Patients in Making End-of-Life Decisions - Assignment Example

How Utilitarianism, Virtue Ethics, and Deontology View the Right of and Limits to Patients in Making End-of-Life Decisions name and number Instructor’s name September 16, 2014 End-of-life decisions are loaded with ethical dilemmas because they ask questions about the right of people in choosing to die and to having legal access to different ways of dying, including euthanasia in its various forms. Euthanasia explores implications about the sanctity of human life and the autonomy of patients. This paper asks: Do patients have the right to make end-of-life decisions all the time, or are there only circumstances that morally warrant these decisions? (This inquiry is hereinafter called as “the/this question”). Three ethical theories view and answer this question differently: Rule utilitarianism, virtue ethics, and deontology (specifically Kantian ethics). Among these three ethical theories, deontology provides the best response because it treats patients as autonomous ends who have the right to make end-of-life decisions, but it avoids the slippery slope of justifying suicide and considers rules that should guide moral end-of-life decisions. Rule utilitarianism argues that people have a right to end-of-life decisions if it offers the greatest net good for the majority. Rule utilitarianism evaluates end-of-life decisions through assessing the kinds of acts involved and the emphasis on the act that results to the greatest good for the greatest number of people (Mosser, 2013, p. 6.1). First, it considers that being able to decide one’s death is good if it saves resources because the health care system is already burdened with high costs due to limited medical and human resources (ForaTv, 2010). Second, rule utilitarianism adds the happiness of the patient to the total net good of the majority if he/she volunteers to end his/her life with respect to insufficient health care resources for the public. His/her happiness becomes part of the total happiness of more people. Rule utilitarianism values the net good and happiness that end-of-life decisions can provide to society. The strengths of rule utilitarianism in answering the question are that it considers the effect of end-of-life options to the good of the majority, which is essential in a society with limited and expensive health care resources, and that it does not treat these options as taboo because they can also contribute to net good and happiness. First, rule utilitarianism gives importance to the reality of limited and costly health care resources. It allows stakeholders to find public benefits in sacrificing human life. Second, it removes negative conceptions that see euthanasia as immoral because, if it can produce more good and happiness to more people, including patients per se, then it is a good act too (Singer, 2003, p. 532). Rule utilitarianism underscores important social conditions and redefinitions in answering the question. The weaknesses of rule utilitarianism in responding to the question are: it can lead to disadvantaging minorities, and it can result to the possibility of miscalculating the consequences of these choices. First, it can disenfranchise the minority. Ken Connor, Chairman of The Center for a Just Society, is concerned that minority groups will be the only ones sacrificed the most because of the view that they are second-class citizens (ForaTv, 2010). Rule utilitarianism can enforce the tyranny of the majority by placing importance on their utility over the minority’s (Mosser, 2013, p. 6.1). Second, rule utilitarianism does not consider the problems of poor assessment of consequences. A good example would be a man who decided for assisted euthanasia, when, if he waited for only a year, he would have accessed treatment that later on would have allowed him to create a cure for another illness that could have saved thousands. This example shows that people cannot predict everything, so majority-based decisions might not always be good for more people in the long-term. Rule utilitarianism can possibly lead to discrimination and poor assessment of the consequences of end-of-life decisions. Aside from rule utilitarianism, virtue ethics is another ethical theory that answers the question by emphasizing the importance of courage in making end-of-life decisions and the reasonableness of defying traditional duties in the face of complex challenges, thereby asserting that people have a right to make end-of-life situations in any circumstance. Aristotle (n.d.) described courage as a virtue because it is an exercise in deliberate choice using reason and practical wisdom (as cited in Mosser, 2013, p. 6.2). Patients who decide to die are being courageous when they know that they have made an autonomous, reasonable choice. In addition, virtue ethics believes that people should have the right to make end-of-life decisions whatever their circumstances because they would not do so unless it is not important to their particular complex conditions. It believes that courageous and reasonable people make these decisions that are appropriate to what they are experiencing even when they defy traditional beliefs about life and death (Mosser, 2013, p. 6.1). Virtuous people can make virtuous decisions so they have a right to end-of-life decisions. The strengths of virtue ethics are its ability to empower people in making virtuous decisions regarding their deaths and its emphasis on virtues that are relevant to euthanasia. First, it does not treat people as unable to make important decisions about their deaths if they have virtues that guide them. In the video clip, “Right To Die, Assisted Suicide, Euthanasia Part 1-5,” a woman decides to die with her husband through assisted suicide, even when she is healthy, because she believes that people have a right to death in any situation (relievesuffering, 2012). Virtue ethics sees her as being courageous in making decisions concerning her autonomy. Second, this ethical theory underlines virtues that are relevant to euthanasia, specifically courage and temperance. People who make decisions about their deaths have courage because they know it is not an easy decision, but it must be done, and they also have temperance because they have self-control in deciding the best path for their end-of-life stages (Mosser, 2013, p. 6.1). Virtue ethics removes the taboo on end-of-life decisions and options because they can be virtuous too. Virtue ethics, however, has weaknesses of encouraging suicide that is not virtuous when people are mentally or emotionally ill, and it does not consider differences in conceptions of virtues. First, courage might not be virtuous for instances wherein people have mental or emotional illness. They might think that they are reasonable enough to make these decisions when they may not be in the right frame of mind. The result is a high rate of suicide among these groups. Second, virtue ethics disregards differences in definitions and measurements of virtues. A doctor who thinks that certain people should go through euthanasia more than others indicates differences in virtues. Virtue ethics has limitations in considering different definitions and applications of virtues. The final ethical theory is deontology and it answers the question by asserting that people only have a right to make end-of-life decisions when they are dying and have no cure for illnesses that result to unbearable pain. Deontology explores the universality of euthanasia under certain conditions (Kant, 1786 as cited in Mosser, 2013, p. 6.1). When a patient is extremely sick and in constant pain, living becomes a form of torture that no human being should have to go through, especially when cure is not yet existent. Rachels (1975) argued that prolonging life itself may be more harmful than letting a dying patient to die because the latter may be expanding the patient’s suffering only (as cited in Mosser, 2013, p. 6.7). Active euthanasia is a humane option for those who want to end their lives, and in certain conditions, it is a moral decision that can be universalized. Deontology provides the opportunity for euthanasia to be a categorical maxim that should be available to the dying who are needlessly suffering. The strengths of deontology are that it sets limits to the universality of end-of-life acts by determining the only possible circumstances that will not oppose the role and oath of medical professionals in saving lives, and that it treats people as ends, not means, which utilitarianism does to the latter. Deontology only approves of euthanasia as an end-of-life decision in certain circumstances that will not necessarily negate the Hippocratic Oath. It is about giving options of dying with dignity for people who are suffering and have no cure for their illnesses (West Virginia Public Broadcasting, 2010). It ensures that dying is not the same as forcing doctors to kill them because of special conditions that morally warrant these decisions. Furthermore, deontology respects patient autonomy, underscoring that people are ends, not as means to greater public good alone, in comparison to utilitarianism (Mosser, 2013, p. 6.1). Patient autonomy encompasses the human right to choose one’s death during dire conditions. The weaknesses of deontology are that it does not consider complex ethical scenarios, and that it can result to unethical outcomes. Deontology might not include other factors that can impact the duties of stakeholders in making end-of-life decisions (Mosser, 2013, p. 6.1). An example is that some conditions might be too difficult to assess to ensure that doctors are doing their duties of explaining the pros and cons of euthanasia. Furthermore, deontology does not consider the possibility of unethical outcomes. An example is that a person might want to die and deliberately does things to die faster, but he only does this because his family will get insurance money if he dies unexpectedly. He might be dying but he treated himself as means to his family’s ends. Deontology has limits in assessing the ethical quality of decision factors and outcomes. Deontology provides the best response because it treats patients as autonomous ends who have the right to make end-of-life decisions, but it avoids the slippery slope of justifying suicide and considers the rules that should guide moral end-of-life decisions to avoid conflict with health care duties. First, it is dissimilar from utilitarianism that treats people as means to the ends of higher net good for the most people. Instead, deontology gives autonomy to patients because they are ends as autonomous human beings (Mosser, 2013, p. 6.1). It asserts that people have the right to make end-of-life decisions, not because it is good for the majority, but because they know that it is good for them to die a good death (Mosser, 2013, p. 6.1). Second, this ethical theory avoids the slippery slope of justifying euthanasia that virtue ethics can lead to through offering limits to the right to euthanasia. It specifies that euthanasia is only moral if patients are dying, in severe pain, and incurable. These rules avoid promoting suicide that some people might consider even when they are healthy. Deontology guides people in making the right end-of-life decisions, which is not euthanasia all the time. These rules, moreover, do not violate health care professionals’ duties to saving life by limiting conditions that warrant it. Instead, deontology asks doctors to respect the wishes of the dying. It wants them to explore the rights of patients to end-of-life options when their patients are suffering, dying, and have no treatment in the near future. In other words, deontology decreases the risks of promoting suicide without removing the right of patients in making autonomous end-of-life decisions under particular conditions and without fully undermining the Hippocratic Oath. Virtue ethics, rule utilitarianism, and deontology see and answer the question through their own ethical principles that assess the rightness and wrongness of decisions. Virtue ethics asserts that patients have rights to end-of-life decisions if it is the courageous thing to do and if it is done with temperance; rule utilitarianism states that it is right if it gives the most happiness and utility to the majority; while deontology categorizes this right for certain conditions only. Among the three, deontology works best because it values human beings as ends and it avoids justifying suicide by limiting applicable conditions to euthanasia. It also offers rules with these limitations on patient conditions to avoid undermining the duty of health care professionals in saving lives. Deontology is the best ethical theory because it promotes the universality of the autonomous right to end-of-life decisions without promoting needless death, only death under needless and endless suffering. References Aristotle. (no date). Nicomachean ethics. In Mosser, K. (Ed.) (2013), Understanding philosophy (p. 6.2). San Diego, CA: Bridgepoint Education, Inc. ForaTv. (2010, April 14). End-of-life care: Weighing ethics and rationing resources [Video file]. Retrieved from http://www.youtube.com/watch?v=RiTp1w48P3E Kant, I. (1785). Fundamental principles of the metaphysics of morals. In Mosser, K. (Ed.) (2013), Understanding philosophy (p. 6.1). San Diego, CA: Bridgepoint Education, Inc. Mosser, K. (2013). Understanding philosophy. San Diego, CA: Bridgepoint Education, Inc. Rachels, J. (1975). Active and passive euthanasia. The New England Journal of Medicine, 292, pp. 78–80. In Mosser, K. (Ed.) (2013), Understanding philosophy (p. 6.7). San Diego, CA: Bridgepoint Education, Inc. relievesuffering. (2012, Feb. 8). Right to die, assisted suicide, euthanasia part 1-5 [Video file]. Retrieved from http://www.youtube.com/watch?v=UTLN6ea_SR0 Singer, P. (2003). Voluntary euthanasia: A utilitarian perspective. Bioethics, 17(5/6), 526-541. Retrieved from the EBSCOhost database. West Virginia Public Broadcasting. (2010, Dec. 28). The last chapter – end of life decisions [Video file]. Retrieved from http://www.youtube.com/watch?v=8jKUZ8lS9b4 Read More