philosophical guidance, one must make a determination of priorities as it relates to the present example. Is it more important that Ruth be kept happy? Or is it more important that she be kept alive? While an elderly person under such circumstances is unlikely to have a great deal of time left ahead, is the caregiver's highest priority whether or not any medical crises that should occur are not attributable to the quality of in-home care? In such circumstance, anything necessary to extend life should be performed; even at the expense of quality of life, as the compression bandages cause Ruth discomfort. The desired outcome itself being the justification for whatever measures are needed to bring it about. Ryan, (2010) However, if the priority is to maintain Ruth's happiness regardless of medical necessity, then the compression bandages could not be employed. One might indulge in a cynical view stating that with the likely abbreviation of time left ahead for Ruth, attempts to prolong her life could be construed as exercises in futility. Ergo, with the greatest good of years left to live likely out of reach, the caretakers must then settle for the next-best-thing possible, being adherence to her wishes. So whatever makes her happy, is good and moral in this instance. MODERN EXAMPLES By way of contrast, one must then decide whether it is always better to 'follow the rules' as the final word, or whether one must consistently bend said rules in the ongoing search for the greatest good. It is quite probable that Joseph Stalin truly believed that his policies were best for the Soviet Union. Yet the outcome resulted in death by starvation, exposure, or outright execution of million of Russians, over two years he ordered the executions of 700,000 foreign nationals. Mcloughlin et al. (2003) His policies of agricultural collectivization caused a famine that resulted in the deaths of between 5 and 10 million people. Krasnolutska, et al. (2003) Can such a monstrous outcome be The case of Ruth Symonds as pertaining to the implementation of Modern Medical Ethics. justifiable on the basis that Stalin was abiding by a higher principle of nationalist Utopia that permitted immediate sacrifice towards the implementation of this long-term objective? That question falls to whether everything a dictator does is motivated by a stringent, ideological basis from which Deontological obligation can be construed, or whether such acts of brutality are the result of outcome-based, teleological opportunism? Only the dictator himself could address such a question. For the Deontologists, as long as Stalin's intentions are good, then actions made while motivated by a rule-set formulated under good intentions were moral. But to the extent that his actions were motivated by undisciplined caprice, they were unjustifiable. Deontologists would be compelled into adopting a similar view. There are several other examples; such as Southeast Asian dictator Pol Pot, who was driven by a resolute conviction that man's true place must be found only in an agrarian environment without modern conveniences. To this end, Cambodian cities were emptied forcibly, the population rerouted to concentration camps while the cities themselves became state-enclaves and torture chambers. The disruption of infrastructure and subsequent executions killed 21% of the country's population. Genocide Studies Program, Yale. (2008) Were both of these men driven only by a clear sense of duty? Those that adopt a purely Deontological perspective must weigh their choices cautiously. Certainly, a more positive outcome would have resulted for the millions of victims of these men had they not been subject to their dictators' obligations. The 'right' course of action for the home-care nurse must, in every instance be informed by beneficence. But the nurse herself, or the organization that employs her must make the determination of priorities as listed above to judge what is truly in the patient's best interest. To what extent will The case of Ruth Symonds as pertaining to the implementation of Modern Medical Ethics. overriding her wishes detract from her well-being? AUTONOMY, NON-MALEFICENCE, & BENEVOLENCE But these decisions are being presented with a possible presumption that the wishes of the patients could, under some circumstances be disregarded. This cuts to the issue of Autonomy. And whether and how it is justifiable to violate the desired condition of self-determination, even under the guise of a soft, benevolent paternalism. Pollard, (1993) Where health exists, a sound mind exists, and thus there should not exist compelling contingencies that justify the violation of autonomy. For the widow given in the example, a determination should be reached simply that she still exhibits the qualities of a sound mind in order to render invalid a decision that would violate her personal choice. Beauchamp, et al. (1978) And naturally, it is almost a cliche in terms of medical ethics as routinely taught in the academies to 'do no harm', the principle of non-maleficence. Lakhan et al. (2009) Physicians since time immemorial have performed bleedings, demonic exorcisms, and various amputations under the theory that it might be beneficial. The medical practitioner must attain every assurance that a proposed treatment will not first harm the patient. Challenges of this oath come in the form of chemotherapy, certain harsh surgeries, that do convey risk factors. But such risks are arguably allowable if leaving a malady untreated would be more harmful. A serious determination is needed whether the Nurse's proposed regimens are indeed acceptably non-maleficent given both medical and psychological considerations. REFERENCES Schindler, David L. (1986) "The Problem of Mechanism," Beyond Mechanism: The Universe in Recent Physics and Catholic Thought, ed. David L. Schindler (University Press of America, 1986). Beauchamp, Tom L. Childress, James F. (1978). Principles of Biomedical Ethics. Published February 15th 2001 by Oxford University Press, USA Hanke, David (2004). "Teleology: The explanation that bedevils biology". In John Cornwell. Explanations: Styles of explanation in science. Oxford & New York: Oxford University Press. pp. 143–155. ISBN 0-19-860778-4. http://books.google.com/?id=ZWpq14vS7WQC&pg=PA143&dq=%22biology+is+sick+%22&q=%22biology%20is%20sick%20%22. Retrieved 18 July 2010 Krasnolutska, Daryna. Pavliva, Halia. (2003) Ukraine Irks Russia With Push to Mark Stalin Famine as Genocide". Bloomberg.com. 3 January 2008 Lakhan SE, Hamlat E, McNamee T, Laird C (2009). "Time for a unified approach to medical ethics". Philosophy, Ethics, and Humanities in Medicine 4 (3): 13. McLoughlin, Barry; McDermott, Kevin. (2003). Stalin's Terror: High Politics and Mass Repression in the Soviet Union. Palgrave Macmillan. p. 141. ISBN 1403901198. http://books.google.com/?id=8yorTJl1QEoC&pg=PA141. Pollard, BJ. (1993). Autonomy and paternalism in medicine. [Med J Aust. 1993 Dec 6-20] - PubMed Result Reiss, John O. (2009) Not by Design: Retiring Darwin's Watchmaker. Berkeley, California: University of California Press Ryan CJ. (2010) Ethical issues, part 2: ethics, psychiatry, and end-of-life issues. Psychiatr Times. 2010;27(6):26-27. "The Cambodian Genocide Program". Genocide Studies Program. Yale University. 1994-2008. http://www.yale.edu/cgp/. Retrieved 2008-05-12. Read More