The Role of Conscience in Health Care Ethics - Book Report/Review Example

Topic: Obedience to ity of the Obedience to Authority 1. What is conscience, and what is its role in health care ethics? The lessons derived from the Nazi atrocities on Jews have been the testing ground of conscience in the medical science. The question is how such acts are committed without any provocation, on a mass scale, by groups of people, who would not have committed such acts in the normal course. The death camps to systematically exterminate the Jews were manned by administrative personnel. The killing process was methodical and the force that did the unpleasant assignments was not trained to be savages, they were carrying out the responsibility imposed on them. In the normal parlance their conscience was not different from any other citizen of Germany. At the time of committing the crime, they knew, what they were doing was wrong. How those people, who were decent in the normal course of their disposition, sealed the emotional chamber of their hearts and indulged in unimaginable savagery? The German citizens who were in charge of the death camps were commonplace normal citizens. Stanley Milgram (1983) writes “Behind that is unthinkable in an individual who is acting on his own may be executed without hesitation when carried out under orders” (p. xi).What is the genesis or root cause of their unethical behavior towards a particular community? The physical condition apart, an individual remains generally mentally weak and submissive when one is afflicted with health-related problems. The moral question in health issues was examined by Stanley Milgram, the psychologist, who developed the Milgram experiment related to induced electric shocks given by the learners to a group of people under the command of the experimenter. This experiment validated the conclusion that when people are ordered to do something by the people in authority, most of the people will obey, fall in line, and execute the orders even though the act is against their conscience. Milgram experiment was repeated a number of times and the results were the same. People were willing to mortgage their conscience and will carry out orders, howsoever mean they were. To such people obedience is a virtue and killing the conscience is not. It is satisfying to note that Milgram has been contradicted. The time element is also the factor. 2014 is not 1933(the year in which Adolph Hitler took the reins of power in Germany). A strong reason which killed the conscience of the average German and turned them against the Jews was the relentless propaganda unleashed by the top hierarchy of Nazis that all Jews were evil incarnations. A thick coat of negative thinking engulfed the conscience of Germans and they were unable to transcend it when needed. In the subsequent experiment, the fact came to light that people were willing to act as per the dictates of their conscience and disobey the ill-founded orders. In health care, the role of conscience is highly important. An individual in the healthcare system at any level does not deserve to be there, if one does not follow the ethical norms in dealing with the patients under care. The best type of moral education needs to be given to the medical fraternity at all levels as conscience is an important issue in this science. Harmonious blending of medical science and metaphysical principles is necessary in healthcare environment. Conscience must represent the decision-making capacity of humankind to preserve integrity and ethical wholeness. 2. What is the role of authority in health care ethics? Each discipline has distinct parameters of ethics. In healthcare system it is linked to individual liberty. Any medical system consists of different levels of forums and authority. Medical technologies, modes of treatment have ethical implications in administering health care. Most of the hospitals have an established mechanism to decide the ethical issues. At the terminating point of law ethics enters. The moral conscience is predecessor to the development of legal rules for social order. Community is the ethical guardian of the individual and the relationship between the patient and the treatment provider is no less than that of a guardian. The medical practitioner is the protector of physical and psychological health of the individual placed under care. In health care system certain actions are spontaneous, they need to be taken on the spot without delay, and some actions are taken on command by the higher authority. Stanley Milgram (1983) argues “For an act carried out under command is, psychologically, of a profoundly different character than action that is spontaneous” (p. xi). The operating level and necessity of the present-day health care system is much complicated and right along with ethics, lawyers and risk managers (who is generally an attorney) find place. The presence of ethical issues goes in tandem with legal and risk management in the health care system. There are different levels of authorities and at each level the pressure of ethical decisions varies with the level of authority they are allowed to exercise. For example, the authority of the attending doctor is generally more than the authority of the nurse in charge of the patient. There is no fixed ethical solution to an ethical dilemma and it is situational and varies from patient to patient. In all cases, notwithstanding the long experience, it is better for a nurse to respect the authority and carry out the duties as per the instructions. It may so happen that the decision of the nurse is ethically right but legally wrong. In addition to protecting the interests of the patient, the concerned medical staff has to protect one’s own interest also. In such circumstances respecting the instructions of the higher authorities is the best choice of professional ethics. Stanley Milgram (1983) argues “The essence of obedience consists in the fact that a person comes to view himself as the instrument for carrying out another person’s wishes, and he therefore no longer regards himself as responsible for his actions” (p. xii).The important issues like empirical knowledge and personal beliefs will have to be kept aside and the ethical choice of the higher authorities need to be followed. But there are certain fundamental principles, for which even the authority will have to be questioned. For example, in cases of choice of telling truth versus deception, it is better to stand by truth by keeping the long-term perspective in view. Stanley Milgram (1983) writes “But humanists argue for the primacy of individual conscience….insisting that the moral judgments of the individual must override authority when the two are in conflict” (p.2). In fine, the role of authority in health care ethics is a delicate issue and no cut and dry formula can be applied. The problem in dealing with the authority when the doctor, nurse and the patient have ethical conflicts becomes problematic. For example, how a nurse will view the case of a patient who wants to have an abortion, when according to her personal beliefs the person considers it as the murder and the doctor remains neutral or considers it from the profit angle, assuming that one has been offered a hefty sum for treating the patient? There is no final definition of authority in health care ethics, as we are dealing with human beings, whose inner world is known to the concerned person only and it is difficult to take decisions based on feelings. 3. Discuss human freedom in relation to this book. As we go through the contents of the first chapter of the book, the reader realizes how human freedom faced the gravest challenge in known history of humankind. Referring to the holocaust, Stanley Milgram (1983) writes “These inhumane policies may have originated in the mind of a single person, but they could only have been carried out on a massive scale if a very large number of people obeyed orders” (p.1). Obedience! Sometimes what sins are committed in the name of obedience! One individual decided to terminate the freedom of millions of persons belonging to a particular community, and the freedom of that community was in peril. The men, when interviewed later, could not explain or give valid reasons for their heinous conduct. They had no ground and found it difficult to believe that their fall could be to that extent. The grave incidents are comparable to the road-rage, devoid of all reasoning. Stanley Milgram (1983) writes “Ordinary people, simply doing their jobs, and without any particular hostility on their part, can become agents of a terrible destructive process” (p.6). Their behavior defied scientific explanation and the momentary madness had its way. Why ordinary men became cold-blooded killers? They were not thoroughly convinced about the tasks allotted to them, nor were they happy about their responsibilities. When the operation was over and when the men returned to the barracks, they were thoroughly shaken. The massacre brought to the surface the deep signs of unpleasantness about the tasks they performed under duress and compulsion. When the killings became routine, the Nazis turned desensitized and many of them accepted killings as part of their duty. The unwillingness was a temporary phase. Many new methods were introduced to the annihilation program and peculiar procedures developed. Each Commander designed the best method suited to the situation, but as for the policy instructions that originated from the highest level no ambiguity was seen. Hitler was clear about his objectives. Wipe out Jews, wherever an opportunity happened amidst the war-scenes. The soldiers had no option but to comply with the orders of their unit commander and when the orders were stern and clear, no scope existed for personal choices. The soldier was worried about the consequences of disobedience of orders from higher authorities that it may result in punishment for his family members. Reference Milgram, Stanley (1983).Obedience to Authority: The Experiment that Challenged Human Nature. New York: Harper Perennial, 1983. Read More