The world that people live in today is one that encounters new introductions from time to time. There are several changes being brought into peoples lives. Accepting or rejecting these changes depends on a variety of factors. While people might have to look at the practical side of these new encounters, they also have to question them from an ethical perspective.
Indeed, it is important to question the manner in which one does certain things. People ought to address whether their actions are right or wrong. Often, the end result of these actions may not matter as much as taking the right action. For others, it is the end result that matters. Or, there may be some other consideration that fits somewhere in between. Regardless of the right or wrong seen in an action or the method applied to decide on such a matter, one must firs begin with the necessity of questioning an action.
In todays world, there are several advances made in a variety of fields. One of the main fields to focus on would be the medical industry, as there have been leaps and bounds seen as far as invention and innovation are concerned. With these tremendous steps taken come tremendous responsibility. Indeed, this is the reason why there is need to question and scrutinize them. The need to do so is so important that now there are even fields of research and study that are designated to it, which are known as Medical Ethics and Bioethics. While medical ethics and bioethics sought to deal with the developments in medical technology, an important question to ask is do advancements in medical technology interfere with societys ability to behave in an ethical manner Or is there always an ethical way around these advancements
Medical Ethics
Medical Ethics is fundamentally an area of applied ethics. It is more specifically defined as a study of moral values that help in judgment in the field of medicine. Medical Ethics is applied to clinical settings, and it also encompasses philosophy, theology, and history. Within the medical profession, it is in sync with several fundamentals of branches healthcare ethics, such as nursing ethics (Code of medical ethics, 2006).
Apart from this, Medical Ethics is usually perceived more as applied professional ethics. In contrast to this, Bioethics seems to have wider concerns, as it also encompasses philosophy of science as well as issues in biotechnology. However, both fields are believed to overlap, and the distinction of one from the other seems to be a matter of wider application as opposed to professional agreement (Code of medical ethics, 2006).
Bioethics
Bioethics appears to be more encompassing, and there are various definitions of it as a result. This is because of its application in various fields. An all-encompassing definition of Bioethics would consider it to be a study of ethical and moral implications pertaining to newly introduced biological advancements as well as biomedical discoveries, which are related to genetic engineering as well as drug research (Niebroj, 2010).
Bioethics looks at issues very specifically that emerge within medical and biological practice. These issues encompass issues that are related to the nature as well as distribution of treatment, which entails the authority rendered by the patient, the physician, etc. It further includes the scope as well as boundaries of confidentiality, limits of intervention and experimentation. It also encompasses genetic research along with its applications (OMathuna, 2010).
Persistent Vegetative State
Medical Ethics and Bioethics are both applied ethics that are made use when people are faced with particular situations that call for possibly difficult decisions. One particular situation where these applied ethics may be applied is when a patient is in a persistent vegetative state. This situation is such that the patient is not in a position to take any decision. Therefore, the only people left to do it are the family members or the authorities (Vosa et al, 2010).
Magnetic Resonance Imaging
Medical Ethics and Bioethics are applied ethics that can help to take decisions in situations that call for Magnetic Resonance Imaging MRI. The reason why there is some level of controversy when an MRI is recommended is due to the fact that an MRI can result in death. This is due to the possible interference caused magnetic force in the MRI that can damage other essential electronic devices of a patient, such as a pace maker. Although, there are certain precautions that can be taken, it is still known that MRI usage can result in death (Weisbard, 2010).
Coming back to the descriptions and definitions of Bio Ethics and Medical Ethics, there are variations to be considered. These include Primum non nocere, Kantain Ethics and Utilitarianism.
Primum non nocere
Primum non nocere is a Latin term which means First, do no harm. Emergency medical services operate with this as their fundamental philosophy. All medical learn this as part of the ethical teachings imparted to them. Nonmaleficence is a term that they are thus familiar with. As an example, an implementation according to this principle when a person is in need of medical attention, one would rather not do anything at all as opposed to doing something that might cause greater harm. This is why people are advised not to move an injured person if they are not qualified if time permits, they ought to wait till paramedics arrive. More specifically, it can be asserted that Primum non nocere is invoked when there is debate concerning intervention there are obvious risks as opposed to fewer chances of benefit. It is known that this term is a sacred one that has been practiced for since the latter 1800s. It has also been understood that this phrase reflects hope, positive intentions, and humility. It also signifies the fact that human actions that carry the best of intentions may give rise to unwanted outcomes (Code of medical ethics, 2006).
Kantain Ethics
Kantian ethics forms an interesting slant in medical and bio ethics. According to his views, if the only objective in life was to achieve happiness, humans would do nothing else but seek pleasure hoping that everything would end up in sheer contentment. However, this is not the case, and happiness is not always within our control. Happiness and contentment depend to a great extent on fortune, and may not have anything to do with good actions. Therefore, being in a state of happiness and being good are two entire different matters.
At the same time, Kant says that if one is to obviate skepticism or nihilism, and for ones ethical moves to be founded on rationality, it would have to be unconditional it would need to bear no exceptions. It would also have to be universal, which means that it would have to be applicable to every human being, regardless of who they are (Loewy Loewy, 2004, 38).
Utilitarianism
Utilitarian ethics is characterized by the idea of moral value of a particular action. The moral value of that action is governed entirely and singularly by its utility, which refers to its use in providing pleasure and contentment. In other words, the moral value for a particular action is governed by the result produced or its outcome.
History of Medical Ethics
The history of medical ethics has significant bearing on the same subject today. Along with this history, there are important names like Socrates that are remembered. Often known for his humor and also remembered as the Grand Daddy of Humor, Socrates made an indelible impression on medical ethics.
Socrates method of teaching medical ethics, philosophy and mathematics indeed has a lot of history that has come down a long way. The method employed was to motivate a group of people, who were students or practitioners, so that they would be able to work on a conceptual, ethical or psychological issue through their collaborative output. This could take place with minimum help from the teacher, whose role would be simply to compel the students to work along a rigid set of guidelines. These guidelines enforced would be structured in order to ensure results that would be productive, diversified, as well as have a consensus-oriented thought process (Birnbache, 1999, 1386-7423).
There are quite a few characteristics of the Socratic teaching procedures that are very effective as well as attractive. These are particularly suited to imparting medical ethics procedures to small groups. The idea begins from the commencement of pertinent and singular individual experiences. It involves interpretation and a fastidious action in a procedure of inter-subjective confrontation and confirmation. It must also be added that the role of non-directivity from the teacher with regard to all that is contained in the discussion is a must. The participants need to make clear their own thoughts as well as their method of understanding others thoughts. Also, there must be a rigid separation of content and meta level discussion, and there should also be practical use of the emotional and motivational level that grows in this group procedure (Birnbache, 1999, 1386-7423).
According to experience though, it is said that the Socratic group tends to have several setbacks. These may be avoided through being less rigid as far as the rules are concerned. Largely, this refers to the restriction of considerable interventions by the teacher, as well as the overemphasis on group consensus. The Socratic method of teaching medical ethics is one that demonstrates how rigid one has to be in order to attain an outcome that is governed by strict principles.
Medical Ethics in the Present Day
In the current day and age, it is of utmost importance for medical practitioners to focus on ethical decision making very, very carefully. While, the more commonsense reason for doing so would be to avoid liability, it is more important to do so because of the need to prove ones worth as a person who works for the betterment and improvement of the quality of life. Certainly, doctors and other associated authorities would be worried about liability, but their aim should be to fulfill their role in serving humanity and doing what is right.
Many generations and centuries ago, people would not have been able to press charges against hospitals for issues like medical malpractice and medical negligence. Today, however, people live in a very different world. Doctors and concerned authorities are answerable to the law. This is such a severe issue that there are particular guidelines that have been developed in order to safeguard doctors (Mitchell et al, 2010).
Indeed, there seems to have been a shift in favor of the doctors and medical authorities with regard to legislation. This was not the case many years ago. However, this has also been a necessary measure in order to protect professionals from situations in which they have no fault. To balance this out, there are also laws which uphold the rights of patients. These can be invoked in the even of any injustice or deliberate negligence that has affected the patient.
Indeed, it must be said that any criminal proceedings that arise out of a medical situation can be severe. Such legal battles have been known to cost hospitals millions of dollars. This is why there is a great deal of emphasis laid on ethical practices that doctors must be fully aware of.
Additionally, as opposed to yesteryears, physicians cannot withhold information from their patients. Patients have a right to know about their conditions according to legislation today. As opposed to this, many years ago, a physician did not have to reveal what condition a patient was really in. The secrecy may have been for a number of reasons, some ethical, and some unethical (Mitchell et al, 2010).
An example of the reason why patients may not have been told about their condition was
When there was no cure for their ailment. In such a situation, doctors thought it was best to let the patient believe they were fine. This might have prevented suicidal behavior as a result of despair. However, the ethical consideration would not only include the necessity of being honest with the patient, but would also call into question the sense in keeping secret a persons disease that might be contagious.
Ethics Applied to Different Situations
Ethics may be applied in a variety of situations, medical and non-medical. It is important to follow principals so that individual rights or not infringed. However, in many situations, the same ethical rules may not apply. This is primarily because of the fact that the outcomes of some situations may be known before hand while the outcomes of others may not be known. Despite knowledge of the outcomes, it is often legislated that ethical practices must be applied. This is why in every known case today, ethical provisions under law will be applied. However, one must consider past evidence where an ethical principle cannot or should not be applied to all cases. In view of Permanent Vegetative State that a patient may be in, the ethical consideration by law to keep a person on a feeding tube and ventilator may not be applied (Vosa et al, 2010). There have been several examples of these situations, where, by law, the hospital insists on placing the patient on life support, and a family members want it removed. Some of these cases have gone on for years (Annas, 2010). While, by law, it is largely seen that hospitals are ordered to place patients on life support, there are situations under which this may be overruled. If there is no one to tale a decision for such a person, his or her written consent would have to count. In the absence of either of these, there remains ambiguity, and such a case is open to debate, court battles between family members, etc (Wade Johnston, 2010).
Ethics as a Means of Propaganda
While ethics is a genuine means by which people may act more carefully in sensitive situations, ethics itself may be used as a means of propaganda. Over the years, this is precisely what the world has witnessed, particularly in the developed world. The concept of ethical thinking and practice is talked about so much that people immediately call into question actions that are newly introduced or have some controversy attached. Ethics has affected the lives of thousands of people, and subjects ranging from animal testing and global warming to genetics and socio-economic rights, are all critically looked at. When ethics is picked upon in view of any subject, it is instantly a means of propaganda the issue of concern is propagated, and people become aware of its importance (Mitchell et al, 2010).
Generally speaking, the ethics issue is normally taken up under the banner of pro-life and sustenance. This means that people or pressure groups call into question anything that interferes with the quality of life or if anything negates life itself. If one takes a look at the issue of abortion, for example, the main point that is focused on is life activists believe that what action is taken, no life should be lost. The result is that abortion in any sense cannot take place. The pressure from pro-life groups is so intense that the ethical vehicle for upholding life is in itself a means of propagating the issue.
Apart from the abortion issue, pro-life pressure in the ethics propaganda also infiltrates the arena of PVS patients. Regardless of their condition and their low chances of recovering, years later, they still insist on the patient being kept on life support (Vosa et al, 2010). They assert that there is always a chance of a person coming out of their vegetative state as long as there is life, there is hope. Though there isnt complete agreement on this issue, it is this stance that keeps their demands afloat.
Many feel that the pro-life banner is carried a little too far at times. In the abortion issue, for example, it is one that cannot always be agreed to because of the dangers that a mothers life might be in. The issues can be complex, and there is need to consider it on a case-by-case issue (Mitchell et al, 2010).
When considering the pro-life banner in terms of PVS patients, one tends to feel the same way every case cannot be decided according to what the ethical approach says. There are several cases that stand as an example in this view. One in particular is the Terri Schiavo Case. The husband of this patient fought for many years to get his wife of the life support apparatus, but the parents of the patient did not allow it (Perry et al, 2010). After some years, way beyond the known period of possible recovery, Teris husband handed his authority over to the court. After many petitions and court battles from 1993 to 2005, the case was decided in favor of Teris husband. One has to ask whether it was really possible or ethical to maintain PVS patient in that state for so many years. Therefore, it has to be said that there isnt complete agreement in this type of issue as well (Wade Johnston, 2010).
Ethical Rules as Limiting factor
Ethical rules may create obstacles in certain cases. They can limit the extent to which one would want to make an effort to act in a desired way. If one considers the limitations set out when there is a PVS patient, it can be said that in the absence of a written wish from the patient, the hospital gets to take decisions. This may prevent relatives from taking a decision to take the patient of life support. While the hospital may be taking the right decision in order to allow a certain amount of time to elapse before there is no chance for the patient to recover, relatives may find themselves battling for many years beyond a reasonable time frame.
Again here it can be said that those in favor of extending life regardless of the condition a person is in are responsible for these ethical actions. Indeed, there is overwhelming support for this, and this means that opinion of the majority will have to be followed. Hence, such orders are legislated. However, in view of PVS patients making a statement prior to being vegetated, patients may not be put on life support. This is the difference between such a desire and euthanasia. Patients do not request to be injected by anything lethal, but they do have the right to refuse any intrusion in writing prior to the worsening of their condition (Vosa et al, 2010).
Law vs. Ethics
Indeed, what is signed into legislation is done so for the common good of the people. There are many people who are in favor of preserving life. It is difficult not to agree with them, particularly since one would not want to see patients lose their lives due to sheer negligence. Therefore, the safest way to go about establishing a norm is to have it passed through the legislative process. When this is done, people are bound to act accordingly. However, the dilemma that comes along with such an action is that it may not be reversed easily. As an example, if there is no relative present when a PVS patient needs a decision taken or in the absence of a patients written desire. In such a case, a PVS patient will be kept on life support for a lengthy period. Perhaps, a PVS patient may not have desired such treatment in an unconscious state. However, he or she would have little control over it (Mitchell et al, 2010). In the presence of relatives conflicting over the issue, it may be years before the life support may be removed, as seen in the case of Terri Schiavo.
It does cross many peoples minds to break the law when there is need for ethical action. However, since a larger majority has favored a certain ethics to be legislated, it goes against the law as well as the consensus to break a law for a perceivable ethical action. For example, if a family member believed that a relative in a PVS would not have wanted to be in life support, he or she might consider removing the apparatus on his or her own. This might be ethical according to what the person thinks, and perhaps it is so. However, if the law does not permit it, the person is likely to face severe consequences.
One also has to realize that by breaking the law for a perceived ethical reason, the very action of disobeying the law is wrong. If one were to win a legal battle, it would be a far better example (Wade Johnston, 2010).
What people want to do in certain situations is may be a matter of desire. However, that desire might be driven by an ethical thought. In a situation where a relative is in a PVS condition, the desire to remove the life support apparatus after the medically advised period can be termed ethical. If the law does not permit it, the person is in a dilemma, and feels that his or her right of choice for the relative is being denied (Vosa et al, 2010).
Looking at the same issue from another angle would have one satisfied that at least a patient in a PVS condition has the right, prior to being in such a condition, to desire in writing whether or not he or she should be placed on life support. That is the right a patient is given. Once a patient, who has not written what his or her desire is regarding life support apparatus, loses his or her rights of choice. Additionally, if there is no relative nominated to take this important decision, the rights of choice are automatically transferred to the medical facility the patient is at (Vosa et al, 2010).
Case Studies
While one may not agree with the consensual ethical agreement that is enforced through law to maintain PVS patients on life support, there are certain cases where this ethical life favoring law has proved its worth. An 18 year old woman, who met with an accident, was pronounced to be in a permanent vegetative state. After 15 months, the patient began to show signs of responses. These were inconsistent. However, with treatment, the responses became increasingly consistent, and she improved over the next 5 years. Eventually, she was sent home for long term care (Childs Mercer,1996, 24-25). This case is indeed rare, but it does show that people can emerge from a permanent vegetative state, which affirms the ethical consideration not to put such patients off life support.
Another even more surprising case was that or Carrie Coons, an 86 year old lady who was said to be in a persistent vegetative condition. She had suffered a stroke, and the family had petitioned the court to allow her feeding tubes to be removed. However, only days after the decision went in their favor, Coons began to show signs of recovery. This puzzled the family and the doctors too. This case raised questions regarding the reliability of diagnosis when people are in persistent or permanent vegetative state (Steinbock, 1989).
In contrast to the miraculous recovery of few patients in PVS, it must be said that there are also a great many patients who do not recover. These people are known to suffer for years before their life support is switched off. One example of this is Nancy Cruzan who was on life support for around four years. Her family finally got legal authorization to switch off her support, and she passed away twelve days later. Another similar tragic case was Karen Ann Quinlan, who slipped into PVS after consuming drugs and alcohol. The family went through legal battles so that they could remove her life support. After getting a decision in her favor, they proceeded to remove the support. They were surprised to see that she could breathe without a ventilator, and survived for an additional nine years on a feeding tube. She eventually died of pneumonia.
Apart from the above case, there are several other tragic ones. The most high profile case among these is the Terri Schiavo case. It had the most attention and spoke volumes of whether it was really ethical to keep a person on life support for an extended period (Huang Ahronheim, 2010). This leads one to ask whether or not it is really necessary to insist on a person being kept alive in a vegetative state. Having considered that, it must also be asserted that even cases that appear to be hopeless have demonstrated miraculous turnarounds. Therefore, how can one really gauge when would be the right time to turn of life support apparatus Also, how can one tell after what length of time a person might show recovery
The answer to this is there is no guarantee of when a person in PVS will show signs of recovery. Also, the period of 12 months that has been seen as a maximum recovery period, is flawed. With expert opinion in this regard failing in view of miraculous recoveries, one cannot say for sure whether or not a person at an advanced age will not recover. Indeed, this is precisely why medical ethics insists on giving a person in PVS life support until his or her health declines (Wilson, 2009).
Finally, it can be asserted that advancements in medical technology, such as the life support introduction that consist of the ventilator and feeding tubes, may not really interfere with societys ability to behave in an ethical manner. This is because this technology has helped to bring people back into consciousness after they have been diagnosed with very low chances of recovery. Having said this, it must be asserted that there could be an extended period allowed after which a person may be considered to be in a PVS. In view of the rare miraculous recoveries witnessed, hospitals would need to extend this period significantly in order to make sure they encourage people to give their relatives more time for recovery. After all, when there is life, there is hope, and every chance ought to be given to a patient to recover from a PVS. This is what should be done provided that patient has not put into writing his or her desire to be kept off life support, and also if he or she has not nominated any relative to take the decision.
