Patients Confidential Disclosures through the Lenses of Kantian Philosophy - Essay Example

Patient’s Confidential Disclosure through the lenses of Kantian Utilitarian Ethics Many times, in the of life, people are faced with a moral dilemma- whether to do a certain thing or not. We also do not know which is right, to do something one way or to do it in another way. Different schools of philosophy have come out with different theories on what is moral or ethical and what is not. The Kantian ethics propounded by the German philosopher Immanuel Kant in the eighteenth century is one of them. Another school of thought called the Utilitarianism was advocated by John Stuart Mill in the eighteenth century. Both these schools of thought seem to be opposing each other, as they encourage different ways of looking at things .The following example shows the difference between the two schools of thought. The story centers round Theresa Rice, who is a pharmacist in Argen Hospital. She works in the Hypertension clinic, counseling the outpatients. One day, James Edison, a 58 year old patient who is suffering from mild hypertension tells her something which causes her a dilemma. Edison says that he had been passing blood with stools since some weeks. Theresa advises him to consult a physician but Edison refuses. He says that he believes he has cancer. Edison remembers his mother who died from cancer after suffering for a long time. He recalls that she had undergone many surgeries and other treatments, but finally died in great pain. Edison remembers that his mother had given up all hope, and was miserable in the end. She was always thinking that she was a burden to the others. His mother’s misery and painful death had made Edison determine that he would not die in such a manner. He did not even want to know if he had cancer. Rice suggests to Edison that he should consult a physician. She says that she would call a physician to the consulting room to examine Edison. At this suggestion, Edison becomes agitated. He tells Rice that she should not disclose to anybody what they had talked about. Edison’s behavior causes a moral dilemma for Rice. She now has to decide whether she should tell a physician about Edison’s condition or not. If she tells the physician, she will be breaking faith with the patient, and will feel guilty for making the confidential disclosure of a patient public. She also thinks that a patient has a right to determine what treatment he should have. No one should interfere with a person’s intentions. On the other hand, if she does nothing about Edison’s condition, his condition may become worse. As a pharmacist, she feels that she is responsible for her patients’ welfare. If his condition became worse, Rice would feel morally responsible for it. She would also suffer from a feeling of guilt. Rice decides to get others’ opinion to help her out of the dilemma. She pretends that she is telling a fictional case, and tells her colleagues about Edison’s case and the dilemma it has caused. Her colleagues, Madera and Jessica Mise also agree with her that the pharmacist has a moral responsibility for the welfare of their patients. They both agree with Rice that patients have a right to choose their own medical treatment. Madera thinks that Edison was not thinking rationally He was quite comfortable when he discussed his condition with Rice. He thinks that Edison’s response to his condition is too emotional. Medera is of the opinion that Rice should consult a physician and find out what Edison’s options are. She should then inform Edison about his choices of action. If the condition was really serious, then, according to Medera, Rice should inform a physician and let him contact Edison. In Madera’s opinion, the patient’s welfare is the most important factor. If a patient does not understand what is good for him, it is the duty of the pharmacist to act in the patient’s best interest. Jessica Mise, another friend of Rice has different opinion. She thinks that Rice would be doing an immoral act if she consults a physician against Edison’s wishes. Mise says that whatever the patient tells the pharmacist is confidential. If the pharmacist tells it to a physician, then she would be breaking the confidence. Mise is of the opinion that the most important thing here is to respect the patient’s wishes, and to respect the confidentiality of the conversation .If the patients feel that they cannot trust their pharmacists, then the relationship between all the patients and their pharmacists will be soured. Mise also says that pharmacists have knowledge of drugs. Therefore, a pharmacist’s opinion might spoil the relationship between the patient and his doctor, which is a bad situation. After listening to all their arguments, Theresa Rice decides to do some research. She finds out that there are many causes for blood in the stools, and not all causes are serious. She also finds that there are other serious causes for the condition, which is not because of cancer. If the patient had cancer, and it caused the bleeding, there would be other symptoms. But Edison had shown no other symptoms. She discovers that further medical tests would have to be done to find out whether Edison’s condition was serious or not. Now, Rice’s dilemma has become deeper. She has two alternatives. The first alternative is, that she can tell Edison about the other causes of his condition, and persuade him to see a physician .She will not inform a physician herself about Edison’s condition. By doing this, she will be doing her duty. She will be morally right in the light of Kantian ethics. Immanuel Kant, the German philosopher brought about a revolution in the thinking of the philosophers in the eighteenth century .He published his “Critique of Pure Reason” in 1781, which became the cornerstone of Western philosophy. According to Kant religion must be based on morals. Everybody experiences the moral sense- a feeling that some action is wrong. We may ignore the feeling and give in to temptation, but still the feeling persists. We feel that we must avoid bad behavior. As will Durant says, “The moral law in our hearts is unconditional and absolute”.(Durant 276)An action is good , according to Kant , when it is done in obedience to the inner sense of duty and the moral law. Thus, if Rice tells Edison about the various other illnesses which can cause his condition, she will be doing her duty as a pharmacist. She will not be breaking any moral law since she has not told the physician about Edison. Her information can give Edison some hope and he may agree to see a physician. This might lead to medical treatment which might cure his illness. But it may so happen that Edison is diagnosed to have cancer after all. In that case, Rice is still morally right because she has done her duty towards her patient. Edison would feel anguish if he was diagnosed with cancer, which would also cause anguish to Rice. Since she has not informed the physician against the patient’s wishes, Rice need not feel bad. She has not broken the confidentiality of the disclosure. The moral law in her heart would tell Rice to give Edison the choice of consulting a physician or not. She would have to tell him about all the other diseases which could cause such symptoms. At the same she will not be breaking the trust of the patient, which is an immoral act. According to Kant, an action is good not because it has good results, but because it follows our inner sense of duty. He tells us not to bother about our own happiness, but do our duty. If Edison is annoyed and refuses to see a physician, Rice would feel unhappy because she feels responsible for the well being of her patients. But her unhappiness or happiness is not important, according to Kantian ethics. We should strive for perfection, forget happiness. Thus she would be morally right in advising Edison to see a doctor, but she should not force it on him. She should respect the decision he takes about his own medical treatment. The second alternative that Rice has is that she herself should consult a physician and tell him about Edison’s condition. Here she would be breaking the confidentiality of the patient’s disclosure. Although according to the Utilitarians, this is not a moral act, it can be excused because it helps the patient in the end. Bentham and John Stuart Mill advocate the theory of utility and the Greatest Happiness Principle. According to the theory of utility, the ultimate end is a life of greatest pleasure and least pain. John Stuart Mill, was an Englishman who advocated the Theory of Utility. According to him, all action is for the sake of some end, and rules of action must be according to the end. He advocates a science of morals. According to Mill, truth and falsehood are questions of observation and experience. Utilit, or the Greatest Happiness Principle says that an action is right if it promotes happiness, and an action which promotes unhappiness is wrong. Thus any action that reduces pain is right, and an action that increases pain is wrong. In the case of Edison, the action taken by Rice, of informing a physician might eventually reduce Edison’s pain. So it is right in the light of the Utilitarian theory. But, on the other hand, if Edison is indeed suffering from cancer, her action will cause him much greater pain of knowing he has the disease. But the end of the action, which is the cure of the patient’s disease, justifies Rice’s actions. . He might only be having a disease which is not cancer. In that case, the physician’s treatment might cure him. If Edison is really suffering from cancer as he feared, then medical treatment might bring him less suffering. This is morally right in the light of the Utilitarian theory. Although a patient has a right to determine his own medical treatment, the pharmacist must act in the patient’s best interest. Rice will also feel happy when Edison gets the required medical treatment, which again is in accordance with the Utilitarian theory. As Madera said, the patient’s welfare is the most important thing for the pharmacist. If Rice follows Madera’s advice and consults a physician, she will feel less uneasy about Edison’s condition. Thus, it contributes to Rice’s happiness. The dilemma of Rice can be handled in different ways, according to the different schools of thought-namely, Kantian and Utilitarian. Both sides agree that it is unjust to break faith with anyone. If Rice informs the physician without getting the consent of Edison, she will be disclosing confidential information. This is nothing but breaking faith with the patient. According to the Utilitarians, it is not regarded as absolute. If there is a stronger obligation, one is allowed to break faith. Here, in the case of Rice, she has a stronger obligation, which is the welfare of her patient. So she need not feel morally wrong if she tells the physician about her patient’s condition and get his advice. The Kantian way expects Rice to do her duty and follow the moral law which is dictated by her heart. For Kant, a right action is not based on pity, reward or punishment. The moral action is based on a feeling of duty. If Rice follows Kant, then she should educate Edison about the various options he has and leave the final decision to him. References Durant, Will. “The Story of Philosophy” Washington Square Press Inc. New York. 1962 Kant, Immanuel. “Critique of Practical Reason” London . 1909 as quoted by Will Durant. Read More