Introduction
Ethics in the medical field have received increased attention in the recent past. In fact, advancement in therapy and medical diagnostic technology has triggered new challenges, which would raise ethical concerns. Therefore, the discipline has been widely evaluated on the ethical principles of practice as well as on the standards and quality of care offered. In particular, the debate on the appropriateness or otherwise of physician-assisted termination of life has been wide (Paulus 1). By definition, medical ethics are said to be a system of moral principles by which values, as well as judgments, are applied in the discipline of medicine. Therefore, ethical medical practices have been shown as critical in clinical settings (Paulus 1).
On the other hand, the terminal healthcare, stems from the management or treatment of such health conditions as are considered incurable or difficult to manage. Often, terminal illnesses result in death or lingering physical, psychological, as well as emotional suffering. Therefore, in the ongoing debate on legalization and the appropriateness of the physician-assisted death, ethical concerns arise (Callahan and Peter 1). In fact, to the majority of terminally ill patients, euthanasia presents a desirable solution to the termination of suffering. Nevertheless, not all governments have legalized the practice because of the opposition presented by the respective societies on the grounds of morality and ethics. However, besides justifying the morality or ethics of euthanasia as a management procedure, one would consider the debate from a different perspective. Such a perspective focuses on the appropriateness and ethical desirability of extending healthcare to the terminally ill patients. Therefore, this paper, presents research on the question of why terminal healthcare could be socially and ethically undesirable.
Background Information
There are various health conditions, which are considered as terminal. Such conditions do not have curative medication and therefore, the only mechanisms often available are management mechanisms (AMA 1). For instance, many cancer diagnoses are fatal and lack curative medical treatment, especially at the advanced stages. Nevertheless, medical advancement has resulted in effective tools for management of such conditions with the aim of reducing patient suffering while prolonging the patient’s life. However, it is worth appreciating that without the known treatment, terminal illnesses lead to death (AMA 1). In fact, even though the medical management practices and interventions, the patients experience serious sufferings and would have to succumb at some point (Mohanti 1). Therefore, much of the previous discussions would be based on whether the prolonging of the life is desirable or ethical, considering that death would be ultimate.
With many people arguing in support of the management practices, others would challenge the motive of the medical management practices. For instance, to some, terminal health care would reduce much suffering even when the patient awaits death, which is highly desirable. Secondly, others would support terminal healthcare from the premise that increased efficiency would be realized through the advanced medical science and technology (Callahan and Peter 1). Nevertheless, the opposing opinions would point out that terminal care could only be beneficial to the medical practitioners and the pharmaceutical companies who reap much from the sale of the services and medications. In fact, some would argue that terminal care is extremely expensive and often leaves the society and the respective families in a worse state after draining all resources without a cure. In essence, the debate would take the different perspectives while considering the social and ethical desirability of the terminal healthcare.
Ethical Dilemmas and Concerns
The debates illustrated above arise from positions of ethical dilemmas regarding the application of the advanced technologies, resource utilization, and helping the dying patients. For example, a dilemma arises in the choice of the most appropriate medication to embrace for the management of suffering of the patients and the associated resource allocation (Paulus 1). Secondly, ethics would regard how the society or the families of the patient would suffer from the allocation of resources to the patient as compared to the gains realized in easing the suffering of the patient. Another dilemma arises in the question of ethics in allowing the patient to suffer so that the society can save the resources (Callahan and Peter 1). Finally, an ethical dilemma arises in the question of how desirable the death of the patient would be by the consent of the physician attending to him/her. While such dilemmas arise almost daily, different opinions justify different interventions. However, one would appreciate that the patients are entitled to life, and therefore, nobody would have the legal mandate to assist or facilitate death. However, on some occasions, the patients prefer death to life and therefore approach the physicians through consent to have life terminated through medical assistance (Paulus 1). For instance, a patient may opt to die through lethal medication or withdrawal from a life-supporting machine. Nevertheless, one should appreciate that such provisions of the law are not available in all countries. In fact, to some countries, allowing euthanasia would infringe the rights of patients to live as the physicians would decide to cause death without the consent of the patient. Other reasons for failure to legalize physician-assisted deaths would be ethical and religious concerns (Mohanti 1). On the other hand, even in the countries where euthanasia is legalized, supportive legal framework often applies to ensure that the physicians adhere to the law.
Literature Review
Decision making in terminal healthcare has been evoking ethical concerns (Fischer 1). In a study to evaluate the decision-making process in the context of terminating life through physician assistance, McIntosh and Vander embraced the model of resources, values, knowledge responsibility, as well as the law (1). Accordingly, the study involves the analysis of various cases of making decisions regarding terminal illnesses. The social workers were shown to have the primary responsibility of conveying the information on a patient’s status in the event of diagnosis of the terminal condition. Therefore, the social worker would need to be informed, accustomed to values and ethical standards in the palliative care system, and embrace the client-centered approach (McIntosh and Ralph 1). The importance of appropriate conveyance of the bad news to the patient would be as important as it would be for the family and close relations. At times, the medical practitioners are known to overlook compassion and embrace efficiency in the management of the terminal illnesses. For instance, when the patient or the guardians agree to facilitate physician-assisted suicide, then the physicians would not resist, especially in the cases where the law permits euthanasia. Furthermore, the justification of the social or ethical inappropriateness of continued sustenance of a patient’s life through life support mechanisms would be relied upon while deciding on the ethics of supporting terminal healthcare (Callahan and Peter 1).
However, according to the study by McIntosh and Vander, making the appropriate decisions in health care has not always been easy (1). In fact, sometimes, the medical practitioners are forced to take the decisions that would be considered ‘less wrong.” Furthermore, the decisions made may lack any way to prove the appropriateness or otherwise of the future. Therefore, the professionals are mainly guided by a predefined code of ethics, which are developed from cultural values, social/legal norms, and professional theory (McIntosh and Ralph 1). However, with the increased advancement of technology and legal persuasion, professionals would be challenged in applying the professional code of ethics in all situations.
In another opinion, physicians have a social commitment to sustain human life as well as reducing the sufferings (AMA 1). In such case, whenever the performance of one of these responsibilities, conflicts with another, then the patient’s preference would always prevail.
The principle of autonomy requires that the physicians respect the decisions of the patient. For instance, when the patient intends to terminate life through withdrawal from life-sustaining systems, then ethics would dictate that the physician adheres to the consent of withdrawing him/her from the machines (AMA 1). The decision would also be guided by the surrogate appointed by the patient or as would be appointed by the family in the instance that the patient is incapable of making the choice. Nevertheless, ethics and morality rationale comes into play whenever the physician in charge has justifiable concerns against the decision made by the surrogate towards the termination of the patient’s death. Accordingly, when the physician establishes justifiable reasons to doubt the motives of the surrogate towards the patient, then he/she would have the moral authority to overlook the call to facilitate death (AMA 1). However, the medical practice ethics also highlight the importance of considering the interests of the family and the society before making the decision to terminate the life of the patient. Whenever the reason of caring for the terminally ill is outweighed by the ethical interests of the society and the family, then such life-sustaining measures would need to be overlooked.
This paper, however, takes the position that terminal health care would be socially and ethically undesirable. The explanation would be derived from the social perspectives as well as the ethical debates highlighted.
Discussion
Terminal illnesses have been shown to contribute to significantly a large number of deaths in the modern populations (McIntosh and Ralph 1). While medical advances have made progress to prolong life, even for the terminally ill, the technology has not yet delivered curative medicine to the terminal conditions. Life support technologies, in particular, are widely used to sustain the body functioning of the terminally ill patients when at the critical position of death. For the hospice care, the health care professionals such as the doctors, the nurses, the social workers and other related professionals try to offer the dying patient as much comfort as possible. The quality of life and pain control are the primary focus of the hospice care. Indeed, the motive of the hospice care is to ensure that the dying patient realizes a “good” and honorable death (Callahan and Peter 1). Therefore, the medical interventions recommended are aimed at controlling pain while prolonging life. Nevertheless, challenges arise with the ability of the patients and their families to manage the costs associated with the medical care.
In fact, many of the medical care funding options available do not cover such care as terminal care. Therefore, the cost is often left to be borne by the respective families and the society. Often, families result of selling their assets to manage the costs of the terminal care. Repeated and overexploitation of the family resources lead to their depletion (Callahan and Peter 1). In the same aspect, the overexploitation and possible depletion of the family resources contribute to more suffering for the families and the dependents. On the other hand, families and the societies suffer psychologically when the patient is admitted to the hospital or is receiving the terminal care at home. In fact, such suffering would not be quantified because there are other people who suffer even than the actual patient. Therefore, in that aspect, the debate would focus on evaluating which suffering would be desirable to the patient or to the majority of the family and society members (McIntosh and Ralph 1).
The discussion would equally focus on the ethical dimension of the case. For example, neglecting a terminally ill person by the family member and society would be unethical. Similarly, neglecting the family or other dependents for the sake of caring for one dying person would be unethical (Fischer 1). However, when the debates regard exploiting the resources for the greater good, then everyone would be justified. One would thus argue in support of withholding the family resources from the use in medication purposes of the terminally ill with the argument that the resources produce benefits to the larger population; hence, more desirable than committing the resources to an individual who is facing impending death (Mohanti 1).
On the other hand, morality and ethics would command all resources to be sacrificed for the sake of one life because the act would be desirable and much good would be realized by prolonging his life and lowering the suffering (Fischer 1). In fact, the argument would indicate that when the patient suffers or dies, the society and the family would suffer more than when the patient is in the hospital. Either of the arguments would be justified and hence, the reason to commit or withhold the public resources for the sake of the patient. However, another ethical issue would arise in the understanding that the physicians attending to the patients and who demand the hefty amounts of money would always be sure that the patient would not survive. In fact, one would consider it unethical that the physician would continue asking for hefty amounts of money for treating the condition without sympathizing with the sick and the dependents (McIntosh and Ralph 1). Similarly, much of the finances remitted go to the payment of the medication administered and therefore, the medicine manufacturing companies benefit greatly. The question would thus be on how ethical the medical practitioners and the medicine producing the companies would be while charging hefty amounts of money from the sick (Fischer 1).
Therefore, the physicians and other medical practitioners involved in the delivery process in the terminal care would be blamed on overlooking the basics of ethical principles in medical care (Mohanti 1). Medical practitioners operate under the guidance of the ethical principles of autonomy, justice, nonmaleficence, and beneficence (Fischer 1). These principles are to be applied in the cases of the terminal illnesses by the practitioners. Nevertheless, when the therapy turns futile, and the suffering increases, the patient or the surrogate would result to requesting for withdrawal or withholding of the life-sustaining interventions. In fact, at the extreme, nutritional support of medical support may be stopped to facilitate termination of life for the patient (McIntosh and Ralph 1). However, the current studies focus on the ethics in the desires of some people to prolong their lives or the lives of the loved ones at the expense of others. The societies and families would result to bearing the high burdens associated with the terminal healthcare aimed at prolonging the lives of the patients.
Therefore, as argued previously, all or much of the resources of the families are utilized without considering the impacts of the individuals who depend on the resources (Mohanti 1). As such, the argument would confirm that the exploitation of resources for the sake of the terminal cases at the expense of their families and the society would be undesirable and unjustifiable. The commitment of the resources would produce much suffering to the society than the assumed good that would be committed to the patient (Callahan and Peter 1).
Conclusion
From the literature reviewed and the discussions highlighted, one would observe that the argument of whether or not caring for the terminally ill is ethically or socially desirable would have various approaches and rulings. Nevertheless, this paper takes the position that caring for the terminally ill would be undesirable. First, the social undesirability is justified by the fact that much of the resources used in the management and medical care would be used at the expense of the larger good. The family and the society would result to selling the only assets to meet the medical bills of the patients. However, such would be done with a more or less definite reality that the patient would succumb at some point. The medical caregivers and the medical supply companies become the most beneficiaries from the exploitation of the families and the society while the majority of the dependents suffer from the depletion of the resources.
Besides, the dependents of the patients would result in becoming burdens to the society after the depletion of the family resources. Therefore, this paper takes the position that prolonging the life of terminally ill while caring for them would not be desirable because the ultimate death would leave the dependents and the society in a worse state. Moreover, when the patient is undergoing treatment, the family and friends experience psychological issues than would be after the death of the patient.
On the other hand, ethical consideration would support the quick death of a terminally ill person, a situation that would produce the larger good of the majority. The explanation is that when the patient is enrolled in the terminal healthcare, the suffering would be higher with the family and friends than with the patient. Ethically, any action taken should pursue the benefit of the majority, and therefore, this paper would recommend that such patients should not be enrolled for any such medication. In essence, it would also be ethical that the common resource is safeguarded for the good of the majority instead of being committed in the course of managing the terminal illness, which has no known treatment.
Recommendations
From the discussion, this paper holds the stance that terminal illness care would be less socially and ethically desirable. Accordingly, the paper recommends that instead of spending the family resources on a condition that would not be recovered, then the patient would not need to be sustained. Instead, the option of physician-assisted death would be more viable. The deliberate termination of the life would serve the interests of the patient and that of the family and the society. In fact, failing to sustain the life through the medical care would be more desirable to the society than embracing the expensive terminal care.
Works Cited
AMA. “Opinion 2.20 – Withholding or Withdrawing Life-Sustaining Medical Treatment.” Opinion 2.20 – Withholding or Withdrawing Life-Sustaining Medical Treatment. 2016. Web. 27 Apr. 2016.
Callahan, Daniel, and Peter Augustine Lawler. “Ethics and Health Care: Rethinking End-of-Life Care.” The Heritage Foundation. 2012. Web. 27 Apr. 2016.
Fischer, D. S. “Observations on Ethical Problems and Terminal Care.” The Yale Journal of Biology and Medicine. Yale Journal of Biology and Medicine, 1992. Web. 27 Apr. 2016.
McIntosh, Beverlee, and Ralph Vander Hoek. “Negotiating the Path of Ethical Decision-Making in Health Care Social Work.” University of Windsor. 2006. Web. 27 Apr. 2016.
Mohanti, Bidhu K. “Ethics in Palliative Care.” Indian Journal of Palliative Care. Medknow Publications, 2009. Web. 27 Apr. 2016.
Paulus, Stephanie C. “Palliative Care: An Ethical Obligation.” – Resources. 2016. Web. 27 Apr. 2016.
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