Medical Ethics in Palliative Care - Essay Example

Medical Ethics in Palliative Care Introduction Practitioners of Jainism walk around with brushes with which they sweep ground in front of them; thisis not out of a desire to keep the ground clean but rather to avoid stepping on and killing any insect that may happen to crawl in front of them. To them all life is sacred, irrespective of the species and people should do their utmost to preserve it, on the other extreme end there are the pro-choice activists who believe that people should have the right make choices whether on matters of their own death, or even that of their unborn children. Nevertheless this does not necessarily mean they value life less, on the contrary many argue they value it too much to allow it to suffer unnecessarily. This begs the question, just how precious or sanctified is human, life? That is probably the most subjective moral question one can posit , and the answers will vary widely based on the respondent religious humanist beliefs or lack of thereof. Many people hold that life is indeed priceless and/or sacred, however their view of how it should be treated in different circumstances tend to be radically different, under the phase sanctity of life, the idea of life’s sacredness is widely applied by pro-life activist to argue against issue such as abortion, euthanasia and abortion (Doerflinge and Gomez, 2010). Central to the debate on life sanctity is the subject of euthanasia which is one of the most controversial moral, religious and medical issues of all times (Baranzke 2012, p.295). The setting in which it most frequently arises is in palliative care where many patients spend the last days of their lives under medical care without any hope of recovery only awaiting what is assumed to be a certain death. In some cases, patients in this situations or their family may request that treatment is stopped or that the patient is given a lethal dosage or drugs such as morphine to “save” them from pain. While it is allowed in some states and countries but the legality has not significantly served to reduce the amount of controversy surrounding the issue. This paper will discuss the importance of sanctity of life through several arguments against euthanasia for patients undergoing palliative care and then examining and disproving some of the opposing views that have been used to trivialize sanctity by pointing out their underlying weakness with a view to prove that; irrespective of the intentions, euthanasia is morally and medically unjustifiable. Background The concept of euthanasia has been in existence for almost as long as the formal practice of medicine has and in some societies it probably predates it. Prior to Christianity, the ancient Greeks and Romans liberally practiced it and the societal attitudes towards; infanticide. Euthanasia and suicide were radically tolerant by modern standards. This can be attributed to the fact that they probably did not have cogently defined beliefs in the inherent value or sanctity of human life. Despite the existence of the Hippocratic Oath which many pre-classical and even modern day physicians were/are supposed to adhere to in retrospect; it was doubtful if very many doctors complied. Given the rife mercy killings in the time, the prohibition that forbid doctors from administering “… a deadly drug to anybody, not even if asked for, or from suggesting such a course of action,” (The Hippocratic oath, 1943). With time the attitude towards euthanasia in Europe were control by the church which outlawed it and it was not until the 20th century that the fight to legalize the concept which was defined in many ways including the right to die and the right to a decent death gained enough momentum cause notable ripple in public opinion. In the USA efforts to legalize euthanasia commenced in the early 20th century heralded by a recommendation by the New York Medical Association that terminally ill people who are in pain should be allowed a gentle and easy death. Other states such as Ohio and Iowa made similar proposals but all this were rejected. In 1920, two Germen professor proposed the killing of animals they described as being devoid of value and to a great extent, this and similar opinions such as eugenics and social Darwinism were foundation to the involuntary euthanasia of the infamous third Reich in which thousands of “cripples and idiots” were eliminated or neutered for the betterment of society (Vermaat 2002 p.21). After the second world war, the Nazi’s association to the social Darwinism that promoted euthanasia had the effect of reducing the clamour for legal killings in Europe, however , this gradually changed and the struggle went on to gain support in the late 20th century. Today, given the secular nature of politics and societal sentiment, the act has been legalized in several countries in Europe such as the Netherlands and various states in the US such as Montanan and Washington. Meaning of Euthanasia In a palliative care context, given this is the scenario where the issue is most prominent, the act of euthanasia generally involves; a physician providing medical means through which a terminally ill may end their life or by otherwise facilitating their death through action or inaction according to the patient’s or their next of kin’s recommendation. In medical practice there are various understandings of the practices through which a patient’s death can be knowingly facilitated, that somewhat limits the scope of the definition above. While euthanasia is essentially understood as the act of a third party assisting a patient to die in response to suffering, there is another concept known as Patient assisted suicide (PAS) which is the act of a doctor prescribing or advising a patient on a lethal drug or dosage they can use to facilitate their death, the primary difference is that in the latter, the patient takes the drug himself. However for purposes of this paper, euthanasia will be understood as any action that is centrally to the dictate of hypocrite’s oath in which physicians are prevented from occasioning harm to the patient wheatear knowingly or otherwise. . Critical analysis An analysis on ethical issues facing palliative care providers in relation to euthanasia are often a daunting; they must take to account a variety of philosophical, medical moral and in many cases religious ethics, not to mention matter of criminal law depending on the country in question. Understandably, the issue is extremely complicated and before it can be understood in the contexts of any situation, all these and other factors must interplay and maintain a balance. The term sanctity of life has been used to justify opposition of euthanasia based on the assumption of the universal nature of this characteristic given that for example Christianity, Buddhism and indeed many other religions despite their radically different theisms agree on the sanctity of life (Perett 1996 p.310): However, it must be conceded that the attractiveness of this argument is to a large extent the engenderment or applying a simple solution to a complex problem. For this reasons, while sanctity is a key consideration, it should not be applied in the debate purely based on its own merit but on a variety of other augments that transcend the different understanding of life’s preciousness and holiness even and include even those who abstain from conventional religious and moral beliefs. For this reason, the arguments examined herein will take to consideration the legal, religious and medical ethics that come into play in respect to subject at hand. The issue of euthanasia is not an isolated one and in many ways it interplays with other similar issues in which termination of life is justified based on a multiplicity of factors. When abortion was first legalized in the UK there was a divisive public debate the value of human life. Quintessentially, by virtue of lifting the protection of the unborn child, courts automatically retreat form the sacred vie of life and chose instead to promote the right of the woman to choose whether she wants to keep the child or not. This brought about the now famous right to choose issue and unsurprisingly the effects of the decision extending to the end of life decisions with efforts to sanction Eurasia and PAS under the principle of one’s life to die being fuelled by the laws on abortion. Everett Koop famously remarked that that with abortion on an arbitrary basis being accepted, the other forms of “killing” for which so many advocates would follow suit at rates so high as to surprise even their advocates(Koop 1984, p.337). Majority of the modern religions are in opposition of the concept of euthanasia and although the same cannot be assumed to follow for all their followers, the religious argument against killing off patients to ease their pain is one of the most common. It is centred on the concept that euthanasia is an affront to the sanctity of life since only Godhas the power to determine the boundaries of life and as the creator, it is only he that should be allowed to determine when a life should be terminated. Arguments for; Euthanasia is Ungodly and seeks to supplant the creator’s mandate. According to Christian beliefs, which is in this respect mirrored by Islam and Judaism, the womb is a place where gods handwork is carried out and each life is endowed with unique traits and tendencies, in addition everything that happens to a human being happens for a reason and the fact that we do not understand it is not justification to play his role. Under this position, everyone was created for a reason and in the eyes of Godall are equal, therefore terminating a life for the sake of ending suffering is wrong since even this suffering may be seen as serving a higher purpose that may not be so overt to the individual. In some eastern religions which may not subscribe to the same believes on a deity as Christians Muslims and Jews who are predominate in most of the west, and America, suffering is viewed and a means through which ones soul is sanctified and purified. Therefore, eliminating someone’s life for the sake of alleviating suffering would be considered morally wrong as it interferes with their transcendence through this or into the next life as the case may be. Pro euthanasia bills attempt to humanize what according to Christina ethics is tantamount to humanizing murder by protecting doctors from facing prosecution should they aid a patient at dying as long as they are over 18 years of age. These bills are being crafted in a manner that makes them appear caring by using words such as compassionate or medical assistance which is actually ironic since the word medical is drawn from Latin, medico “to heal” and therefore making someone die as a form of medical assistance is obviously the antithesis of the term medical. Religious leaders further argue that contrary to the belief that human life is holy and priceless the quality of life mentality that promotes euthanasia deigns to place value of a human life based on its mental or physical properties. In the same way cars, computers and houses are valued, based on their functional capabilities, the quality of life movement attributes life and assumed that once someone is no longer effective in their functions, they should be eliminated to ease the burden they cast on humanity. Humans, however according to religious opinion should not be valued on the merit of their abilities but for their own sake and this value is invaluable making all human life priceless and inherently discounting the rationality for euthanasia. Immanuel Kant summed up this view by saying that humans are inherently valuable and life should be treated as an ends in itself as opposed to a means to an ends which is the view people assume when they support euthanasia (Kant 1981 p.30). Irrespective of one’s religion or lack of whereof, they are entitled enjoy their rights as human beings and likewise obliged to respect other’s right among which is the inalienable right to life. In a way, euthanasia is a form of discrimination against those who are terminally ill since they are essentially deprived of their life simply because they are deemed too expensive to look after and thus branded a burden. Furthermore, the primary tenets of traditional religion is based on a set of commandments among which murder is universally prohibited on the basis that life is sacred and only the deity has a right to take it away. Several religions have recognized that in as much as suffering is painful it serves a crucial role in bringing them closer to Godor connecting them with nature. This idea was immortalized by John Paul the second in a speech where he claimed that in suffering there lies a power that draws a person interiorly close to Christ (Briggs, 1984). Therefore, people should not take it upon themselves to eliminate suffering through eliminating the victim since the pain may be purposeful; a common comparison is the biblical suffering of Job who was put through pain to test his faith. It would however be naïve to expect the religious argument to appeal to everyone given that although religion professors may constitute a large percentage of the world’s population, there is a significant number of those who do not believe in a deity. In addition, even those that profess religion do not necessarily practice it, for example the catholic church has for a long time been said to oppose artificial family planning, the fact that Catholics in the UK do not have a notable excess of children as compared to other denominations is evidence that many of them actually do use contraceptives. Nevertheless, this by no means nullifies the argument, at the end of the day; some of the points made herein are universal and not limited to faith matters. One of the arguments proposed by the church is that euthanasia results to people losing value in the lives of others, even from a purely secular point of view, this argument still holds considerable merit. Euthanasia Devalues Human Life In a society where euthanasia is allowed, the respect of life will ultimately be lower than where it is illegal, this is because the core justification for euthanasia is that the sickly and disabled are essentially less worthy of life than the healthy ones. The slippery slope argument contends that when society allows voluntary killing of those who it deems incompetents and vulnerable if they request it, it will be a short walk to killing off those it deems undeserving of life. This is retrospectively exemplified in the Nazi’s practice of social Darwinism under which the state had the power to decide who deserves to live or die and/or who should be allowed to have children. Idiot and cripples were murdered in cold blood under the premise that they were a burden to society, although the comparison between deciding if to switch of a patient’s life support and the deniable killing of thousand may seem farfetched, it is not entirely improbable. The Slippery Slope Argument, Voluntary Euthanasia Leads To Involuntary Euthanasia. One of the justifications for euthanasia is that it relieves patients from physical and mental suffering; however mental problems may at some point cause a patient to be incapable of making a coherent decision regarding their own life. In addition even when the practice is allowed based on the patient’s own request; there is a lot of leeway for manipulation by the doctors or relatives who may for some reason or other wish for the patient to die. In addition, the gpatient will be under pressure albeit indirectly from their family to request for euthanasia even if they do not wish for it since they will feel like a burden. Furthermore, is euthanasia become a common practice some patients may feel guilty for using up medical resources and request to be killed not because they have lost hope or are necessarily in extreme pain but since they think that they are being treated at the expense of others who may stand a better chance. Given that family members even under normal circumstances have been known to have relatives killed especially for the sake of money, euthanasia will potentially provide a loophole through which murder may be legally committed. The pro-choicers posit that when there is a conflict of opinion between a terminally ill patient’s opinion and their doctor on the issue of lifesaving treatment or the right to die, the patient’s wishes overrule the doctor’s. This implies that the doctor should respect the patient’s desire to have their life terminated even if the latter may not be in in sound mental health. Euthanasia Reduces Motivation For Palliative Care And Invention Of Cures Allowing euthanasia will also impact negatively on the motivation for caring for the terminally ill which is the purpose of palliative care. Consider a situation where a doctor or nurse working in a hospice where a patient can freely request and expect to be killed should they so wish, they will lose motivation to provide quality care since the goal of keeping the patient alive and comfortable for as long as possible would be defeated. Besides, proponent of euthanasia presumes that doctor’s knowledge about a patient’s condition is absolute and there is no room for error. This assumption is however fallacies and the fact that a doctor has pronounced a patient as a hopeless case do not guarantee that their chances of recovery are nil. Euthanasia is presented as the end of the road for people suffering terminally, consequently it is instituted it will act as a pseudo cure in that it will eliminate the patient and disease. If the same had been done for smallpox the plague and other diseases, it is quite possible that not much attention may have been expended to finding a cure for them. It could also potentially increase the rates of suicide among “healthy” people who have been diagnosed with conditions such as cancer since they would assume that the end result is being put down like an animal and prefer to go on their own terms. Treatment of terminally ill patients provided physicians with exposure to the diseases such as cancer at their extremes, the observations and knowledge gained from this experience are very important in helping them develop cures and better treatments. To underscore the importance of preserving life at any cost , Chappell is quoted saying that … death is in nobody’s best interest”(Chappell 2003, p.40) and in due consideration of the fact that the living patient could indirectly or directly contribute to the betterment of society this statement is easily appreciated. Ergo, instituting euthanasia in any form withdraws and important experience that could if well utilized result in the discoveries of a cure. For example a doctor treating patents in the last stages of AIDs can observe how different patients cope with the disease and use the data collected to carry out comparative analysis which may be used in coming up with effective treatment regiments. Opposing arguments Divine Exclusivity for Giving and Taking Life Flawed The arguments for against euthanasia are not however without their flaws and this have been exploited by pro-lifer who with the intention of proving that the practice is compatible with ethical practice of palliative care. The rationalist school of through provides some very compelling arguments in opposition primarily based on the fact that the idea of divine exclusivity in the determination of death as well as popular taxonomic argument that seeks to prove disallowing abortions lacks philosophical and logical merit. The assumption that Godgive and Godtakes away has been challenged as an ethical imperative based on Hume’s conjecture that this if followed to its logical conclusion would imply that doctors have no mandate to prolong life and therefore even the ordinary treatment of ills would also be in disobedience to gods commands. The argument is also critiqued on the premise that the argument is voided when it is applied to people whose religion does not prohibit the taking or life or those who subscribe to no religion at all (Hurst and Mauron 2006, p.108). Opponents rightly point out that the medical ethics are patient centred and the doctors should not impose their own presumably Christian values on the patient as the RANZCP principle code of ethics forbids doctors from such. While conceding that the logic behind these arguments is relatively sound, it is important that one takes cognizance that inasmuch as not all subscribe to the Christian or Islamic beliefs the argument here is not based on the foundation or religious but medical ethics. When the doctors refuse to allow a patient euthanasia they will essentially be acting according to medical not personal ethics, therefore even if a doctor is an atheist, they will be obliged to adhere to the ethics of their profession. Hume’s argument against euthanasia is akin to arguing against normal medical procedures is fundamentally flawed in that he tries to equate a situation where a patient is being treated with the objective of curing them to one where they are being made comfortable in readiness for an imminent death. In additions, treatment is equitable to preserving life while euthanasia is the same as terminating life, therefore when one treats they are upholding Gods work while in the latter they are essentially destroying it so under no circumstances can the tow be compared. The Axiom Another powerful opposing philosophical argument is grounded on the claim that there can be no axioms in medical ethics and should one try to construct them they would run into a theoretical conundrum. Assume, opponents will claim, that that the sanctity of life were to be considered an axiom (Jewell 2005 p.3), in that premise, even the respect of a rational human being would similarly be an axiom; however this two cannot logically co-exist. This is because the latter would require that doctors respect the autonomy of the individual asking for euthanasia, however on the basis that life is sanctified this request would be have to be denied thereby cancelling out the binary axiom. This argument however also contains a flaw, the requirement or rationality for an individual qualify to have their autonomy respected makes eliminates the axiom in the case of mentally unsound or inaccessible patients. For example if someone is in a coma, it would be impossible to determine their mental state or even learn of their desire to be killed since they are incapable of expressing either. As a result the onus of making the decision would ultimately fall in the hands of the kin or attending physicians, furthermore, in situations where the suffering I mental either as a result of or in addition to the illness, they would lose their autonomy since it would be impossible to determine if they were of sound mind when requesting to have their life terminated. Summary In conclusion, the sanctity of a human life is provided for by among other factors the fact that it cannot be recreated or even replicated since humanity does not possess the abilities or knowledge to achieve such feats otherwise palliative care would not be necessary. By allowing euthanasia, the message being sent along is that it is better to be dead than sick and disabled, the subtext of which is that some lives are worth less than others and are not even worth living. By virtue of the fact that someone has been deemed eligible for euthanasia by a doctor, it makes them subhuman in the eye of the doctor and the society as well as their own if they capable of comprehending the situation. That is why in places euthanasia or assisted suicide is allowed, the doctor will not be charged with murder even if they would have been arrested for the same if they killed a healthy person. References “The Hippocratic Oath”: Text, translation and interpretation By Ludwig Edelstein Page 56 ISBN 978-0-8018-0184-6 (1943) Baranzke, H., 2012. "Sanctity-of-Life"--A Bioethical Principle for a Right to Life? Ethical Theory and Moral Practice, 15(3), pp. 295-308. Briggs, K.A., 1984, Feb 11. POPE SAYS SUFFERING CAN MEAN SPIRITUAL GAIN. New York Times. Chappell, T, Why euthanasia is in nobodys interest, Philosophy Now, 2003, no 40, p 11. Doerflinge, M and Gomez, C., 2010. Killing The Pain Not The Patient: Palliative Care Vs Assisted Suicide. National Conference of Catholic Bishops. Available at: http://www.usccb.org/issues-and-action/human-life-and-dignity/assisted-suicide/killing-the-pain.cfm Hurst, S and Mauron, A. The ethics of palliative care and euthanasia: exploring common values. US National Library of Medicine National Institutes of Health. ;20(2):107-12. Jewell, P. (28–30 September 2005). Rationality, euthanasia, and the sanctity of life. Australian Association for Professional and Applied Ethics 12th Annual Conference ; Adelaide . Available at: http://w3.unisa.edu.au/hawkeinstitute/gig/aapae05/documents/jewell.pdf Kant, I, Grounding for the metaphysics of morals, 1981, USA: Hacjett, p 30. Koop, E and Schaeffer, F, C., 1984 “Whatever happened to the human race?” In The Complete Works of Francis A. Schaeffer, vol. v. (Westchester, IL: Crossway Books, 1984), 337 Perett, R.W., 1996. Buddhism, euthanasia and the sanctity of life. Journal of medical ethics, 22(5), pp. 309-313. Vermaat, E, 2002. Euthanasia in the Third Reich: Lessons for today? Ethics & Medicine, 18(1), pp. 21-32. Read More