End of life: the medical ethical dilemma Research Paper
The medical profession is increasingly facing a number of dilemmas today. Such dilemmas as what medication to give to a patient, what type of treatment to administer, or even wrong diagnosis are prevalent today. However, topping the list of the medical moral dilemmas is euthanasia.
Euthanasia is also referred to as mercy killing. It is a ranging debate in this amongst medical practitioners (CNN 2009). They are faced with the moral dilemma whether to use technology to keep a patient alive or just accept their fate and let the patient die naturally.
This is further complicated by the latest discoveries in the field of medicine; the studies on human health especially the brain. Families and relatives of patients do not help the matter. They threaten the doctors with severe legal actions on grounds of professional negligence.
Those that are religiously inclined urge the medical practitioners to keep their patients alive with the promise of God performing a miracle. Where matters of faith and religion are involved in health issues, most medical practitioners do not know how to respond.
There has been effort to legalized euthanasia but still many of the opponents are unwilling participants in the act (Cohen et al, 1994).
The basis of this issue is intentional versus unintentional death in a patient. Bioethicists are faced with the dilemma whether it is moral to end the life of an innocent person, if all medical procedures seem inefficient to sustain life. We see a patient who has been under excruciating pain requesting his physician to consider euthanasia as a way of helping him end his pains.
This death is intentional. The goal of relieving a patient’s death is morally right but the means used to achieve this are wrong, within the moral system, as no one has the right to end an innocent person’s life (Quill & Battin 1997).
Quill and Battin continue to explain that there four rules that manifest this situation. The first concerns itself with the nature of the medical act to prevent life. Acts such as pain relief may reduce a patients suffering and sustain life but the effects of this pain killers may hasten death.
Are such actions morally right? The second concerns the intentions of the medical act. The fourth factor entails striking a balance between on the one hand, the bad effect and on the other hand, the good effect. It is important that physicians ensure that the bad effect does not in any way overcome the good
The biggest moral conflict in this issue is the idea of futile treatment. Modern medicine has an amazing ability to maintain life, even when it is most naturally possible for patients to die. This has changed the way families of patients view end of life issues.
Families argues that there are remote chances that of a patient surviving if life support care is given but physician tend to disagree. Physicians on their part have tried to formulate a policy on the issue futile treatment, but their efforts have not been successful, as they cannot agree on a working definition of the term futile treatment.
There are some challenges experienced in resolving this dilemma. Key among them is the disagreement amongst the medical practitioners. A good example is the case of a nurse manager at Queen’s Medical Center’s intensive care unit.
Cheryl Fallon was the nurse manager at this hospital when its ethics committee deemed it appropriate to pointless to sustain the daily transfusion of blood for a female patient at its intensive care unit who was suffering from leukemia. With no blood transfusion, death was imminent.
The ethics committee from a different hospital differed and advised the family to continue with the transfusion. Despite this, the patient died two weeks later. Furthermore, there is conflict amongst medical practitioners because many are unaware of some key guidelines, such as the permissibility of withdrawing treatments (O’Donnell et al, 1993).
This however has not watered down efforts by managers in the medical field to address the issues. Different practitioners play different roles.
Managers, physician, clinical workers, physician and lawyers have collaborated to form ethics committees, which thoroughly debate this matter. Medical professors continue to do research in the functions of the brains and establish when is the brain can no longer sustain life.
As already implicitly highlighted, death is not just a medical matter but also a moral and spiritual matter. Resolving this conflict will require an all-inclusive plan. To begin with, medical ethics must focus on the rights of the patient in light of the medical condition the patient is suffering from.
This is because medical decision-making is primarily centered on the patient. Physicians must release information to the patient and family relevant to decide whether to undergo or forgo a proposed treatment and that he or she must comprehend the information and know the consequences of such treatment.
The patient must freely make the decision. Although Medical practitioners will have the power to influence the patient, all manner of coercion must be resisted. Despite the fact that a physician is the one who carries medical facts, it is the patient’s sphere of values that should mostly influence the medical act performed.
Medical decision-making also has a social dimension, which includes the family. At this point, the question on what constitute a family and whether, and to what extent family intrest influences medical decision making must be comprehensively debated by all parties concerned.
This is because sometimes, a patient may be in a coma and therefore not be in a position to make any decision regarding the form of treatment to be administered. A policy on when and to what extent the family should be consulted will be formulated.
This plan give the patient the primary right to freely make medical decision affecting them. The role of the doctors is to inform the patient of the most suitable treatment alternative including all its benefit and dangers. Clinical officer plays the role of ethicists.
Their work is to prepare the patient psychologically and liaise with the patient family. They must inform the patient of the legal implications of such treatment and ensure that the said treatment is administered within the legal framework.
In conclusion, it is worth to note that the death is viewed by a majority of societies as a spiritual matter. It is only acceptable when it happens naturally and in acceptable circumstances. The evolution of medical technology has compounded the death dilemma matter further.
Even though physicians acknowledge that technology is ahead our morality, they also understand its futility in maintaining life. Debate on mercy killing (euthanasia) is not yet conclusive. Rachels (1993) categorizes euthanasia as either passive or active.
He argues that allowing a patient to die (passive euthanasia) of an incurable ailment is morally acceptable while active euthanasia (inducing death) is equivalent to killing and therefore not.
“The cessation of the employment of any extraordinary means to prolong life is the decision of the patient and his immediate family. The advice and judgment of the physician is freely available to the patient and the immediate family.” (p. 77).
CNN. Death and dying: when is it time to let go. (2009). Retrieved from http://edition.cnn.com/2007/LIVING/wayoflife/07/27/livingwell.endoflife.reut/index.html
Cohen, J., Boyko, F., & Wood, J. (1994). Attitudes toward Assisted Suicide and Euthanasia among Physicians in Washington State. New England Medical Journal, 331, 89-94.
O’Donnell, S., Guilfoy, J., Wolf, N., Jackson, Koch-Weser, J., & Donnelley , S. (1993). Decisions near the end of Life; professional views on life-sustaining treatments, American Journal of Public Health, 83, (1), 14-23.
Quill, T. E., & Battin, M. P. (1997). The Rule of Double Effect – A Critique of Its Role in End-of-Life Decision Making. London: Sage.
Rachels, J. (1997). Passive and active euthanasia. In Pearlman, Jonsen & Jecker.
(E.d.). Bioethics; an introduction to History, methods and practice. London: Jones and Bartlett Publishers.
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