Ethic
Hawa Wolopa
Final Paper
5/1/21
Introduction
Over the years, the healthcare bills have been so complex. Patient rights for self-determination and advocacy have weighed with contradicting views. Several questions arise when a patient is either incompetent, a minor, or generally in a state that they cannot decide on their health and the medical procedures performed on them. On the other hand, those who can make decisions may choose to settle well with physicians and families. Decisions such as euthanasia, desire to be allowed to die by starvation, withdrawing care to patients in coma, terminating a pregnancy, and so many other related issues have always remained to be complex. When such problems arise, the morality of the decision is always in question. We live in a dynamic society, and people have different views on such matters. In most instances, such matters have resulted in legal matters that end up in court. Even when the court decisions are made, there always remain questions about whether the decisions made are correct. Such matters can be supported or objected to based on various ethical theories and bioethical principles.
Autonomy
Autonomy is a principle of bioethics that refers to "the right to make decisions about one's own life and body without coercion by others" (Pence, 2017, p.16). This principle allows people to make decisions about a range of issues that affect their lives directly. Some of these decisions may include those that affect their health. In medicine, people make a tone of decisions about some medical choices, practices, and procedures. The principle provides competent patients the right to choose and make decisions about their health. This principle also encourages people to write wills and directives while they are qualified. This principle of autonomy comes up so often in medicine, especially when a significant procedure or decision about to end life comes to question. The question, therefore, remains whether the patient's decision is best or whether it settles well with family members. The patient's bill of rights advocate for the principle autonomy and in a much broader way discourages people other from influencing a patient decision. A patient can refuse care, and that has respect according to this principle.
Nonmaleficence
Nonmaleficence is also one principle of bioethics used mainly in medical ethics, "First, not harm" to mean 'not harming others.'This ethical theory is direct to physicians and other medical workers who shouldn't do something that can potentially harm a patient if not competent. This principle mainly affects the physicians and families. Any medical decisions made should be in the interest of the patient and not the family or physicians. Sometimes physicians may wish to do research, but they cannot use a patient without consent to use them as 'mere pigs' to do a study. Any healthcare worker is expected to carry him or herself with higher standards. You could advocate for a resident, but you would not do something that can compromise their health. This principle becomes challenging when a patient decides to hurt them, but the physician or any other healthcare worker has to implement it.
Beneficence
Beneficence is another principle of bioethics that would mean "do good." In medical ethics, "it grounds the moral difference between therapeutic and nontherapeutic experiments” (Pence, 2017, p.16). Whatever procedures and experiments are done, it should be done to benefit the patient and not just purposely for a study. The bill of rights for patients specifies the limits to which caregivers can reach. It is good to advocate for the patient, but it has to be for their benefit. In all the care given, patients should be assured that they will receive the best care.
Act Utilitarianism Theory
This theory dramatically supports the bioethical principle of autonomy. Patients should be allowed to exercise their rights and do what benefits them most. According to this theory, one would argue that "actions are good in proportion to which are intended to promote happiness and bad as they tend to produce unhappiness." (McGraw-Hill, p. 54). Whatever a patient chooses is what pleases them most, and that ought to be respected. When a patient is suffering and wants to end their life, it can be stressful for families.
On the other hand, a family may wish their loved one who is suffering to die. It is done by euthanasia or withdrawal of care, such as ventilators, supplemental oxygen, and tube feeding. Regarding this theory of Utilitarianism, one would argue that "the duration of each harm and benefit must be considered. A minor pain that lasts for years is more of a harm than a serious pain that is over in a second" (McGraw Hill, 2010, p.46). Therefore, allowing someone to die can be painful but short-lived. However, seeing someone suffering, such as in a coma, can be traumatizing for a long time.
Kantian Ethical Theory
When considering the example of Elizabeth Bouvia, she wanted to exercise the principle of autonomy. Still, physicians may have been confused with the other two principles of beneficence- 'to do good' and nonmaleficence, 'to not harm.' In regards to autonomy, the California Court of Appeal Judge ruled in her favor stating, "if the right for self-determination is as to his medical treatment is to have any meaning at all, it must be paramount to the interests of the patient's hospital and doctors. The right of a competent adult patient to refuse medical treatment is a constitutionally guaranteed right which cannot be abridged" (Pence, 2017, p. 23). In other words, the patient has the absolute right to make medical and life decisions and should not be coerced by doctors or family members like in the case of Bouvia. Also, when considering the principles of beneficence and nonmaleficence. The Kantian ethical theory discourages people from treating others as means to accomplish their ends. Physicians cannot use patients for study without their consent. The Kantian ethical theory argues that "Act regarding all persons in ways that treat them as ends in themselves and never simply as means to accomplish the ends of others" (McGraw Hill, 2010, p.95). Patients’ rights and desires should be honored and respected.
Conclusion
Patients have a right to self-determination and can invoke the principle of autonomy. As a healthcare worker, I always try to advocate and act in the patient's best interest. They are honoring their independence and working regarding beneficence and nonmaleficence. This principle will be the driving force. When it involves a family deciding on their patient's care, teaching is essential to the patient and the family in making decisions. Still, at all times, for a competent patient, their interests and desires should be respected.
References:
Introduction to Ethical Theory [McGraw Hill, 2010] Online
Pence, G. E (2010). Medical ethics: Accounts of ground-breaking cases. New York: NY McGraw-Hill.