- May 31, 2020
Who Lives, Who Dies, Who Decides?
WhoLives, Who Dies, Who Decides?
Ethicsis relevant to the field of healthcare just as it is to otherprofessional disciplines. Contentious issues such as euthanasia andphysician-assisted suicide, the body as a commodity, whetherpedophiles should be punished or treated, and the brain deathcontroversy call for high levels of soberness in professionaljudgment. According to Ekland-Olson,the sociological and clinical process is crucial in devising a moralground for decision-making (111). The historical and medicalperspectives of these issues can assist in shaping ethicaldecision-making. Healthcare practitioners are continually facingethical dilemmas concerning a broad set of issues that arise in theclinical setting. For this reason, it is important for them to definetheir set of moral beliefs that could enable them to know when andhow to change their positions whenever they encounter tough dilemmas.Defining a set of beliefs requires viewing controversial issues froma variety of perspectives (Ekland-Olson116). This paper will discuss the controversy surroundingpedophilia in other words, whether the issues should be consideredas a punishment for crime or treated as a brain disorder. Thediscussion will include the controversy surrounding the brain deathcontroversy, the body as a commodity, euthanasia, andphysician-assisted death.
Pedophiliais among the most debated issues in health care and law. Mostpsychological health professionals consider pedophilia as a mentaldisorder while a significant number of legal experts considerpedophiles as criminals who are keen on molesting children sexually.Krueger and Kaplan definedpedophilia as a brain disorder in which an affected individualexperiences an irresistible sexual attraction to prepubescentyoungsters (99). According to Poepplet al., pedophilia affects persons aged 15 years and above(683). Therefore, a pedophile is an individual who has been diagnosedwith an abnormal sexual orientation towards children approaching thepuberty stage. Arguably, the disorder primarily affects more malescompared to females. Poeppl et al.established that healthcare experts assume virtually all peopleliving with this condition are males (681). However, the reasons forthe high incidence of pedophilia among the male gender are stillunclear.
Thedebate as to whether psychological health professionals should treatpedophiles for mental disorders just as they would do to variousother brain disorders such as schizophrenia, panic attacks, andobsessive-compulsive illness is an open argument. Poepplet al. articulated that the American Psychiatric Associationincluded the disorder in their Diagnostic and Statistical Manual ofMental Disorders (DSM) in the late 1960s (680). Therefore, this showsthat the medical fraternity has for a long time considered pedophiliaas a brain disorder. According to Rose,the American Psychiatric Association groups the mental disorders withother paraphilias that make the affected individuals have incessantsexual fantasies and behaviors that involve non-consenting sexencounters (1215). From a medical perspective, individuals who havebeen diagnosed with pedophilia should be treated for a braindisorder. Both pharmacological and non-pharmacological treatmentmodes are effective in managing pedophilia (Ross115). However, a patient’s response to the medication isaffected by several factors. These include the extent of white matterdamage in the brain, the stage of the disorder, nutrition, andadherence to treatment schedules (Kruegerand Kaplan 85). Medications aim at minimizing the sex drivethat pedophiles experience. Although currently there is no real curefor pedophilia, the known modes of treatment focus on assistingpatients from acting on their sex drive. Some mental health expertsalso argue that pedophilia is difficult to treat since it resemblesthe characteristics of homosexuality. Therefore, treating pedophiliacan play a significant role in controlling the behaviors ofpedophiles.
Furthermore,treating pedophiles for a brain disorder could be a long-termsolution to handling the problem. Unlike punishing pedophiles forcriminal conduct, which does not necessarily remedy the condition,treatment of the condition is a much stable solution to handlingpedophilia in the society. To justify the need for treatingpedophilia like any other mental disorder, Rosediscussed that pedophiles do not choose to act the way they do(1214). Instead, they experience an inner sex drive for which theycan do little to resist this contradicts nonprofessional’sparlance that pedophilia is a choice. In nonprofessional’s point ofview, pedophilia is similar to heterosexuality and homosexuality,that is, actions that people choose to engage. Therefore, this hasbeen a contributing factor to the recent increase in stigma againstpeople suffering from pedophilia. The stigma towards pedophiles isattributable to the notion that people suffering from the disorderare sex offenders. In her study, Rosefound out that pedophilia has neurological origins (1213). Therefore,treating pedophilia is crucial in rectifying the brain’s impairedneural pathways. Fewer white matter in the brain means that itbecomes unable to identify relevant stimuli for provoking sexualarousal. Notably, this is the reason behind pedophiles’ sustainedsexual orientation towards prepubescent youngsters.
Insteadof treatment alone, punishing and treating pedophiles at the same canbe effective in addressing issues of child molestation. This isbecause individuals can sexually molest children by arguing that theyare suffering from pedophilia. Besides, punishing some pedophiles forcriminal conduct can act as a deterrent measure against theincreasing cases of child molestation (Ross115). Punishing such persons for criminal conduct shouldhowever follow a unique pattern. Kruegerand Kaplan (85) indicated that punishment of this category ofpeople should take place with close consultation of mental healthexperts who would offer useful advice for appropriate punishmentsthat would not interfere with treatment schedules that aim atcorrecting the severity of pedophilia. According to Ross(115), if pedophilesare incarcerated at institutions that do not offer the chance offacilitating their treatment, these individuals can fail to recoverfrom pedophilia. They can in turn to be a security threat toprebuscent children. For this reason, although punishment can act asa deterrent, it can work against the purposes for which it isintended that is, correcting and minimizing instances of sexualharassment among prebuscent youngsters.
MakingMedical Decisions for Competent and Incompetent Individuals
Makingmedical decisions is the single fundamental determinant of thedirection that a patient’s life takes. The choice and quality ofmedical decisions is the reason some patients successfully recoverfrom ailments, preconditions, and medical conditions while othersfail to recuperate. In any given situation, decision-making is acomplex process in which the brain undergoes various sets ofprocedures by evaluating available alternatives before determiningthe best option (Jackson 54Rahime 454). According toBilanakis, decision-makingis a process through which one decides what to do as per theprevailing circumstances and the best possible way of addressing aparticular situation (133). In healthcare settings, either patientsor medical professionals make medical decisions. For instance, inmost cases, physicians make all decisions regarding drugprescriptions while patients make choices on whether or not to attendpost-treatment checkups.
Froma medical perspective, healthcare practitioners are in the bestposition to make medical decisions concerning the wellbeing ofpatients. The pre-eminent knowledge, position, skills, andexperiences of medical practitioners place them in the best positionto pre-empt detrimental errors that could potentially arise whenincompetent patients make medical decisions about their life. Rahimearticulated that although it is important for patients to have theirown autonomy, it is unquestionably vital for healthcare experts tobalance such self-sufficiency against the best interests of an illperson who may not necessarily have an adequate understanding of thelong-term outcomes of decisions that affect their wellbeing (455). Inthis light, it is necessary to evaluate carefully the mental capacityof patients at all times (Bilanakis133 Jackson 55).Such an evaluation is necessary during the process of legallyestablishing the competence of a patient when the need to make majormedical decisions arise. Usually, this is the case when theimplications of medical decisions are staid. For instance, for someailments, patients are known to refuse medicinal treatment,especially when they feel that the indicated mode of treatmententails several regular injections and dosages. This can haveprofound consequences on the life of a patient. To deal with such ascenario, it is important to follow the rule of law, which in manycountries directs physicians to assess the mental competence ofpatients (Batool and Kumar 2).
Atcertain crucial points of patient care, it is useful for physiciansto make clinical decisions for persons who have been determined to beincompetent to make major decisions concerning their wellbeing.Although the ethics of medical decision-making are diverse, it wouldbe unjustifiable for healthcare practitioners to leave medicaldecisions at the hands of persons who are incompetent for one reasonor another. Substituting decision-making for this category ofpatients is crucial in improving their health and sustaining theirimproved conditions (Batool andKumar 2). In essence, substituting major decisions is key inthe process of patients care and treatment. There are various reasonsthat can cause incapacitation among patients. These factors could beinborn or influenced by the surroundings. Irrespective of suchfactors, physicians have a central role in improving the medicalconditions of this category of patients.
Whenpractitioners successfully determine that, a patient’s mentalcapacity is up to the task, it is important for clinicians to respectthe medical decisions that they make. In as far as practitioners maynot fully agree with the decisions that competent persons make inspite of the substantial damage that such choices could have on theirlives, it is essential for these experts to respect them (Batooland Kumar 2 Bilanakis 133). Besides, this shows that theyhave done their professional responsibility of exposing theconsequences of indecisive medical choices. Bilanakisindicated that it takes much effort for healthcare practitioners toaccept and respect medical choices that competent persons make (133).The reason for such is that the law requires that healthcareprofessionals have to respect one’s wishes on medical matters.Ekland-Olson discussed thatthe gravity of the decisions that some competent persons make is thereason some physicians and nursing practitioners fail to obey suchchoices (165). In the recent past, some patients have sued thesepractitioners for going against their choices despite the benefitsthat such actions from health professionals have had on theirwellbeing. Therefore, this shows that the professional duty ofhealthcare practitioners and the need for respecting patients’autonomy complicates the entire issue of medical decision.
Anotherissue surrounding decision-making for incompetent persons revolvesaround patients who were previously competent to make decisions.Batool and Kumar have arguedthat a lack of decision-making ability can also occur to persons whohave been previously determined in the past to be competent (2).Therefore, this implies that healthcare experts have to evaluate themental capacity of their patients on a continual basis to identifypossible lapses in their thinking and decision-making patterns. Apatient’s ability and capacity to think properly can undergocertain alterations that could hamper their aptitude to senselogically and soundly. Thus, this is where it becomes reasonable forpractitioners to make decisions for this category of patients.Substitute decision-making is a duty that practitioners have in lightwith the professional ethos and ethics of medical practice (Bilanakis133). Clinicians can exercise substitute decision-making on atemporary basis for patients whose mental lapses are expected tochange for the better within a specified duration. Therefore, thismeans that patients can be allowed to make medical decisions upontheir recovery from disease. Moreover, substitute decision-makingshows that the healthcare fraternity does not compromise thewellbeing of their clients based on incompetency challenges thatpatients could be going through. Instead, by exercising substitutemedical decision-making, healthcare experts improve the lives oftheir clients.
Self-determinationmeans that individuals have the right to make medical decisions(Batool and Kumar 2).Competent persons can objectively refuse to accept treatments forwhich they feel would not address their health needs better.Therefore, despite the health implications that such choices mayhave, nobody should coerce such persons, as any form of intimidationwould be loosely translated to mean an infringement of the freedom ofchoice. However, it would be ethically correct for any person toconsider the advice of their physician carefully before deliberatelydeciding to neglect the medical choices and counsel of professionals(Ekland-Olson 113). The reason is that in as much as a competentpatient may opt to disregards the counsel of medical practitioners,the decisions that these practitioners make endeavor to suit theprevailing medical needs of patients. Moreover, choices thatphysicians make aim at suiting the best interest of the challengesthat patients go through.
Sellingand donating of body parts and organs have existed for a long time.Epstein indicated thatselling of body parts denotes the act of using an organ as acommodity by receiving money in exchange for such sections to be usedfor medical purposes (112). Donation denotes the practice of givingone’s organ or body part freely to be used for medical purposeswithout charging a fee (Epstein119). People can sell or donate any part of the body that theydeem can help save the life of another needy individual. Peoplemostly sell their kidneys and bone marrows. Surprisingly, some go anextra mile to sell their blood, as well as other components such aslong hair (Hausleben 67).Although the motives behind the sale and purchase of body parts arediverse, these practices have been widely debated. Usually, for aseller, they engage in the practice of body parts selling because offinancial motivations and the profitable nature of the act. On thedownside, for patients who are, in this case, the buyers usually optto purchase body organs because of the urge to recover from a medicalcondition. For patients, the choice of buying body organs is usuallythe last alternative for which they can do little. According toEkland-Olson, selling of body parts will not cease any time soonbecause of the uncontrollable desperation that patients experienceupon realizing that they do not have another alternative to live thelife they would want under normal circumstances, one that is devoidof unnecessary pain and suffering. This is the primary reason thatmany patients are usually willing to risk all their finances to buyexpensive body organs for which they perceive would improve thequality of their lives.
Nahavandiargued that the donation of a body organ to play an auxiliary role ofsustaining the life of another person is both ethically and legallycorrect (24). The reason is that unlike selling, donation seeks toensure the life of another person is not put into jeopardy because ofa deficit of a particular organ. Therefore, donation is an acceptableform of medical remedy. Furthermore, donation does not arouse theraft of questions that arise when people engage in the sale of bodyorgans. According to Hausleben,healthcare practitioners have always agreed that donation is abetter form of addressing the needs of patients who have deficiencyof certain body organs that are crucial in the sustenance of humanlife (65). Besides, donationhappens with the full knowledge and consent of a donor party. On theend side, body selling is both ethically unacceptable and acceptablewith near equal measure. From a patient-centered care perspective,selling of body organs is ethically acceptable when there is a lackof willing donors to donate organs to patients who are on the vergeof death, especially when other measures such as the use oflife-support and dialysis machines have yielded little to no results.Moreover, selling body parts plays a pivotal role in addressing thedeficiencies that exist in the availability of body organs. On thecontrary, the practice is ethically unacceptable when people view itas a normal way of making money (Nahavandi19). This can potentially result in an increase in humantrafficking for the sole aim of illegally obtaining and selling thebody organs of unsuspecting persons. This can extensively damage theintentions of such body sales. Moreover, it can taint the positiveimage of the healthcare sector.
Forboth donation and sale of human organs to be considered as ethical,healthcare experts have to consider a broad range of factors. First,a prospective donor or seller should be in a proper state of physicaland mental health (Nahavandi 27).This would place them in an excellent position to give out theirorgan. Secondly, only qualified surgical practitioners shouldsurgically carry out the surgical removal of organs from a donor’sbody (Cohen 283). This wouldprevent medical errors that could arise when unqualifiedpractitioners are allowed to carry out such delicate procedures.Thirdly, there must be witnesses who could attest to the entiredonation or sale procedure should legal lawsuits arise.
Despitethe shortage of body organs needed to sustain the live of patients incritical care, selling and donating body organs should take placeunder the jurisdictions of the law and within the principles ofethical, professional, and moral conduct. These practices should notbe allowed to erode the acceptable social, ethical, and moral normsof a society. In other words, people should engage in such practicesfreely without being coerced into engaging in them. The law shouldprotect both donors and sellers of body organs to ensure thesepractices serve their intended purposes. Nahavandiindicated that the World Health Organization advocates the protectionof donors against exploitation by unprincipled public healthpractitioners and business people who would seek to utilize thesepractices for ulterior reasons (22). Therefore, as controversial asthey may seem, these practices can best save the lives of needypatients when done ethically, morally, legally, and professionally.
TheBody as Commodity
Sincethe beginning of medical practice, body organs have often had a sharpdeficit. Therefore, many patients have died because of inadequacy orunavailability of body organs. This has prompted some people to seetheir bodies as commodities for sale to addressing theseinsufficiencies. According to Nahavandi,the option of organ markets has gained popularity due to thelucrative nature of organ selling and buying (17). For instance, inNorth America, most people place the value of each of their kidneysat about $7000 (Cohen 283).To most people, this is both a quick and easy way of making money.This has been the cause of ethical and legal dilemma concerning therights that individuals have in disposing their body parts.Commercialization of the human body is a double-edged sword that hassaved the lives of many needy patients who were on the verge of deathwhile leading to gross human rights violations at the same time.Human rights violations result from the tendency of people to engagein illegal tracking of healthy people to act as organ donors inforeign countries far from their usual homeland.
Improvementsin medical technologies for effecting transplants are one of theprimary reasons why people are increasingly seeing their bodies ascommodities for earning extra cash. Today, it is fairly easier forsurgeons to surgically remove and transplant various body organs withalmost no negative effect to the donor (Hausleben164). Therefore, people are increasingly seeing body marketsas alternatives for their financial difficulties. Advancements insurgical equipment have simplified the previously tedious surgicalprocedures that initially took several days before completion. Forinstance, the frequency of renal failures among patients in manyhealthcare facilities prompted researchers to come up with innovativesupport machines for simplifying surgical procedures. Thissignificantly minimized faulty kidney transplants that initiallyaroused fear among donors. Therefore, today, one can have absolutecertitude that a kidney donation procedure will serve the purposethat is intended.
Advancementsin biotechnology have also increased the number of people whocommodify their body parts. According to Cohen,in the next thirty years, people will start selling their DNA becauseof the progressive nature of biotechnological developments in themedical field (280). This implies that there needs to be a form ofregulation in organ commodity markets to protect the misuse of organtransplantation.
Arguably,human commoditization violates all principles of human dignitydespite the benefits it has had on needy patients. The sale ofkidneys, bone marrows, sperms, blood, and eggs compromises humandignity. Ekland-Olson indicated that it is unjustifiable for a personto sell any part or organ of their body for monetary gains (89). Thisshows that people who view their bodies as commodities fail torespect the value and sanctity of their body parts. This is thereason why Epstein indicatedthat the human body is too valuable for anyone to compare them withany other commodity that would normally go for a fee (123). Indeed,from perspective, it is difficult to quantify the value ofcompensations that patients pay to obtain body organs. Usually, thepatient becomes the chief beneficiary of commodity markets. Thecompensation that donors receive for their selling their body part incommodity markets is incomparable to those body parts. Conversely,this does not mean that patients should not receive bone marrows,kidneys and other transplants from other people (Ekland-Olson 143).Instead, people should freely donate their organs without necessarilyreceiving financial compensations for donating those parts. As partof appreciation, patients can return the favor using their own tokenof appreciation. The act of attaching monetary value on body organsshould not be received with acclaim at any given time.
Seeingthe body as a commodity will imminently result in illegal dealingsamong unprincipled healthcare practitioners and the public. This canhave fatal implications especially among minority groups such asthose who have disabilities (Nahavandi26). The lucrative nature of body organs potentially becomethe driving force behind possible exploitation of this organtransplants. Although an increase in organ commodities would addressthe current crisis in organs shortages it would result in majorscandals that would possibly damage the image of the medicalprofession. Epsteinindicated that kidneys are leading organs that are highly in demandyet have the sharpest shortages (114). According to Nahavandi,out of every 500,000 patients in Europe who are in dire need ofkidney transplants, only less than 100, 000 actually get kidneys(26). This has resulted in the loss of lives when patients can affordkidneys yet they cannot access those kidneys. In light of thesestatistics, unscrupulous dealers can opt to bring the black marketsinto the healthcare sector. As such, the reputation of this nobleprofession can soon collapse on its knees because of illicittransactions that are common in organized crime (Epstein134). Therefore, healthcare professionals have a duty tosafeguard the objectives of the medical profession. They can do thisby refusing to take part in illegal body part and organ selling.
Legitimate,legal, and ethical regulations can form the basis for the moralssurrounding the notion of perceiving the body as a commodity.According to Epstein, anunderstanding of the meaning of equity and justice can aid shape theargument revolving around organ selling in body commodity markets(126). There is a lot of hypocrisy surrounding the perceived justicesurrounding the idea of saving the lives of patients because ofselling parts and organs of the body as well as services involvingthe body. For this reason, healthcare experts should embrace highlevels of professionalism and adherence to the law in order to ensureall matters pertaining to the sale of body parts are legitimatelydone according to the confines of legal regulations. Nahavandiestablished that in most countries, the policies that entail organselling necessitate the full consent and agreement between the sellerand the patients (27). Ekland-Olson also indicated that healthprofessionals should base all their decisions regarding the ethicaldilemmas that could possibly face on the jurisdictions of legalregulations and policies (119). This implies that it would beundeniably illegal for anyone to coerce another to sell any organ ofhis or her body. In this light, in the clinical setting clinicalpractitioners should strive to ensure the surgical removal of bodyorgans for the purpose of transplantation are done both fairly andsquarely. However, it can be challenging practitioners to ascertainwhether body parts that come from donor organizations are obtainedlegally. According to Epstein,this is because some people normally opt to take the shorter routewhen selling body organs (131). They do this by selling those organsdirectly to donor organizations that in turn avail such body parts topatients who may need them.
TheBrain Death Controversy
Theissue of brain death is one that healthcare experts hold diverseopinions about hence, there are several points of departure amonghealth professionals on its applicability and the relevance of itspracticality in healthcare organizations. Arbourdefined brain death as a state in which the human brain cannotfunction properly due to loss of crucial clinical functionalities(40). In all known cases, the loss of these functionalities is oftenirreversible. Some psychiatrists have argued that brain death is anindicator that the body cannot implement its normal functionalitiesneeded to sustain one’s life. In brain death no functionality ofthe brain remains. Instead, there is a permanent cessation of normalbrain functions. Since the brain is the body’s control center,brain death results in alterations in other body functionalities thatrequire impulses and reflexes from the brain (Burkle,Richard and Wijdicks 1463). Brain death according to Bernatand Larriviere can occur naturally as well as when anindividual experiences a catastrophic brain injury, which canimminently result in total termination of the brain stem and upperbrain structure’s capacity to execute their normal functions thatare crucial in regulating various metabolic systems of the body(1394). Burkle, Richard, andWijdicks indicated four major causes of brain death (1467).These are aneurysm or cerebrovascular injury, tumors in the brain,anoxia and severe head injuries which could result for instance fromgunshot wounds or motorcycle crashes. Despite the efforts thathealthcare experts may inject to avoid brain death among patients,the phenomenon is usually a delicate one to handle (Bernatand Larriviere 1395). In nonprofessional’s parlance, braindeath is usually similar to a coma or otherwise a persistentvegetative state. However, Welscheholdhas distinguished these alterations in the brain’s normalfunctionality capacities by indicating that in both a persistentvegetative state and a coma, certain autonomic roles of the brainremain intact but in brain death the all-autonomic functions ceasepermanently and irreversibly (176). This is the reason manyhealthcare organizations use brain death as one of the pillars ofdetermining whether death has taken place thus, a significant numberof medical professionals concur about the permanency andirreversibility of the autonomic purposes of the brain. Diagnosis ofbrain death is an elaborate process necessitates the presence ofneurologic experts who can carry out neurologic examinations of aperson’s brain. During brain death, the brain’s electricalactivity level drops drastically. Therefore, neurologic practitionersintensively examine the complete irreversibility of the brain’sfunctions before establishing complete cessation of the brain’sneurologic activity.
Thecontroversy surrounding brain death is two-fold. First, is whetherbrain death should be linked or differentiated from biological death.This is the primary reason why families of brain death victimsusually find extreme difficulty understanding a declaration of braindeath by medical practitioners. A more direct way of understandingbrain death is that one becomes deceased the moment they experiencebrain death. In essence, brain death means that an individual hasdied (Bernat and Larriviere 1394).According to Welschehold,when physicians diagnose and pronounce a person brain-dead, legalcertification for death can surely take place (174). Many healthcareexperts agree that a diagnosis of brain death can form a legal basisfor an issuance of a certificate death since the body’s normalbiological processes that depend on the brain’s reflexive impulseswill not be in a position to execute their functions. This means thatthe body is biologically dead should there be an absence ofartificial means of sustaining these functions on a temporary basis.As such, the legal time of death comes at the point when physiciansdeclare that a patient’s brain activities have a come to permanentcessation. On the end side, other pathologists insist that a state ofbrain death is dissimilar from a state biological death (Burkle,Richard, and Wijdicks 1468). Their argument is based on theview that certain body organs can continue to function temporarilyamong those declared to be brain dead. These organs can stillfunction when patients are put under life-support machinery. Fromthis perspective, it would be incorrect to link brain death withbiological death.
Thesecond reason for the brain-death controversy is grounded on theethics of organ transplantation in brain death victims. Before anytransplantation can take place, the next of kin and families of avictim are usually notified. Obtaining consent from these people isimportant in ensuring organ transplantations take place within theconfines of the law. Bernat andLarriviere have argued that it is morally unjust to removeorgans from an individual who has been declared as brain-dead (1395).According to Ekland-Olson, it is unjustifiable to remove organswithout the consent of the donor themselves in this case, abrain-dead individual (117). However, Welscheholdcountered this argument by articulating that the process of organtransplantation takes place surgically with the full consent of avictim’s next of kin and family members (175). Besides, the processof transplanting organs takes place under ventilator support hence,the organs under consideration remain alive. In line with thisargument, donating organs is crucial in saving the lives of otherpatients who could be in need of organs from those declared asbrain-dead. Moreover, many brain dead patients usually indicatebefore brain death diagnosis that they would want to donate theirorgans upon their subsequent death.
Therefore,the brain death controversy will continue to elicit differentreactions from the health professionals. While most experts agreethat brain death and biological death are similar since a brain deadindividual is legally dead, this opinion is still divided among asection of pathologists who do not link brain death with biologicaldeath. Also, the ethics surrounding surgically removal and donationof organs from persons who have been declared as brain dead willcontinue dominating this debate.
Physician-AssistedDeath and Euthanasia
Physician-assisteddeath and euthanasia are controversial issues in the contemporaryworld. The controversy surrounding these practices is attributable tothe manner in which death is induced instead of taking a naturalcourse. In physician-assisted death, a healthcare practitioner givesa lethal drug that a patient has to take willingly when they opt foran induced form of death (Emanuel,Onwuteaka-Philipsen, Urwin, and Cohen 79). On the other hand,euthanasia is whereby a qualified healthcare practitioner administersa life-threatening medication on a patient (Chambaere,Cohen, Bernheim, Vander Stichele, and Deliens 891). In botheuthanasia and physician-assisted death, the demise of a patient isartificially induced. Before these practices can take place in anyhealthcare facility, medical practitioners have to allow the law totake its course. The law mandates health professionals to counseltheir patients adequately whenever a patient may feel that inducingdeath could be the best solution to eliminating the suffering theycould be going through. Ekland-Olsonestablished that this is meant to prevent the abuse of thesepractices (122).
Thesepractices are acceptable and unacceptable at the same time indifferent settings. The ethics of these practices depends on thecircumstances that necessitate them. Both physician-assisted deathand euthanasia are acceptable when administered to terminally illpatients under critical and palliative care. For this category ofpatients, the sufferings they go through are quite unbearable.According to Sulmasy, Ely, andSprung, these practices are only permissible if practitionersdo not coerce patients to use them (1600). Instead, practitionersshould first exhaust alternative means of eliminating sufferingbefore resorting to euthanasia and physician-assisted death.
Physician-assisteddeath and euthanasia are useful in alleviating needless painespecially among terminally ill patients. From a terminally illpatient’s perspective, these practices are acceptable since theytake place with their full knowledge. Besides, practitioners have anobligation of embracing practices that minimize pain and sufferingamong patients. From such a viewpoint, it is clear that botheuthanasia and assisted death fairly eliminates the need forprolonged suffering among patients (Ekland-Olson142). Furthermore, these practices only take place candidlyand legitimately. This is because practitioners administerlife-threatening medications with the full consent of the state, thepatient and their relatives. In other words, these practices aremoral from when healthcare professionals and the society in generalsee things from the patient’s perspective.
Althougheuthanasia and assisted suicide do not shield the sanctity of apatient’s life, the need for healthcare professionals and thesociety to respect the ability of patients to make major decisionsregarding their life reasonably justifies these practices(Ekland-Olson 111). Thisargument is motivated by the fact that only patients truly understandthe pains and suffering they go through because of ailments andmedical conditions. As such, patients have the right to determine thetiming and mode of their death. According to Chambaere,Cohen, Bernheim, Vander Stichele & Deliens (894) hasteningdeath is a better alternative to excessive suffering which willeventually result in death. In blunt terms, a patient who undergoeseither assisted death or euthanasia will have escaped needlesssuffering.
Otherthan the morals surrounding these forms of death, these practices areonly undeniably permissible when the law supports their use.Different countries have dissimilar regulations and laws that eitherlegalize or illegalize the practice (Ekland-Olson136). Therefore, it would be untenable for practitioners tocarry out these practices in situations where the existing laws donot support these practices. For example, Switzerland does allowthese practices while the existing laws in Unites States and theUnited Kingdom mainly prohibit these practices (Emanuel,Onwuteaka-Philipsen, and Urwin & Cohen 79). In the U.S,these forms of death are only legal in Montana, California, Vermont,Oregon and Washington (Emanuel,Onwuteaka-Philipsen, Urwin, and Cohen 79). Therefore, inAmerica, it would therefore be illegal and immoral to perform thesepractices outside these five states.
Legally,euthanasia and assisted death are only reasonable and acceptable whenvarious factors are put into careful considerations when the existinglaws support them (Chambaere,Cohen, Bernheim, Vander-Stichele, and Deliens 893). First, awritten request for death should have been done in the presence of awitness. Such a request can therefore act as a piece of evidenceshould legal lawsuits arise. Secondly, a certified medicalpractitioner should have endorsed the request upon carefulexamination of a patient’s medical condition and health status.This means that these forms of induce death are legally allowed whena patient has undergone much suffering because of a terminal illness.Thirdly, a resident physician of the respective healthcare facilityshould have provided alternative means of reducing suffering.Therefore, assisted death and euthanasia should only be utilized aslast alternatives after all other possible alternatives have beenexhausted. Fourthly, these medical practices are only acceptable whena patient who request for their use is above 18 years (Sulmasy,Ely, and Sprung 1600). This implies that both assisted suicideand euthanasia are prohibited among minors. Currently, no country haslaws that legalize these practices among children.
Thehistory of physician assisted death and euthanasia can aid shape theethics and morals surrounding these controversial medical practices.The applicability of these practices is based on their history. Sincethe advent of medicine, artificial means of inducing death have oftenbeen considered as viable alternatives for reducing the sufferingthat patients in critical care go through. Illnesses and medicalconditions have often caused excessive pains and suffering,especially when the efficacy of diverse modes of treatment yieldslittle or no results. The inevitable nature of suffering has oftencompelled some patients to push healthcare practitioners to bringdeath closer (Sulmasy, Ely, andSprung 1600). For a long time, many patients have oftenconsidered either euthanasia or physician-assisted death as betteralternatives to hospice and critical care. Besides, the financialburdens of critical care have for a long time influenced the need forthese forms of death. In the ancient Greek society, famousphilosophers and scholars Aristotle and Plato supported euthanasiadue to their convenience (Chambaere,Cohen, Bernheim, Vander-Stichele, and Deliens 894). Theirargument was majorly because euthanasia eliminated unnecessarysuffering among patients who suffered from life-threateningillnesses. Aristotle particularly held the opinion that it was indeedunjustifiable for any individual to suffer helplessly for the rest oftheir lifetime due to incurable terminal diseases, if physicianscould find alternative means of eliminating such suffering on apermanent basis (Chambaere, Cohen,Bernheim, Vander-Stichele, and Deliens, 893). Therefore, thecurrent argument among the healthcare fraternity that euthanasia andphysician-assisted death are effective in permanently eliminatingunnecessary suffering has its foundations in the philosophicalarguments of Plato and Aristotle. Also, these philosophers arguedthat these forms of induced death are only ethical when the done withthe full consent of a patient. This shows that these practices areundeniably justifiable when proper steps are followed and the reasonfor their choosing them are for the benefit of a patient.
Theethics surrounding euthanasia and assisted death are somewhatconvoluted. Therefore, it could be challenging for healthcarepractitioners to understand when to embrace and support thesepractices despite existing laws that support these forms of clinicaldeaths. From a medical professionalism perspective, both euthanasiaand assisted death breach the Hippocratic Oath of medicine that allqualified practitioner have to take during medical training inmedical schools (Sulmasy, Ely, andSprung 1600). This oath is a unique pledge that all certifiedmedical practitioners make with regard to preserving life. This oathprohibits any healthcare professional from administering any kind oflethal drug, deliberately and inadvertently. This means that whenphysicians, nurses and other clinicians self-administer or givelethal dosages to patients, they go against the oath that obligatesthem to preserve life. Notably, this is because these practices donot preserve life but instead take it away. On the other hand, botheuthanasia and assisted suicide can be said to support the primaryobjectives of healthcare that is, to eliminate or minimize sufferingand pain among clients that seeks healthcare services (Chambaere,Cohen, Bernheim, Vander-Stichele, and Deliens 893). From sucha point of view, it is true that these practices alleviate thesuffering that terminally ill patients go through on a day-to-daybasis. One of the primary targets of the medical profession isalleviate the pains that patients go through. In line with this,medically induced deaths therefore solve the challenges that somecritically ill patients go through in their lifetime. Therefore, itwould be unjust and biased for practitioners to sit aside and watchpatients suffer helplessly.
Inconclusion, controversies are inevitable in healthcare as they are inall other fields of professional practice. Indeed, issues such aseuthanasia, assisted death, pedophilia, making medical decisions forincompetent individuals, selling and donating the body as acommodity, as well as the brain death controversy are debatable. Thearguments surrounding these healthcare issues are expected to gainfurther momentum in the near future. According to Ekland-Olson, theprogressive advancements in medicine are expected to further fuel thedebate about a broad set of medical issues that have already eliciteddiverse reactions among healthcare experts, the religious fraternity,the public, and human rights activists in various corners of theworld (114). The debate surrounding these healthcare issues isattributable to the ethics and morals that surround the intendedbeneficiaries of these practices. The medical fraternity has for along time argued out that issues such as making medical judgments foran incompetent person aims at suiting the best interests of therespective individuals. On the downside, human rights campaignersoppose such practices because of the widespread perception that in asmuch as an individual might have been determined to be mentallyincompetent to make major decisions surrounding their wellbeing, theystill hold the final say concerning central medical issues regardlessof the consequences of their decisions. Also, critics ofcontroversial clinical practices hold the opinion that unprincipledhealthcare practitioners could misuse such practices against the bestinterests of patients. For instance, amoral clinical practitionerscould apply euthanasia on selected patients whose families or closeassociates might have clandestinely requested for the termination ofthe patient’s life for the sole aim of cutting down swellingmedical expenditures. According to Chambaere,Cohen, Bernheim, Vander Stichele, and Deliens, this is usuallythe case when families, guardians, and close associates of suchpatients do not see any improvements in the health of their lovedones despite spending significant sums of money that could haveotherwise been put to some productive use (893). In essence, ethicsin the healthcare industry are debatable. Nevertheless, healthcareexperts are often in the best position to make principled andprofessional decisions that can best address the challenges thatpersons under their care experience during their sessions in medicalfacilities. For these practitioners to make such decisions properly,they have to understand various tenets of ethics and moralitysurrounding controversial healthcare issues. Thus, this was the primefocus of this discussion.
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