Physician assisted suicide

Ethics: physician assisted suicide article

The idea of physician assisted suicide (PAS) is an ongoing conversation in modern America. Since the US has achieved its status in the industrialized world, the question of voluntary euthanasia has been frequently asked and discussed in the social and political arena. There are many reasons to agree with assisted suicide, and many reasons to oppose it.

One of the primary arguments in favor of PAS is medical autonomy. Medical rights to our own bodies have been a fundamental principle since equal rights have been defined. The decision to end one’s own life should be one’s own, it’s that simple.

A secondary factor in favor of voluntary euthanasia is that it is a compassionate act. This is generally the most commonly discussed angle in favor of PAS. If you have ever had a loved one that is terminally ill and is at the end of their life, then this might be something you have thought about. If you have ever had a relative wasting away due to an incurable degenerative disease and they are wasting away, then PAS might have been discussed. Due to the raw emotions associated with PAS, this might be the most commonly thought of justification for PAS.

There are just as many arguments against the use of PAS as there are in favor of it. The primary argument being, PAS goes directly against God’s will and it is unethical to defy God and His will for mankind. People who have strong beliefs in this regard tend to feel strongly that PAS is a sin and not permissible in society.

The Hippocratic Oath is often cited as a reason against PAS. The philosophy of “first do no harm” prevents physicians from engaging in any activity that causes harm or intentional death to their patients. This is a direct contradiction to PAS, which raises the question of whether or not PAS is an ethical practice. Permitting physicians to assist their patients to end their lives is often considered an intentional violation of the oath doctors have taken.

Another argument against PAS is the question of abuse if it is permitted. Often times we hear about scandals in which the medical companies refuse treatment because it is too costly and a positive outcome is unlikely. We all have heard about the family member that makes a decision for a family member that results in the death of a relative. The concern of abuse if PAS is permitted is one that raises the questions of how to regulate such an event that is as subjective as PAS is.

Some people believe that legalizing PAS opens Pandora’s Box. The question of “if PAS is permitted, what next” comes to the minds of many. The social implications that arise as a result of PAS, some opposors believe, can pave the way to permitting “nonvoluntary” cases of legalized suicide. This is a path that many people fear is highly possible and one that they do not wish to go down.

The US is not the only industrialized nation that struggles with the idea of PAS. Many eastern and western European countries also have regulations and laws either in favor of PAS with set regulations, or have a clear stance against PAS. The Netherlands, Germany, England, France, and Spain have all addressed the issue of PAS.

The Netherlands, for example, has the DNR (do not resuscitate) option as well as PAS to address end-of-life situations. There are specified guidelines that dictate how PAS is executed in the Netherlands. The first provision is the patient is to request the act and it must be “voluntary and well considered” (p. 266). The second provision is that the patient must be either about to or already experiencing intolerable suffering. The third provision involves the investigation of all other potential alternatives. All other options must be explored and considered in order for PAS to be instituted. The patient must give informed consent about all aspects of the situation, which makes up the fourth provision. The fifth provision dictates that two physicians must consult regarding each specific case to ensure that independent judgment regarding whether PAS in each case is appropriate. And the sixth provision demands that the professional who carries out the suicide do so with the utmost care.

Another example that has openly dealt with the issue of PAS is Germany. Likely due to the historical implications, Germany is less in favor of PAS than the Netherlands, or even the US. Voluntary euthanasia has long since been discounted in German society and has only recently been accepted amongst some when the Dutch way of PAS is discussed. Germany distinguishes between active direct and active indirect euthanasia. Active direct euthanasia, which occurs when there is direct assistance to a person who is committing suicide, is illegal. Active indirect euthanasia, which is defined as assistance in suicide and not during it, is legal.

In regards to the US, some people consider society not a suitable candidate for PAS in its current state. “The United States is in many respects an untrustworthy candidate for practicing active euthanasia” (p. 276). The implications that led to this assessment include: “sustained contact with a personal physician has been decreasing; the risk of malpractice action is perceived as substantial; much medical care is not insured; many medical decisions are financial decisions as well, racism remains high; and the public has not experienced direct contact with Nazism or similar totalitarian movements” (p. 276). These cultural differences lead people to believe that the US is not “experienced” enough to understand the ins and outs of PAS and its implications to individuals and society as a whole.

Oregon is the only state in the US, since 1997, that has permitted PAS up until recently. On 11/4/08 Washington State passed the “Death with Dignity” law that permits PAS. The law took effect on 3/4/09. In 2009, there were 64 requests for permission to be granted for PAS. So far in 2010, there have been 36 requests. There are specifications in place that permit only a select few to actually participate in the Death with Dignity law resulting in PAS. Safeguards, such as informed consent, multiple physician examinations, psychiatrist evaluation and verification, and other requirements are necessary in order to ensure the individual is of sound mind and body to make a decision such as PAS. The individual must also be suffering from an incurable illness that cannot be managed due to medical insufficiencies to minimize pain or suffering. In regards to the argument about the Hippocratic Oath, Washington does not require any medical professional to participate in the implementation of Death with Dignity unless they chose to do so. As current law stands, no medical professional is required to participate in the assisted suicide of a patient if they do not wish to. It must be an active choice to participate.

There are many pros and cons regarding PAS. There are many valid arguments in favor of PAS as well as many legitimate arguments against it. The idea of PAS is definitely something that is very subjective. People have varying opinions regarding voluntary euthanasia and the motivations for their support either for or against it.

References:

Waller, Bruce N. Consider Ethics: Theory, Readings, and Contemporary Issues.

Custom Publishing: New York, 2005.

Washington State Department of Health. “Washington Death with Dignity Act.”

3/4/10, Accessed: 5/22/10. Internet: <http://www.doh.wa.gov/dwda/>.

Stem Cell Research

Ethics

Regarding this type of research, I take the utilitarian perspective. Stem cell research is very beneficial for everyone. The research could save many lives and improve the quality of many others. Embryonic stem cells have shown to be the most valuable as they contain the ability to morph into any type of cell during their formation. “Human embryonic stem cells are characterized by their capacity for self-renewal and their ability to differentiate into all types of cells of the body” (Stanford Encyclopedia of Philosophy). This makes them a great candidate for battling sufferable diseases. The ultimate goal of this “research is to identify the mechanisms that govern cell differentiation and to turn human embryonic stem cells into specific cell types that can be used for treating debilitating and life-threatening diseases and injuries.” Permitting stem cell research and use allows people to have a longer life and a better quality of life. It causes the most good for the most number of people, therefore should be permitted.

John Stuart Mill and Jeremy Bentham would agree with my standpoint on this issue. However, Immanuel Kant and John Locke would not. Kantian and Locke beliefs involve “doing one’s duty” and “respecting rights, obey nature” (Internet Encyclopedia of Ethics). Permitting stem cell research on embryonic cells and fetuses that are marked for destruction goes directly against obeying nature and obeying God. The idea of not interfering with others comes into play because using these stem cells impacts everyone, directly or indirectly. The consequentialist perspective, that of Mill and Bentham, permits the use of left over embryos and aborted fetuses for research because it benefits the majority and causes the overall most good. However, the opposing view of Kant and Locke state that this type of research would go directly against the will of nature and the will of God.

Now that is decided, ironing out what is acceptable and what is not is much more difficult. The government should regulate this type of research as it is new and there is much room for unethical practices. Bioethical medical practices will need to be implemented to regulate this research. Embryos should not be raised for research purposes because it is just like raising cattle for slaughter. On this point, Kantian views do make more sense. Human life is much for valuable than that. This is a practice that will shock the world and is not acceptable by classical and modern ethical standards. However, the use of aborted fetuses and leftover embryos from fertility clinics should be used for this research. These cells are going to be destroyed anyway, so using them to improve the quality of life for others is ethical. They have already been created and are marked for destruction. Using these cells to benefit others through research is ethical using the consequentialist perspective. .

References:

Internet Encyclopedia of Philosophy. “Consequentialism.” March 24, 2006. Internet:

<http://www.iep.utm.edu/conseque/>.

Stanford Encyclopedia of Philosophy. “Ethics of Stem Cell Research.” April 25,

2008. Internet: <http://plato.stanford.edu/entries/stem-cells/>.

Ethics training on War

Ethics

The first article “The Road to Basra” talks about how the US forces had decided to attack the convoy leaving the city due to information gathered through intelligence. Using US intelligence agents and gathering information, it was decided that those who are considered combatants, and essentially enemies, would be leading a convoy out of the city over night. The second article “White Flags on the Road to Basra” discusses the same incident, but from a different perspective. This article talks about how the convoy was an attempt to retreat from the city, not to simply move. This article also uses the point of view that those who were fleeing the city when they were attacked were young teenagers, some only 13 or 14 years old. During the attack, the Iraqi soldiers fled from their convoy and were tracked down “as far as a half mile from the road” (p. 244).

The ethical implications that arose involve the necessity of these killings. On one hand, people argue that these Iraqi soldiers were catalysts for the war and were enemies. The other side of the argument states that the convoy was attempting to retreat and some of the soldiers were “waving white flags” (p. 244). Even though at this time the soldiers were attempting to surrender, they had already inflicted a great deal of destruction to the Kuwaiti people and land. The intelligence information was that these fleeing soldiers had destroyed evidence of war crimes. Does this make them exempt from suffering the consequences of war? Since they were surrendering at the last minute, does this mean they should have been spared? These are serious ethical implications of war that arose from this situation. Undoubtedly, many people will be on either side of the argument.

Scenarios for Ethical Situations

Ethics From a utilitarian perspective.

Scenario 1:

From a utilitarian perspective, Barb and Jack are not causing anyone harm and are promoting the most good for all, primarily themselves. Their arrangement to have a primarily sexual relationship and to reside together does not cause any harm to anyone else. The fact they have agreed to share expenses of Barb’s birth control method shows that they are both interested in not conceiving a child together. If either wishes to break off the arrangement, they have set rules and standards for doing so. It appears that both parties have clearly outlined the rules and expectations of their situation and are on the same page. Their arrangement, although may shock personal morals for some, does not cause harm to anyone.

Even though Barb and Jack have set rules for their living situation, there are issues that may arise over time. It is feasible to believe that one party may become more involved in the arrangement, developing romantic feelings for the other party. Also, another potential complication is if either Barb or Jack become romantically involved with an outside party and wish to break off the arrangement due to their emotions for someone else. If these two situations occur at the same time, this will definitely result in heartbreak for one party while the other one moves on.

The question as to whether or not this situation is moral is a personal decision. I do not believe it is immoral because the two parties involved have clear set boundaries and expectations of the arrangement. They are not intentionally causing harm to each other. In turn, their decision to live in this situation does not cause harm to anyone else either.

Scenario 2:

Jeremy and Russ are gay, that does not mean they are child molesters. A common misconception about the gay community is that they are deviant sexual predators who push their gay agenda into “infecting” today’s youth. These are extremist words that come from hateful people. Simply because Jeremy invites Victor over for the evening does not have any hidden agenda. The two could simply have a lot in common, just as much as I might invite someone over to spend an evening with my girlfriend and me. As far as the statement regarding Jeremy and Russ not being “effeminate,” not all gay men are flamboyant and colorful. Just like straight men, gay men can be very “average.”

What Jeremy and Russ are doing is quite moral. They are in a committed relationship that causes no ill will or harm to anyone else. If they marched in gay parades it would not impact the morality of their living situation. Jeremy and Russ are living comfortable, quite lives just like any other couple could. If they chose to become active in gay rights, that is their decision (no different than people who walk in cancer walks or rally in immigration protests). These two men are not pushing their lifestyle onto anyone, they are not trying to convince others to become gay, and they are certainly not trying to molest people. They are simply living a life of any other average couple in America. Their living situation is very moral.

Scenario 3:

The licenses of pornographic adult stores have been issued because the local government finds them to be in compliance with all stipulations set forth in their doctrine. Although the religious groups find the content of these stores deplorable, it does not make their presence immoral. The religious communities may be right in their assessment that the adult content stores are a bad influence on the community however they are not soliciting people to enter their businesses and are not coercing the underage to frequent their doorsteps.

The adult content stores are moral because they are not causing harm on anyone. Those who chose to enter the stores do so of their own free will. Everyone in the community knows that is contained inside those walls, so when people enter the stores along that street it is obvious what they will find inside. This does not make it immoral for the stores to be in business. If anything, the religious groups should focus on the individuals making (what they perceive as) immoral choices. The business owners are abiding by all their rules and regulations. The stores are ensuring that only those old enough are permitted entry, they have the appropriate licenses to function, and are following the law. They are within moral guidelines to function. The licenses should not be revoked because people will still want to have adult content stores they will wish to go to and make a conscious decision to frequent. The stores are not making immoral choices; if anything it is the customers (which in itself is a stretch) making poor choices. At least the stores are relatively close and not spread across town.

Ethics and Virtue

Ethics

The idea of virtue ethics is relatively simple-“we become good by doing good” (p. 98). By conducting ourselves in a particular manner that causes good in the world and in life it causes us to become good people, therefore ethical people. Ethical acts transform people into ethical beings. This approach to ethics focuses on the character of the person making the decision, rather than the decision itself. Individualism focuses more on what the individual forms as their own code of ethics.

Care ethics looks at empathy and emotions when formulating an ethical foundation. It incorporates these emotions with the utilitarian perspective to use our feelings with what works best for the group. This is an ethical theory that I find intriguing because it is permitting some subjective elements into this realm of thought. Utilizing and valuing our emotions and feelings is positive, however cannot fully dictate what is ethical because then the basis would be too broad. Incorporating the feelings with the utilitarian perspective enables some level of subjectivity, but also tightens the range so that most people are close in their personal ethics.

Social contract ethics states that those involved in the moral contract are those who the moral consideration is applied to. Those who have not committed to the contract are not subject to being held accountable to it or protected by it. Utilitarians state that all who are affected deserve moral consideration, and often times it can involve humans as well as animals. Eastern views, such as Buddhism, state that all living creatures deserve moral consideration. Jainists extend this to involve root crops as well, as the plant has to be killed in order to consume the crop. Darwinism limits moral consideration to only humans; simply only those “who have moral capacities and are ends in themselves” (p. 143).

In respect to moral consideration, my belief is that anything with a heartbeat deserves moral consideration. Even though animals cannot make moral, ethical decisions, they still are eligible to receiving our moral approaches to decision making. For example, if I saw a dog wandering around in the field behind my house, I would feel ethically obligated to do something about it. I would either call the humane society, take the dog to the shelter, or adopt and feed the animal. Just because the animal does not specifically make moral decisions does not mean that I cannot and should not provide the dog with moral consideration from my end. This is an ethical approach that I believe should be adopted by everyone. We are all creatures on earth and should be bound to looking out for one another. If a being, such as an animal, is not capable of doing so, then it makes it our ethical burden to do what we can for them in order to assist in their survival.

To discuss a recent environmental dilemma, the first incident that comes to mind is the most recent oil spill that is occurring right now in the Gulf of Mexico. Not only is the oil spill a direct result of human interaction with the environment, but it is also impacting the way of life for many people who reside in the Gulf areas. All of the animals, the fishermen, the residents, and all other impacted life forms deserve our moral consideration because this environmental disaster directly impacts everyone. Those who depend on the fish and seafood in that area will not be able to earn the money they typically would during this time of year. The animals are in distress due to the oil covering the animals, their homes, and their food. The residents along the coasts are at risk of contamination and potential life-long health issues as a result. We have a moral obligation to do what we can in order to help reduce the negative impact this BP oil spill has already caused on the environment and everyone who lives near it.

The utilitarian and care ethics approach requires that we take action in this oil spill. Not only is it in the best interest of the majority of people in the world, but it also causes direct harm to the environment and the wildlife that depends on a safe, clean home to live in. As an individual, the only thing that can be done at this time is to ensure that future situations like this can be prevented by protests, legislative actions, and community education. In order to help prevent future spills, we must prepare ourselves in order to try to wean off of our oil dependence, work on limiting where we drill, and pre-plan how we will take care of the oil spills if/when they occur in the future.

On a side note, my family purchases Dawn dish soap which is used in helping clean oil and debris off of wildlife in situations like this. By supporting a great company who is environmentally aware, I can have a small hand in helping restore healthy life for those living in the Gulf region. 

 

Reference:

Waller, Bruce N. Consider Ethics: Theory, Readings, and Contemporary Issues. Pearson Custom

Publishing: New York, 2005.

Society ethics

Ethics

Social Ethics

Utilitarian ethics focus directly on increasing the best possible outcome for all while minimizing the suffering of all. This ethical view tends to be more impersonal than other ethical perspectives, such as care ethics as it focuses on what is best for all without taking into consideration any familial ties with others. An example of utilitarian ethics would be rationing of resources during World War II. In order to ensure that everyone had all necessary resources, including milk, bread, etc., the government rationed out certain items in order to maximize the good for the most and minimize the most suffering.

Social ethics is founded in contracting society as a whole in order to outline what is ethical and what is not. Once society has decided what is permitted and what is forbidden, the entire population is contracted into behaving specific ways in accordance with the social contract. We all live within some level of social ethics. As a society, we have decided that having sexual relations with those under age 18 is illegal. In some cultures, the age of consent is much lower sometimes even as low as age 12. These are differences between the cultures that causes the idea of “what is acceptable” to be different based on the society.

Egoism has two kinds: psychological and ethical. In psychological egoism, the idea that we are all concerned about ourselves in a selfish, self-interest manner is what rules our ethical decisions. Ethical egoism however suggests that we should be concerned about what is best for us as individuals. Essentially psychological egoism states that we do act in our own self interests while ethical egoism states that we should act in our own self interests. Often times we see the idea of egoism in colleges and high schools. Many times people decide what is best for them and act in their own best interests in both college and high school in order to fit in. An example would be the teenager who makes fun of another in order to feel better about themselves. In this scenario, it is all about the individual and how they feel and believe they can better their social status. It is definitely an egocentric way to approach situations.

Relativism focuses on what is relative and relevant in each culture. The phrase “when in Rome, do as the Roman’s do” epitomizes this form of ethical thinking. This ethical theory will inevitably vary from culture to culture as there will always be differences between different societies. This method of ethics is apparent between varying cultures that exist within the US borders. If one goes to a Japanese restaurant, for example, then blending in with the Japanese culture one would take off their shoes and sit on the floor as occurs in the Japanese culture.

Care ethics emphasizes reason combined with feelings and empathy for others. This ideal in ethics focuses more on relationships and affection than solely on reason. Different from utilitarian ethics, care ethics does take into consideration any personal and emotional ties we have with others, such as family and friends. In regards to care ethics, looking at those closest to us and making decisions based off of how connected with others we are takes precedent. Strangers are more likely to be treated differently than our family and friends as a result of this line of thinking. For example, if a car was about to catch fire and my brother and her friend (whom I’ve never met) were in the car and I could only save one person, using care ethics I would save my brother first. With this line of thinking I have more of an interpersonal connection with my brother than I do with his friend, therefore I would put him first.

Let’s take into consideration a societal dilemma that we can apply ethics to. The job of the US president is to maximize the most benefit for all while minimizing suffering for the most people possible. This utilitarian approach is what makes a good politician. However, often times we see people involved in politics who take on the egoistic or care ethics approach. Some simply look out for themselves, while others will look out for their friends in the business. A good leader will adopt the utilitarian approach that will serve all people under his protection the best. Once the leader of a group of people begins to utilize the utilitarian approach, many others will take note and hopefully adopt the same measures. Unfortunately, many people will see this as a sign of weakness and utilize their own egoistic approaches in order to further their own agendas (as is the demon of politics).

Personally, it is easy to see the pros and cons of each approach to ethics. The idea of utilitarianism is idealistic, but irrational as a fool-proof approach. We are all founded in some level of social contract theory, as many of our laws are founded in this. Egoism sometimes rears its ugly head, but is also sometimes necessary. Relativism applies when we are working with others and their customs. And care ethics is ever so present when we consider others, specifically those we are close to.

Reference:

Waller, Bruce N. Consider Ethics: Theory, Readings, and Contemporary Issues. Pearson Custom

Publishing: New York, 2005.

Online ethics

Ethics: What are they?

The realm of ethics has common themes amongst all that are asked, however there are some varying approaches and stances among people. A code of ethics must be consistent and rational to the majority. A code of ethics must also be relevant and pertinent. If there is an issue that is not important, ethics does not come into play. Many believe in a divine code of ethics, while others believe in a more rational, tangible code of ethics.

Having a concrete set of ethics can pose problems. As in divine codes of ethics, “if God says it is this way, then it is this way” does not settle all ethical disputes. That can often result in more issues and ethical questioning. However, having a code of ethics that is too flexible causes a lack of consistency and holds no validity in the long run. Finding a balance between a code of ethics that leaves a little bit of flex room and one of the two extremes is a tricky dance.

There are many common themes throughout codes of ethics, however the approaches to the code’s development varies from theory to theory. God’s law is from the foundation that what God says is what is ethical. Other approaches, such as those from Plato and Aristotle, push forth the idea that a code of ethics comes from “careful thought and judicious reasoning” (p. 18). Plato encourages the rejection of feelings in ethical decision making. Immanuel Kant argued in categorical absolutes, basically stating that a single statement is all inclusive of the potential implications that can be associated with an issue. For example, Kant preached the absolute concept of “do not steal” (p. 21). There is no variation in Kant’s statement and it has an absolute statement with an absolute outcome. Kant’s foundation was based on reason and will, stating that these two elements fuel the decision of an ethical issue.

On a separate tangent, David Hume spoke of ethics in a more passionate and emotional level. Hume believed that ethics were based primarily on emotions and feelings, rather than rational thought and decision making. This is similar to what is known as intuitionism, which relies primarily on intuition and hunches in making ethical choices. Hume’s approach, as well as the intuitionistic approach, focuses more on feelings and emotions rather than rational cognitive thought. Calculating a specific conclusion as a result of the decision making process has no place in these two theories.

The basis of devising a code of ethics is simple. Treating others in a manner you would expect to be treated is a good start. Living your life the way you believe is right and just is another good step. Society dictates much of what we should and should not do, and often times these rules are based off of rational decision making. However, we cannot ignore those intuitive hunches and feelings we get about certain situations. This is where ethics gets a little more complicated. Sometimes rational processes can be more beneficial in a given situation, especially if there are cultural differences in question and opposition. However, gut feelings that are carefully strengthened and skills that are honed cannot be discounted either. Ethical living may vary from one culture and/or society to the next, but there are relatively consistent variables amongst almost everyone on this planet.

It is not difficult to live ethically however making the ethical decision may not always be the popular decision. For example, I once observed a classmate cheating on an exam and the classmate did express to everyone that she did not need her cheat sheet. Although putting myself out there and stating that I did not find that to be acceptable behavior of a college level student, I stated “that’s not right” and walked away from the situation. After class I disclosed my classmate’s actions to the instructor. It was interesting because although at the time I did not believe I had carried out the most popular actions, I later found out that almost everyone who heard the classmate’s remarks also reported them to the instructor. So even though I thought I was alone in my ethic decision, it appears that I was not and what I held to be the ethical choice, but at that time believed was not the popular choice, it turned out that I was not alone in my decision. It did not feel right not to mention what had occurred to my instructor. And on top of that, all of my classmates and I had studied hard to pass that exam, so it was not fair that someone should have an unfair advantage.

A delicate balance of reason, emotion, and intuition can help guide a steady code of ethics. All elements are valuable in their own right and can help keep the other elements of ethics in check. Sometimes logic plays a bigger role, while other times hunches or feelings do. Each element is valuable in decision making and can prove to be beneficial in ethical decision making. There have been times when I have been conflicted between reason and emotion, but I rely on intuition in those situations. Even though I may not have been able to articulate why I felt a certain way about an issue, I relied on my sense of ethical and not-ethical intuition to make a decision for me. Sometimes my brain over-powers my emotions, and other times I am too emotionally invested in a situation to make a rational decision. That is why I personally rely on my intuition.

Reference:

Waller, Bruce N. Consider Ethics: Theory, Readings, and Contemporary Issues. Pearson Custom

Publishing: New York, 2005.