Kantian Moral Ethics and Models of Physician/Patient Relationship - Assignment Example

Question 1: Utilitarian vs. Kantian Moral Ethics.

Both teleology and deontology are philosophical models. While the former refers to the study of ends or means, the latter relates to the study of duty or obligation. Teleological ethics focuses on the result and apply it to understand what the purpose of a given action is. According to teleology, the decision on whether an action is right or wrong is wholly based on whether it produces a good or bad result (Holmes 143-159). In such, the moral obligation is derived from a desirable end. For this reason, this model has come to be known as consequentialist ethics. Deontological ethics contradict this view by maintaining that the focus should be on the action rather than the outcome. This action must be guided by rules called duty. This model is not so much concerned with the end or result. Several theories are categorized under these models including utilitarian and Kantian moral theories. The utilitarian ethical theory is based on teleology while the Kantian Moral theory is based on deontology. Utilitarianism is concerned with the consequences as the basis by which one should take action. While according to Immanuel Kant (1724-1804), who is credited with Kantian ethics, one’s action must be guided by a principle of action or Maxim referred to as a Categorical Imperative (CI) that is a standard of rationality to be followed by all. (Widdows 305-315). Jeremy Bentham (1747-1832) who is the founder of utilitarianism used the word utility, whereby he defined a good action as one that maximizes on 'utility' which is the positive outcome of an action.

Patients have the right to make decisions concerning their medical care without being influenced by their health caregiver. This principle is referred to as patient autonomy. Biomedical professional have a moral obligation to respect their patient's autonomy. However, by applying both utilitarian and Kant moral ethics to this autonomy principle, then several variations come up. This is because the Kantian ethics focuses more on the Patient while utilitarian ethics is society-centered. Professionals are regularly faced with moral dilemmas when it comes to patient autonomy, and it is up to them to weigh which ethical theory is best applied during such times. The Kantian ethics obligates them to duty and therefore to conduct themselves in the best interest of the patient regardless of the benefits or harm to the society. Duty or obligation requires that one does the right thing by the standard of rationality or Categorical Imperative. This means that a doctor would have to go against a patient’s wish where he or she feels that it is for the good of the patient. In such a case, the professional should not respect the patient’s choice if it is irrational or self-destructive. He or she should try to convince the patient otherwise. It could involve providing the patient with facts from the medical point of view. In the situation where the patient insists on being reckless and stands his or her ground, then the professional can go ahead with the right action without consulting the patient. On the other hand, utilitarian ethics urges the professionals to weigh the benefits and harms of a decision in fulfilling their moral obligations. It requires one to weigh an action depending on how much benefit can be ripped from said action. If the benefits outweigh the adverse effects on the outcome, then such an action is considered right. This has been criticized as it does not always cater for the patient needs. Thus, if utilitarian ethics is applied, a professional should agree with a patient’s decision even if it's irrational and arbitrary if the outcome of the decision is considered right by the society. After all, the outcome will be, respect for patient autonomy, good relations between both parties and a happy and satisfied patient hence creating a good reputation for the health facility. Hence the utility in the theory’s perspective, in such a case is fulfilled. A good example is whereby a patient is involved in substance addiction. He expresses an unwillingness to quit, and this puts the professional in an ethical dilemma. The professional is torn in between fulfilling his moral obligation in patient autonomy and doing what is right for the patient. In such a case, and applying Kantian ethical theory, the professional should fulfill duty and do the right thing. This should be in the patient’s best interests such as advising the patient on the adverse effects of the substance addiction and the reasons why it is necessary to quit. Rehabilitation facilities may as well be informed on the issue although this may not settle so well with the patient. Regardless, it is the right thing to do. Applying Utilitarian ethics, the professional would have to weigh the outcome of the situation. Disagreeing with the patient will bring about a lot of adverse effects on the facility and the professional’s reputation hence in such a case, respecting patient autonomy is the best thing to do.

Question 2: Models of Physician/Patient Relationship

Decision-making in the treatment of patients has inspired different models of physician-patient relationship. Such models include the paternalist, consumerist, collegial and contractual models. The paternalist model focuses on the well-being of the patient. The physician decides on the best decisions to undertake without considering the patient's choices. Thus, patient participation is very minimal. This model, therefore, disregards patient autonomy and assigns the physician a guardian role hence it is also referred to as the parental model. Its primary advantage is that it focuses on patient welfare while its shortcoming is that it does not allow for patient autonomy. Secondly, is the consumerist model that allows for the patient to be presented with all the available options in the process of decision-making, from where he or she can choose the interventions the physician should undertake. The role of the physician, in this case, is to provide all the facts to the patient who then decides on the best way forward. It is thus also referred to as the informative model (Emanuel 2221-2226). It has its pros and cons. One pro is that patient autonomy is highly regarded in this case. It, however, has a downside as it requires the highest competence on the part of the physician. Truthful facts must be presented to the patient in a transparent and clear manner. Lack of these facts could bring problems. Also, the patient might not fully understand these facts hence compromising his or her decision-making. Thirdly is the collegial model which is quite similar to the consumerist model in many ways except that it goes a step ahead. Other than offering facts, the two parties work together to analyze the best option. However, the final decision is still made by the patient. In such a situation, the role of the physician is to offer facts and to assist the patient to interpret his or her values. The word ‘values’ in this context is used to refer to the patient’s judgment of the important things in life as well as his or her principles of standards. This model’s advantage is that it maintains patient autonomy; however, the patient might still not choose the best decision. Last but not least is the contractual model. Dialogue is involved in this model, and the physician informs the patient on the best action to take. He tells the patient what he should do. The physician, in an attempt to assist the patient make the best decision, introduces new values other than those of the client in the quest to make the patient understand the best way forward. This suggests helping the patient look at life in a whole new perspective. The patient ends up making the best decision with the shortcoming that it disregards the patient’s values. (Charles 651-661)

When it comes to the issue of truth-telling vs. lying in the best interest of the patient, only the paternalistic model supports this. All the other three models promote patient autonomy whereby it is believed that the patient should decide on his health issues. Most cases that offer physicians this kind of ethical dilemma are found in terminally ill patients such as cancer patients. It is clear that veracity is encouraged where treatment could save a life. However, in cases where treatment can’t work, deception is warranted. After all, no one wants to live their lives on a ticking clock. This can be so traumatic for the patient. The general approach should be the contractual model. It’s best because it lacks the shortcomings of the other models. It considers patient autonomy, offers all the facts, consults on the best decision and on top of that, informs on better values of the patient. Therefore, even in stubborn patients, better values can be impacted which can help change how one views life. According to the universal moral principles, the physician is bound to inform the patient of all the facts simply because it is the moral thing to do. The patient, being an adult has the right to choose the path of his or her life. This is because only one can wholly examine themselves based on their values of their lives.

Question 13: Stem cell research

Stem cells are biological cells that can still undergo replication through mitosis. The fact that they can develop into any type of cell has become a matter of interest to scientists. They also serve as a repair system where they replenish other cells. Stem cells include both adult and embryonic. Adult stem cells are found all over the body, and they regenerate cell types of the organ of their origin (Gershon 928-929). Their discovery led to the first human bone marrow transplant. Consequent transplants have resulted in saving many lives with blood-related cancers. The science behind this significant step in medicine is that the bone marrow contains stem cells. Actually, the bone marrow is a very good idea of the potential of stem cells since it regenerates the blood cells including the platelets, red and white blood cells. According to studies, 200 billion new red blood cells are generated by the bone marrow every single day. Up to 450,000 platelets can be produced daily. Therefore, serious diseases that affect the bone marrow interferes with these stem cells causing harmful blood conditions and lack of immunity. The fact that such a transplant can cure blood cancers such as sickle cell Anaemia, lymphoma, and leukemia, creates curiosity on the potential of these stem cells in our lives. This has led to the stem cell research which promises to provide solutions for some of the greatest medical challenges. These include the treatment of cancer, diabetes, blindness, immune disorders, heart diseases as well as Alzheimer’s and Parkinson’s disease. Adult stem cells, though applied in the cure of blood-related diseases, are limited in their differentiating while embryonic cells have the potential to differentiate into any type of cell hence the big interest in them. However, these are obtained from human embryos, and this has led to a considerable controversy due to the ethical implications of the research.

Among those who stand against this research are pro-life advocates who believe life begins at fertilization hence embryos should be protected just like any other human being. Following this, they term the destruction of the embryo as murder. With this comes the question whether the promise of such research is worth overlooking the ethical complication. This is an issue that has been heavily debated by politicians which saw President George Bush abolish such research citing strong beliefs during his tenure. However, his successor, president Barrack Obama revoked this decision stating that he was driven by his desire to apply science to ease human suffering. Truly, the possible outcomes of this research cannot be ignored (Ruse 111). With more people succumbing to terminal and chronic illnesses such as cancer, heart diseases, and diabetes every day, a solution cannot be overlooked. Still, measures need to be put to ensure that a certain line is not crossed. Scientists have considered this and are researching on techniques of obtaining stem cells without destroying the embryo, and this has proved quite successful, hence winning support from parties and individuals who previously opposed the research. Personally, I lean towards the research and its potential. This is informed by its advantages including possible cures for damaged organs, cancer, spinal cord injuries, congenital disabilities, strokes, heart disease, Parkinson’s disease, Alzheimer’s disease and diabetes. Millions of people around the world die from these diseases every year.