Applying Ethics in Practice - Case Study Example

Assignment 3: Essay—Applying Ethics in Practice In the scenario, or in one like it, the ethical principles of autonomy, beneficence, non-maleficence, and justice should be the framework. People who are facing the end of their lives with no or little hope of surviving and a lot of likelihood of having to face unbearable pain and suffering often look to our topic, assisted suicide. Issues that should be considered in this scenario include, but are not limited to, sanctity of life beliefs, death with dignity beliefs, and the perceived rights of key stakeholders in the scenario. Those are the directions we follow in our examination of our topic (Western Mail 2007 and Oxford University Press 2005). As mentioned above, this essay is a discussion of a scenario where the ethical principles of autonomy, beneficence, non-maleficence, and justice come into play. These principles are also discussed in general. Autonomy is used as a means of determining peoples’ moral principles. Beneficence occurs when someone does something for someone else. Non-maleficence means doing no harm to others. Justice is the quality of being fair (The Atlantic Monthly 1997; Journal of Criminal Law and Criminology 1998 and The Christian Century 2000). The lady in this particular medical case study has found herself in a serious predicament that many older individuals have to face at a certain time in their lives. She cannot speak, she needs a feeding tube, she will not take her medicine, and she is becoming increasingly dehydrated. It does not take a genius to tell that this lady wishes she would go ahead and move on from this human life than to be subjected to the type of treatment she is being given, even though the treatment in question is being given to save her life. On one hand, the general public feels sorry for her, wishing she would somehow but gently be put out of her misery naturally and with no pain or illegal activities. On the other hand, the general public struggles with the idea that this lady may be better off is she is ‘helped’ out of her misery and allowed to move on, especially if it is her own personal wish to do so (Harvard Journal of Law and Public Policy 2000 and The Humanist 1996). This is a rather complicated ethical matter, with many individuals teetering in the middle, refusing to make a choice one way or the other, and avoiding the whole question altogether unless, they had to face that own situation one day either with themselves or a loved one. No one wants to find him- or herself in a situation like that (Routledge 2001 and the Hastings Center Report 1993). If treatment were to be stopped, the lady’s caregivers know for sure that she would die. This means that stopping treatment would fall under the category of assisted suicide. This is a hotly debated topic that brings out the strongest of emotions in a variety of people, particularly those who are family members and friends of the loved one that may be receiving assisted suicide. Many people’s heads just spin and they do not really know the right thing to do. The best way to deal with this situation in an ethical manner is to look at both options, list the pros and cons, and make the best and well-informed decision possible (Theological Studies 1997; Insight on the News 1994 and Praeger 2002). As previously mentioned, this is a complicated topic, because believers on both sides are often straddling the fence. They must consider many factors when deciding whether or not to support assisted suicide. Some of these factors are ethics, morals, legality, medicine, safety, and the famous slippery slope. To avoid a biased viewpoint here, the essay will be presented objectively, showing both sides to the story and the beliefs of both supporters and non-supporters (Free Inquiry 1996). Arguments in Support of Assisted Suicide According to APA (2009), ethical and moral arguments should be employed. For instance, self-determination is a principle that can control the time, place, and nature of ones death. This goes on to place quality at the end of life above the sanctity of life itself. In a case where the care of a person is futile, one factor to consider is the use of sophisticated medical technology, such as life support, to prolong life. Another factor to consider is preserving the dignity of such a person. Autonomy and self-determination are closely related. This principle says that a person should have the right to decide whether or not they should continue living when put in this situation. Furthermore, they should have the right to choose the course of this process (Praeger 2000). The supporters that believe in these statements obviously believe that they are choices, and even so, they should be respected. However, they only believe these choices should be respected when decisional capacity has been thoroughly evaluated (Western Mail 1997). It goes to say that no person should have to endure prolonged pain or suffering. Some believe that, when the burdens of life outweigh the benefits of death, the patient should be able to choose whether or not they would like to undertake the process of assisted suicide. They also argue that assisted suicide for patients who are incurably ill and who are suffering greatly is not genocide because it falls under the categories of dignity, honor, and respect. It is a process that the dying patient chooses and it is not forced upon them (APA 2009). Legally, people tend to favor assisted suicide when it is in their best interest. It is good, however, that legal safeguards are built in that protect these patients from the illegal practices of practitioners (The Hastings Center Report 1999). According to the APA (2009, pg. 1), “Medical arguments contend that competent terminally ill patients wishing to choose assisted suicide may feel abandoned by physicians who refuse to assist. The criticism that medical doctors agreeing to assist in suicide would be violating the Hippocratic Oath is refuted on several grounds. First, the original Oath prohibiting killing also prohibited abortions, surgery, and charging teaching fees, all of which have been recently modified to meet contemporary realities. Second, assisted suicide, unlike euthanasia, does not involve the ending of life by a physician, as it is the dying person himself or herself who takes the steps to end his or her life. Third, the Oath requires physicians to take all measures necessary to relieve suffering, and some interpret this to include assisted suicide when that is the only way suffering can be relieved” (Western Mail 2007). It is indeed legally possible to protect patients through the safeguards and the slippery slope, and most importantly abuse. It will require appropriate legislation. Furthermore, an oversight committee would need to oversee such actions. The committee would include ethics professionals as well (Oxford University Press 2005 and Praeger 2000). “Several models for safeguards have been proposed and typically include confirmation of diagnosis, prognosis, treatment options, and decision-making capacity, assessment for alternative means of alleviating suffering, nondirective counseling, education of physicians, and education of the public” (APA 2009 pp. 1). There are other concerns for supporters: Legal end-of-life interventions, Double effect, Terminal sedation, Slippery slope, Abuse, Standards of care, Appropriate regulation and oversight, Financial concerns, Mental health evaluations, and Treating those that can be treated (APA 2009). Arguments in Opposition to Assisted Suicide Those who are socially and economically disadvantaged are the root of ethical and moral arguments. It has become a concerned that those who are at some type of disadvantage such as women, the disabled, differing ethnic groups, sexual deviants, other minorities, and sick older individuals in general will be coerced into assisted suicide rather than wholeheartedly choosing the process themselves. Sadly, these groups may be most easily coerced into the process because of their position in society or their state of well-being (or lack thereof). Also a particularly sad concept is that health insurance and other means to obtain proper healthcare is become increasingly scarce in areas such as the United States, so many of these individuals may not have the choice to take care of the high costs of remaining alive (APA 2009). . Ethical arguments opposing the ideas are as follows: Family members worry physicians make the end-of-life choice with just a brief consultation, Cost containment is too important to physicians to overlook, They do not respect human life, They do not believe killing is wrong, and They akin it to Nazi Germany where unwanted groups were put to death just because they belonged to a group (APA 2009). There are legal arguments against assisted suicide, and some of them are as follows: Worries about civil suits when there are wrong diagnoses or incorrect prognoses, Misuse, Abuse, Improper application, and Coercion (APA 2009). “Medical arguments against assisted suicide include the possibility of misdiagnosis, the potential availability of new treatments, and the probability of incorrect prognosis. Because medicine is fallible and research is ongoing, incorrect diagnoses may result in unnecessary requests for assisted suicide or in requests that are carried out just before the introduction of a new treatment that could prolong life. Another medical argument is that requests for assisted suicide may indicate that improved palliative care, aggressive pain management, and better psychosocial support are needed. Further, there is serious concern that the availability of assisted suicide may create a disincentive to providing appropriate but costly medical treatments or to improving the quality and availability of palliative and hospice care” (APA, 2009, pg. 1). The following are also objections to assisted suicide: Goes against the physician’s role as a healer, Poses societal risks, Risks ill persons’ feeling abandoned or losing trust in healthcare, The Hippocratic Oath is violated, Safeguards, Slippery slope, People may be killed that have hope, People may be killed that can be healed, and People may be coerced into be killed (APA 2009). Unfortunately, no safeguards are possible in this process. Written contracts or requests are highly involved and unrealistic, especially in the case where a patient is seriously ill and unable to make sound decisions (APA 2009). According to APA (2009 pp. 1), “Arguments supporting or opposing assisted suicide are generally made from several frames of reference. These include ethical and moral arguments, legal arguments, medical arguments, and arguments regarding safeguards and the slippery slope. Ethical and moral arguments include the principle of self-determination to control the time, place, and nature of ones death, placing quality at the end of life above the sanctity of life. Other factors include the desire to preserve dignity and personhood in the dying process and opposition to prolonging life by using sophisticated medical technology when it is recognized that care is futile. Closely related to self-determination is the principle of autonomy. This principle states that persons should have the right to make their own decisions about the course of their own lives whenever they can. By extension, they should also have the right to determine the course of their own dying as much as possible. According to these arguments, even when choices are socially shaped they should be respected as autonomous as long as there is appropriate evaluation of decisional capacity. No person should have to endure terminal suffering that is unremitting, unbearable, or prolonged. When the burdens of life outweigh the benefits because of uncontrollable pain, severe psychological suffering, loss of dignity, or loss of quality of life as judged by the patient, and when the circumstances are not remediable, the dying person should be able to ask for and receive help in assisted suicide. It is further argued that assisted suicide for incurably ill persons experiencing extreme suffering can be distinguished from euthanasia used for the purpose of genocide on the grounds that it is based on principles of dignity, honor, and respect and is chosen and enacted by the dying individuals, rather than being forced on them against their will. Conclusion It cannot be said that unintelligent people occupy one side of the argument and that intelligent people occupy the other side. Different philosophies guide these positions. So do different value systems and life experiences. High levels of moral development can also occupy these locations. People either agree with assisted suicide or are against it. They have their own reasons for picking a particular side. Some believe that it is compassionate and socially responsible, while others believe that it is morally wrong and a form of murder. Both sides agree, however, that there are both pros and cons to the process. Where they disagree is how they assess those different pros and cons. It can be hard to decide what is right, because all of the issues surrounding assisted suicide are incomplete (APA 2009). Flowchart References “Assisted Suicide Worries Allayed.” 2007. Western Mail (Cardiff, Wales). Battin, Margaret Pabst. “Ending Life: Ethics and the Way We Die.” 2005. Oxford University Press. Emanuel, Ezekial. “Whose Right to Die? America Should Think Again before Pressing Ahead with the Legalization of Physician-Assisted Suicide and Voluntary Euthanasia.” 1997. The Atlantic Monthly, Vol. 279. “End-of-Life Issues and Care: Assisted Suicide.” 2009. APA. Retrieved 4 May 2009, from http://www.apa.org/pi/eol/arguments.html Feinberg, Brett. “The Court Upholds a State Law Prohibiting Physician-Assisted Suicide.” 1998. Journal of Criminal Law and Criminology, Vol. 88. “Foes of Assisted Suicide Marshal Arguments.” 1997. The Christian Century, Vol. 114 Gorsuch, Neil M. “The Right to Assisted Suicide and Euthanasia.” 2000. Harvard Journal of Law and Public Policy, Vol. 23. Hallock, Steve. “Physician-Assisted Suicide: ‘Slippery Slope’ or Civil Right?” 1996. The Humanist, Vol. 56. Hillvard, Daniel and John Dombrink. “Dying Right: The Death with Dignity Movement.” 2001. Routledge. Kamisar, Yale. “Are Laws against Assisted Suicide Unconstitutional?” 1993. The Hastings Center Report, Vol. 23. Kaveny, M. Cathleen. “Assisted Suicide, Euthanasia, and the Law.” 1997. Theological Studies, Vol. 58. Larson, Edward J. “Assisted Suicide is a Slippery Slope.” 1994. Insight on the News, Vol. 10 Lindsay, Ronald A. “Assisted Suicide: Will the Supreme Court Respect the Autonomy Rights of Dying Patients?” 1996. Free Inquiry, Vol. 17. Olevitch, Barbara A. “Protecting Psychiatric Patients and Others from the Assisted-Suicide Movement: Insights and Strategies. 2002. Praeger. Palmer, Larry I. “Endings and Beginnings: Law, Medicine, and Society in Assisted Life and Death.” 2000. Praeger. Salem, Tania. “Physician-Assisted Suicide.” 1999. The Hastings Center Report, Vol. 29. Read More