Ethical Dilemma and Life Issues

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Right to Die

The right to die is a pressing issue because of its controversial nature, even though it has been legalized in some states. Under certain circumstances, patients generally have the right to reject medical treatment or appropriate pain management, even if their choice would hasten their deaths. According to Kinzbrunner and Policzer (2011), on many occasions, the courts have been called upon to solve cases pertaining to the right to die. In Satz v. Perlmutter, it was ruled by the Florida District of Appeals that competent patients had the right to accept or refuse medical treatment. In a different case, Elizabeth Bourvia, a cerebral palsy patient, attempted to starve herself to death by requesting the doctors to remove her nasogastric feeding tube, but her request was declined by the hospital. When the matter was taken to the California Court of Appeals, the judge ordered for the removal of the tube stating that Bourvia had the right to ask for the assistance to end her life.

The courts have also been supportive to involuntary euthanasia but insist on the need for a more stringent standard of evidence before such procedures are approved. Other issues that are also considered include the patient’s self-determination, the right to privacy, the interest of the state, interest of the third party, and the ethical image of the doctors (Kinzbrunner & Policzer, 2011). However, futility issues or quality of life issues have not been clearly dealt with by the Supreme Court of the United States. It appears to condone passive or active euthanasia in situations where there is convincing evidence that there was informed consent to euthanasia.

The Obligation of Health Care Professionals

The Hippocratic Oath requires healthcare professionals to act in a way that benefits the sick and protect them from harm. It is their responsibility to make sure that patients get what is best for their lives irrespective of the consequences (Woods, 2007). This view is seconded by the Code of Ethics for pharmacists that give health care professionals the responsibility to promote the good life of every patient in a compassionate, caring and confidential manner. Similarly, doctors are also required to get informed consent of the patient or interested third party before making decisions on the right to die. However, the federal law permits physicians to bypass informed consent in situations where informing the patient would render him unable to make a rational decision. This presents healthcare professionals with a dilemma: should they take care of the interest of the patients or consider the wishes of the family members and other interested third party?

Such controversies make health care practitioners experience moral distress. For instance, if a patient rejects medical treatment, the nurse will have to obey the patient’s wishes. However, at the back of his mind he knows that it is wrong to lose life so easily. Similarly, health care professionals suffer from moral distress when they understand that the medication they provide to the patient would only raise false hopes but the patient will eventually die (Woods, 2007). In situations where the patient is totally unconscious and the third party insists that the patient has to continue with medication, medical practitioners are expected to continue with treatment even when they are sure that the patient will eventually die.

Rights and Obligations of Family Members to Relative’s Right to Die

Health care professionals should obtain consent from immediate family members or third parties with significant interest to the outcome of the patient if he is incompetent of making reasonable decisions about his life. The courts generally allow for the withdrawal of treatment from terminally ill patients at the request of close family members or for the best interest of the patients. According to Lo (2009), the court’s decision to withhold medical treatment is based on the individual’s right to privacy as provided in the Constitution. This is seconded by the law on the right to self-determination, and the concept of autonomy. Every person is also entitled to individual liberty as guaranteed in the Constitution. The right to privacy also protects the patients to choose whether or not he wants to die.

Caring versus Curing

Callahan (2006) asserts that quite often doctors are only concerned with curing patients. However, there is a need to care for patients before administering cure. The Hippocratic Oath emphasizes the need for healthcare professionals to protect patients from harm. It is, therefore, necessary that when a patient is in pain, the doctors should attend to him quickly and in a humanly manner to ease the pain and later proceed to treatment. For instance, in an emergency case, where the patient suffers from atrocious pain, health professionals should not keep the patient waiting by taking him through the first-come-first serve routine.  They should instead attend to him immediately. Similarly, if a terminally ill patient is in atrocious pain and he does not have the money needed for medication, he should be first treated and the financial issues dealt with later.

Ethical Principles and the Right to Die

Healthcare professionals have an ethical obligation to take care of the patients. Young, Koopsen and Farb (2005) affirm that they are guided by ethical principles and moral rules. In situations of ethical dilemma, healthcare professionals should first consider the application of moral rules. If not, they should consider the third step which comprises ethical principles. These include;

Autonomy

This principle states that an individual’s liberty of action, choice and thought should not be interfered with. A patient, therefore, has the liberty to follow his will in relation to medical treatment. They can decide what will happen to their own bodies in terms of what to take or not to take (Young, Koopsen & Farb, 2005). For instance, a patient can decide whether or not to comply with prescribed medication. Autonomy, therefore, gives the patients the right to die.

Informed Consent

This principle directs that all patients must be informed of the risks and benefits of medication. There are five elements of informed consent, such as: disclosure, competence, voluntariness, understanding, and consent (Young, Koopsen & Farb, 2005). Disclosure requires that a patient should be provided with all the pertinent information needed to make an informed decision; competence requires that an individual has the ability to make informed decisions for himself; voluntariness requires that a person makes decisions without any coercion; understanding requires that a patient understands whatever he is consenting to, including risks and benefits. This principle, therefore, requires medical practitioners to respect the decision of the patients or close family members. In case a patient decides to continue with medication, the doctors should respect the decision even when they know that he will eventually die. However, this contradicts the Hippocratic Oath which requires doctors to act in the benefit of the patients.

Confidentiality

Healthcare professionals are required to keep the patient’s information private, unless permitted to do so. The applicability of this principle might cause moral distress to healthcare professionals. For instance, if a patient rejects medical treatment and asks the doctor not to tell his family, the professionals might find themselves in a dilemma. In some instances, healthcare professionals might be ethically justified to violate this principle, if the patient lacks autonomy or if keeping private information might harm others (Young, Koopsen & Farb, 2005). It is, therefore, upon the health care professionals to understand to obey or violate the principle of confidentially.

Beneficence/ Nonmaleficence

 These two principles are complementary: beneficence indicates that will do what is good to others, while nonmaleficence refers to the act of taking due care or avoiding harm. Health care professionals are, therefore, required to act in the benefit of the patients by avoiding any harm (Young, Koopsen & Farb, 2005). However, this in a way prohibits the right to die because ideally if a doctor feels that withdrawal of treatment would harm the patient or cause death, the principle requires that he should not do it. This would cause harm to the patient and, therefore, contradict the two principles. Such situations further contribute to moral distress.

Fidelity

This principle requires that the actions of healthcare professional demonstrate loyalty to patients. It, therefore, gives the professionals the burden to act in the patient’s best interest. The obligations of fidelity might be covenantal or contractual (Young, Koopsen & Farb, 2005). Patients, therefore, expect to be handled in the right manner by health care professionals. Since doctors are in the best position to understand the health situation of a patient and his chances of survival, they should be capable of deciding whether to agree to the patient’s right to die. However, it is argued that this would contribute to abuse of human life by causing unnecessary deaths.

Distributive Justice

 Distributive Justice refers to equal distribution of the society’s burdens or benefits among all of its members. All citizens, therefore, have a right to equal healthcare. Unfortunately, issues, such as the social economic status of the patients, determine the kind of heathcare they receive. Sometimes, patients who pay for their treatment in cash get better quality healthcare than medicaid patients. On most occasions, health care is provided depending on the personal reward the health professionals are likely to reap (Young, Koopsen & Farb, 2005). Justice demands that healthcare professionals should focus on the medical needs of the patients rather than the financial status. However, this is not always the case. For instance, when the cost of treatment is so expensive, some patients reject treatment so that they could die and save their family from bankruptcy. Based on ethical standings, nurses would want to continue treating the patient but since he has no money, they are forced to respect the patient’s right to die.  

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