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Ethical Issues in End of Life Medications

Updated on August 12, 2017

Introduction

End of life care, especially the withdrawal of treatment is the most ethically complex and emotionally and intellectually challenging. In this case, the doctor is torn between prolonging a patient’s life and the need to address the withdrawal of treatment issues. The paragraphs that follow take into account, the ethical frameworks in the 21st century and opinion by asking ethical questions that address the complexity of the matter. To analyze this ethical issue, four principles of medical ethics, specifically, autonomy, non-maleficence, distributive justice, and beneficence will come to play.

According to Picard & Lee, (2013), autonomy is the rule that stipulates that patient has the right to control what happens to their body, a decision that must be upheld by everyone. Non-maleficence principal, on the other hand, states that healthcare providers should avoid at all cost harming their patients. On the distributive justice, the principal states that the healthcare provider should try to be as fair as possible while rendering his services to the patients and allocating scarce medical resources. Moreover, he must be able to justify is actions (Winter & Cohen, 1999). Lastly, beneficence, states the actions taken to benefit others, it is, therefore, imperative that all health care providers strive to be good for patients. These values, though neutral between cultural, religious and ethical theories are shared by everyone across the board. Nonetheless, the same principals do not offer a clear method to choose given a medical situation.

The Withdrawal of Treatment

Gillon (1994) explains that the principals only provide shared set of moral commitments. As a result, there is need to come up with solutions to address these weaknesses in the principal. The deontology approach will be used in this paper as a way of handling end of life, health issue more so the withdrawal of treatment, which is a theory of morality based on a moral decision-making and non-consequentialist opinion of people. The approach maintains that actions are not justified by their consequences, but, on the outcome will determine is the action is justifiable, while not forgetting the means of achieving the results (Christians & Merrill, 2009). To accomplish this, arguments from the sides of the divided that is, pros and cons of the withdrawal of treatment will be put into consideration. For instance, ethical frameworks will be deliberate and applied through a look at the Airedale NHS Trust V. Bland [1993] court case. According to (Keown), the deliberate intention of withdrawing life-staining treatment aimed at causing the eventual death of a patient is known as passive euthanasia. The terms in medical and ethical context are used interchangeably.

Nonetheless, for the sole purpose of this paper, the term “withdrawal of treatment” shall come to play. According to (General Medical Council, 2013; British Medical Association, 2009), medical treatment in the UK can be withdrawn only when the situation of the patient is deemed futile. However, new dimensions were brought to the fore in the Airedale NHS Trust v. Bland [1993] case. For instance, Bland become the first patient to be allowed to die by the court through the withdrawal of life-sustaining treatment. As a result, Mental Capacity Act of 2005 was formed. (Law Reform Commission, 2009; Szawarski & Kakar, 2012) The withdrawal of treatment issue many times provoke emotional response more so from those directly affected by such cases. However, there is no official on how often withdrawal of treatment happens or the number of health providers that have to contemplate on the issue. According to (Ward & Tate, 1994) survey done on the physicians, opinion on the end of life care 91% of those interviewed say they would consider practicing passive euthanasia.

The Argument for Pros and Cons for the Withdrawal of Treatment

The withdrawal of treatment issues is, without a doubt, the most complex. To elaborate on this we will look at some of the arguments on both sides of the divide. For instance, recently, some of the cons, issues on the withdrawal of treatment were used against LPC (Liverpool Care Pathway), a system that was implemented to allow for termination of the life of very ill patients with self-respect and with little distress as possible. Since the time of its inspection, the LPC had extended its services to allow the withdrawal of treatment to patients that were terminally ill. To many, LPC was acceptable medical practice for end-of-life care. Yet, several issues about its operation surfaced, for instance, two-thirds of the patient had their care plan discussed with relatives or carers, despite the fact that LPC received millions of pounds in form of government funding (Sturdy, 2013).

According to Rampe (2009), some of the ethical questions that arise when the Withdrawal of Treatment surfaces are:

  • Should the doctor’s duty and responsibilities be preserving life always?
  • Who should be in a better position to decide whether the Withdrawal of Treatment is ethical?

The Hippocratic Oath was written to act as a guideline to such issues of ethics. In the Oath, the duties and responsibilities of the physicians, such as “… do no harm…” and “…keep secret...” are found. Some perceive this Oath as irrelevant to the modern world, as it fails to address this critical issue of withdrawal of treatment. Nevertheless, the WMA Geneva Declaration, which is the most recent still fails to address this issue too. For instance, one of the quotes from the declaration is very ambiguous and leaves room for open interpretation “.. Maintain ultimate respect for human life”.

Moreover, the UK’s GMP (Good Medical Practice) guide, to which every practicing doctor must abide in are also vague on the ethical issue of end-of-life care. For instance, the guide state that”the doctors should take necessary steps to ensure that there is as less pain and distress, whether or not a cure is possible” (General Medical Council, 2013). As much as one school of thought may feel this is the closest to the withdrawal of treatment, it is still open to debate.

Cultural and religious differences are other aspects that further complicate the issue of the Withdrawal of Treatment. For instance, according to (Ankeny et al, 2005; Firth, 2005; Donavan, 2011), the beliefs of religious groups such as Christianity, Hinduism, Islam, and Buddhism vary. Besides, this religious issues became irrelevant to non-believers. For instance, Dr. Joel Marks, an atheist, is a champion of deontological ethics to make a public declaration that there is no difference between what is wrong right. Dr. Marks says that as much as religious fundamentalists may be correct by saying without God there is no morality. It is worth noting that they are wrong in some ways. He alleges that the deontological issues of morality do not require God to distinguish between what is wrong or right. In his view, the deontological ethical theory is what many religious communities perceive to be unreasonable as believing in the Divine.

In 2009, president Obama obliterated the stem-cell, arguing that the previous government had come up with a false idea of the choice between sound science and moral values. The issue was more about ensuring that scientific data was never lost, concealed or distorted to serve a political agenda, it, therefore, imperative that the government makes decisions based on scientific facts and not ideology. Consequently, deontological theory rejects any moral theory rooted in God or a higher. The fundamental belief in deontological ethics is a real theory based on, among others: a cultural morality that in a way goes beyond the face value of issues; theory of objective; and creates a connection between individual entities in culture.

How Deontology Addresses End-of –Life Care

According to Christians & Merrill (2009) motive is the key to morality under deontological ethical approach, and they are of the idea that clear-cut imperative, duty and good will are the primary cores of moral actions. From the clear-cut imperative of this approach, we learn that for anything to be moral, the action must be in accordance with the universal law (Soccio, 2012). For instance, in the Airedale NHS Trust V. Bland [1993] case, the deontological approach would insist on the doctor withdraw treatment from the patient he is willing for this to become a universal law. So that Withdrawal of Treatment may be performed in all patients in PVS, the doctor may feel that Withdrawal is the right thing to do under a rational duty.

Some of the critics of the deontological approach on ethics claim that it does not emphasize on the outcome while evaluating the morality of an action. It is, therefore, unwise to ignore the outcome in totality, basing on the deontological approach, human life is sacred and uninfringeable. Thus, it is impractical to enslave a few individuals even when this action would enable more people to live better lives. For instance killing one person in order to save much more is not accepted under this approach. As a result, the approach seems to time contradict our natural preferences and what is perceived to be common sense. The approach’s weakness comes to the fore; therefore, especially when it comes to gives directions on how to develop individual virtues.

Conclusion

While evaluating medical issues, a traditional ethical framework such as deontology, suggests that decisions based on morals are the best solution. On other hand critics perceive this conclusion as not applicable. For instance, what the doctor perceives to be morally right may not be in the best interest of the patient. Which raises more questions about what are the patient’s best interest? What are the guidelines for determining these interests? Who has the control of the patient’s body, the government or the doctor? How can one accurately determine if the patient’s condition is futile? (Singer, 2012). From the above, it is safe to conclude that there is need to change the traditional ethical framework as they do not coincide with modern issues.


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