Applying Ethics to End of Life Care can be a difficult task for those involved in making the decisions pertaining to active and passive euthanasia, as well as palliative care when it comes to themselves or loved ones. According to The Last Chapter-End of life decisions “there often comes a time that advances in medicine are no longer your friend, they become the enemy” (West Virginia Public Broadcasting, 2010, Dec. 28). Euthanasia, or right to death; according to Mosser (2014), “the argument for euthanasia is straightforward: A person who is virtually certain to die within a given amount of time and is experiencing or will experience a lot of pain before he or she dies should be able to choose an earlier, less painful death. What purpose is served by keeping a person alive only to experience constant, agonizing pain?” (sec. 6.3, para. 32). The answer to the question would seem rather obvious depending on your point of view. According to Palliummja (2011, March 19) Dr. Balfour Mount stated “People do not have to die with pain”, and Kass (1989) states “Each person has a right to control his or her body and his or her life, including the end of it” (pg. 27, para. 1). Within this paper is a look at three different ethical points of view. The topic of End of Life Care will be explored through the perspective of the utilitarian, the deontologist, as well as the relativists. Each one of these theories have their own take on what is considered morally right and morally wrong. Although each of these theories have their benefits and cons, it is this researcher’s belief that the relativist’s point of view would be the best ethical theory to apply when dealing with End of Life Care issues because it is left up to the individuals own moral standards of what they perceive to be the morally right or wrong thing to do.
We will first take a look through the eyes of the relativist. According to Mosser (2014), “we should recognize that there are no universal or general ethical standards; that a person’s ethical view is relative to his or her culture, society, tradition, religion, worldview, and even individual values. Because moral claims are said to be relative to something else”, he continues with “Even though philosophers distinguish between different kinds of relativism, we will generally use the term to mean that any ethical claim is relative to a set of beliefs and that any such ethical claim is true, or consistent with, that set of beliefs” (sec 6.2, para. 14). It is the individual aspect of relativism that I would like to focus on as the best way to tackle ethical questions pertaining to end of life care. This leaves the decision solely up to what the individual believes is the right thing to do, based on his or her own personal beliefs. If it is considered ok by that individual to go ahead and end their life, through active or passive euthanasia so they do not suffer more pain than what is necessary, then that is what the morally right thing to do would be. The relativist simply says that the practice a given culture/individual adopts as correct determines what should be done (Mosser, K., 2014).
The second ethical view that we will be looking at is the deontological theory. According to Mosser, K. (2014) “deontological ethics focuses on the will of the person acting, the person’s intention in carrying out the act, and particularly, the rule according to which the act is carried out. Deontology focuses on the duties and obligations one has in carrying out actions rather than on the consequences of those actions” (sec. 6.1). In short the deontologists is not concerned with consequences, but rather what it is the law of the land says is right or wrong. This means that even if a patient was certain to experience excruciating pain and suffering, and was certain to die in a matter of days, euthanasia would still not be permissible because the law states that killing is the wrong thing to do. This would present a problem for a patient who is wanting to end their life early because the physician would be bound by law not to perform such acts because to kill a person is against the law. The doctor patient confidentiality aspect cannot be applied in this case. The good thing about the deontological view is that it keeps doctors in check by not allowing a doctor to end a life just because they no longer wish to treat an individual. Kass gives an example of this by stating “Even the most humane and conscientious physician psychologically needs protection against himself and his weaknesses” (pg. 35, para 3). Meaning that the law is set in place so that a doctor does not make killing a therapeutic option. But even though this is a check so to say for the doctor, this cannot be the ethical theory best to satisfy ones individual need or want for an earlier termination of life, if in fact that is what they choose to want happen.
The utilitarian in this situation would ask that we take a look at the consequences of such an act as euthanasia, taking into consideration as to what is the best outcome for the most amount of people. According to Mosser, K. (2014) “When given a choice between two acts, utilitarianism states that the act that should be chosen is the one that creates the greatest amount of happiness for the greatest number of people” (section 6.1). This has its strong and weak points as well. The strong point in this is that it takes a look at every aspect of the situation, analyzing the benefits and cons to either end a life or keeping an individual alive. The problem with this view lies with, who is it that benefits the most, is it the patient and patients family who benefits more, or is it the hospital or physician who benefits more. A point made in the video End of Life Care Dilemma: Who gets booted from ICU stated that hospitals tend to “bounce from the emergency room the person who you know is going to die soon” (ForaTv. 2010, April 14). The reason for this is the amount of money made by keeping ICU beds full. It could cost up to two million dollars to keep an individual alive for two years. In the view of the video provided it would be more cost efficient to end a life and use the two million dollars to pay for school lunches for school children prolonging life for 500 years rather than the two years for the one individual (ForaTv. 2010, April 14). So the question remains, who is it that benefits more? It would seem as if the hospital would benefit more by ending a life because it opens up a new bed for the next individual. When it comes to end of life care and utilitarianism there is no sure way to know that ending a life would be benefitting the right individuals.
In conclusion, it is this researcher’s belief that the best ethical point of view to use when dealing with end of life care would be the relativist ethical theory. This theory allows an individual to make the decision based on what it is that they feel is the right option to do. There is no outside influence as to what a person should do when you are able to make the decision based off of your own moral beliefs. As stated above by Kass, “Each person has a right to control his or her body and his or her life, including the end of it” (pg. 27, para. 1). This right is taken away once you put forth a deontological or utilitarian point of view. The individual no longer has a say in what it is to be done with their life. Many would opt for a less painful death, in fact this researcher would opt for a less painful death knowing that I may spend the rest of my life in agonizing pain, or deteriorating.
Even if it was the patients wish to die peacefully before suffering the agonizing effects of the disease, there is nothing that the doctor can do to assist with these wishes, because the law of the land prohibits murder, and since active euthanasia would be causing the death of an individual with the intent to cause the death, this would be classified as murder, this is why the deontological approach cannot work in terms of end of life care. It removes the individual’s wishes as to what they want to have happen, and replaces it with what society believes should happen. The utilitarian point of view is also one that removes the individual wants or needs from the end of life care factor. It brings in the benefits of others that may out weight the benefits of the individual. It is these reasons presented within this paper that this researcher believes that although each of these theories have their benefits and cons, it is the relativist’s point of view would be the best ethical theory to apply when dealing with End of Life Care issues because it is left up to the individuals own moral standards of what they perceive to be the morally right or wrong thing to do, and there is no other influence on what should be done with one’s own life.
ForaTv. (2009, Sep. 24). End-of-life care dilemma: Who gets booted from the ICU? [Video file]. Retrieved from http://www.youtube.com/watch?v=0XpAYPgjMYg Kass, L. R. (1989). Neither for love nor money: Why doctors must not kill. Public Interest, 94, 25-46. Retrieved from the ProQuest database. Mosser, K.
(2013). Understanding philosophy. San Diego, CA: Bridgepoint Education, Inc. Palliummja. (2011, March 19). Dying for care – quality palliative & end of life care in Canada (English subtitles/captions) [Video file]. Retrieved from http://www.youtube.com /watch?v=Q6mUbIjKEEI
West Virginia Public Broadcasting. (2010, Dec. 28). The last chapter – end of life decisions [Video file]. Retrieved from http://www.youtube.com/watch?v=8jKUZ8lS9b4