Applying Law and Ethics to Practice - Essay Example

Applying Law and Ethics to Practice Introduction The right to life and the right to take away that life are issues that many people disagree on. It is in the context of life and what life means that medical practitioners find themselves torn between giving the best care to their patients while at the same time allowing the patients to have a say in how that care affects their lives and even when it should end. Doctors are increasingly getting torn between patient desires, the demands of society and the demands of their profession. A doctor’s responsibility lies with the patient. The place of the society and community comes second and in light of the patients needs. The idea of death coming from medical practitioners seems for many to be in conflict with idea that doctors are meant to uphold and protect life at all costs. With many advances in medical areas, it is becoming possible to prolong life. Many medical conditions that were life threatening or fatal are no longer death sentences and are becoming increasingly manageable. But the question still remains as to the quality of life of the patient when they receive these extensions. For those who advocate for the right to end life in medical conditions that do not have a cure and the patients are in great sufferings, the best option is the end of the life on the patient’s terms. Many do not see the situation as an ending of life but rather, ending of a dying process that has already began (Vaknin 2009). The quality of life has to warrant living for the patient to find meaning in the sustained life. When the life a patient is living is not found to be of value to the patient they should be accorded the right to end it. On the other hand, there are those who oppose the right to end life. For them life should be protected at all times to its natural end. In patient care, doctors were barred from intentionally killing their patients from the beginning of medical profession (Vaknin 2009). This was deemed ethical enough even at a time when society did not have the benefits of palliate care. It should follow then that the modern society should not justify assisted death on grounds of ethics and better patient care. In Australia study of public attitudes about assisted right to end life show rising support for doctor assisted suicide and euthanasia. In 1962, a study by Van der Maas et al. found 47% of Australians thought a doctor should assist end the life of a patient with no hope for recovery and in pain with a lethal dose. The same response was given by 76% in 1996 (Medical Journal of Australia 1996). The principle of Nonmalicence In an examination of Mr. James B case, there is clear indication that his desire is to end his life. His case would be passive euthanasia. Doctors are governed by the Hippocratic Oath they take. The oath extols the doctors to conduct themselves in a manner that shall bring no harm to their patients but rather aimed to bring about their cure. It is believed that from the Hippocratic Oath comes the principle of nonmalicence (Moffitti 1996). Nonmalicence refers to the One of the ethical principles in this case is nonmaleficence which refers to doctors’ duty and responsibility to cause no harm to their patients. (Kerridge and Stewart 2009) This principle would therefore be deemed in conflict with Mr. James request. What Mr. James is requesting would be considered passive euthanasia. This is the where the doctor would allow him to die without trying extraordinary means to sustain his life. This way of ending life permits the patient to die naturally (Filippo 1992). A doctors’ duty is to assist patients get well and support them in treatment. The nonmalicence principle places demands on the doctor to sustain Mr. James life not to end it. The principle of nonmaleficence guides the rules that prohibit activities that are harmful to the patient (Kerridge and Stewart 2009). While nonmalicence would seem to be in conflict with Mr. James request, ethicists propose four conditions that if fulfilled would render the act of euthanasia moral (Filippo 1992). To begin with the doctor’s act would have to be morally neutral or good. Removing the FED tubes is not morally wrong. To begin with, contrary to euthanasia causing him harm, it is his sustained life that is causing Mr. James harm. Euthanasia would therefore bring an end to the sufferings that are causing him harm. Removing what is causing a patient harm would thus be moral. The first condition being that the act of the doctor would have to be morally neutral or good (Filippo 1992). Since the FED tubes are voluntary, the doctor would not be denying Mr. James mandatory care. The second condition would be that the doctor must aim for the good and must not intend a morally wrong result (Filippo 1992). Thus the doctor must not engage in the act with the sole aim of causing harm. In instances where the patient is conscious, other means must be used so that the euthanasia does not cause further harm to Mr. James. The good act must also be gained directly and not as a result of a negative act (Filippo 1992). Thus allowing Mr. James to die should not be an act of neglect. And lastly the good gained should bear more good for the patient than bad (Filippo 1992). In Mr. James case, it is already what he desires and what he considers his greater good. Thus assisting his death would satisfy the four conditions. The principle of Beneficence The principle of beneficence is closely related to the principle of nonmalicence in that as a doctor is extolled to do no harm to patients, this principle asks that the doctor go further ahead and seek to do good to the patient. A doctor is therefore expected to be of benefit to the patient (Huber 2006). In the case of Mr. James, the doctor ought to do that which will be beneficial to the patient. The principle of Autonomy Doctors have a duty to protect the autonomy of their patients which is deemed a basic ethical aspect. Autonomy grants the patient a right to make decisions concerning their own care (Huber 2006). The patient retains a right to have their decisions in regard to their care respected by doctors and family. If they do not desire certain activities to be conducted towards their care that too has to be respected. To make an informed decision, they have a right to appropriate medical advice on their medical conditions, possible treatment that can be pursued and prognosis (Moffitti 1996) . In Mr. James case, it is clear that he does not desire to continue his life. As a mentally competent adult, he has the right to exercise his desires and to have his wishes respected. Even though he has the support of his family, the decision lies exclusively in his hands. Only he can charter the way forward. The doctor can advice him and his family can certainly request him to change his mind, but in the end, what matters is Mr. James decision and that is what all parties have to respect. The principle of Justice The principle of justice provides that patients should be accorded necessary means to further their treatment while at the same time. However patients can compare the expense of continued care against the benefits of that care. In view of this principle of justice patients are allowed to avoid lengthy and expensive care when death is inevitable. Even when the cost is not a determinative issue and therefore patients can afford the care, the ultimate benefits of the care can be minimal. The law and assisted death There is no international law that approves euthanasia. Every country has its own legislature on issues of euthanasia and assisted death. It is a complicated issue and often the law is not explicit on the issues. While some countries do not approve euthanasia, there are some levels of assistance that can be given to patients who wish to die. Passive euthanasia for example is legal in some countries. In Australia, in the northern territory, euthanasia was legal from 1995 until 1997 before the central parliament overturned the law (Medical Journal of Australia 1996). In some countries the law seeks to protect its citizens from manipulations by imposing penalties on those who assist in death. However, it is increasingly becoming clear that patients have rights and the law should be adequately interpreted and formulated to accommodate them. Advocates for assisted death insist that the law is a servant and should not be so rigid that it cannot serve the needs of its subjects. Sanctity of life While Mr. James request can be granted based on their fulfillment of the principles of ethics, it does not represent the whole picture. There are other issues that his request can be examined in light of. For instance, faith plays a role in determining what a person should do or not do. While religion and faith remain a personal issue for many, societal ethics have often sprung from the dictates of religion. Religion and ethics uphold the sanctity of life. For those who are pro-life, the sanctity of life remains paramount and is deemed holds value despite condition of patients. In light of this, euthanasia becomes a violation of the sanctity of life through deliberate killing of the patient. Value of life and therefore the fundamental duty to protect it does not lie in its significance but rather from simply being. Life can not be discarded because of its inherent value not just to the patient but to society as a whole. Society has a duty to care for life in every stage until natural death. Although for Mr. James his life may seem meaningless in the face of continuous suffering, his life is still valuable to himself and to his family. Challenges to living life as we desire does not mean a reduction in its value. To make life bearable palliative treatment should be practiced in cases of severe suffering and pain. Given the advances in and extension of palliative treatment today, opening the door to euthanasia will deny palliative treatment a chance to play its role and death will be easy way out. Dignity in dying As much as life the sanctity of life can not be denied, life always comes to an end. In some cases, death is eminent, and it is only a matter of time. For those faced with certainty of death, the only choice is to die in a dignified manner. For patients and their families, there is no need to use means to prolong life that deteriorates and reduces the dignity of the patient (Reiser S.J; Dyck A.J; Curran W.J, 1977). A patient does not have to go down the long torturous road to arrive at death. There should be a place to give up the fight. Patients desire to have a say when it is enough and enjoy some quality time with their families and friends before succumbing to death. Conclusion The realms of ethics and law concerning patient care will continue to experience different interpretations with time. As more technological advances are made, the more there will be possibilities of prolonging life. But the quality of the life for the patients may not necessarily improve and they remain the best judges of the benefits of such a life as the primary beneficiaries. Within the limits of ethics, it is possible for Mr. James assisted to end his life for his greater good. The principles of ethics provide for that. However, that is not the only alternative. Mr. James can continue to be assisted to find fulfillment in his life which still holds much value for society as seen by the support shown by his family. References Fillipo, David. 1992. Euthanasia and the Principle of nonmaleficence. Retrieved on 15th May 2010, from http://www.lutz-sanfilippo.com/library/counseling/lsfnonmaleficence.html Huber, Diane L. 2006. Leadership and Nursing Care Management. Philadephia: Elsevier. Humphrey, Derek. 2002. The practicalities of self-Deliverance And Assisted Suicide for the Dying. 3rd ed. Brooklyn: Delta Publishing Group. Lowe, Kerridge, M, & Stewart, C. 2009. Ethics and Law for the Health Professions, 3rd Ed. Sydney: Federation Press. Medical Journal of Australia.1996. The Euthanasia Debate. Retrieved on 16th May 2010, from http://www.mja.com.au/public/issues/nov18/hassan/hassan.html Moffitt. 1996. Ethical Issues in End-of-Life Care. Retrieved on 15th May 2010, from http://www.moffitt.org/moffittapps/ccj/v6n2/article4.htm Reiser SJ, Dyck AJ, Curran WJ, eds. Ethics in Medicine: Historical Perspectives and Contemporary Concerns. Cambridge: MIT Press; 1977:6-7. Vankin, Sam. 2009. Euthanasia and the Right to Die. Retrieved on 16th May 2010, from http://samvak.tripod.com/euthanasia.html Read More