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Case Study: The Clinical Moral Dilemma

Public morality is one of the most dynamic social constructs that characterize the degree of development of a population. The impermanence and non-conservatism of ethics respond to the lack of unambiguity that exists between the ethical question and the answer (Kruijtbosch et al., 2018). Indeed, decisions to help a poor grandmother trying to cross the road or a stray dog in need of food does not seem complex and do not require critical reflection: it forms a basic level of moral issues. In contrast, moral dilemmas similar to discussing abortion or the clinical suicide of a patient by choice are much more challenging to solve and often require additional perspectives. This essay examines the clinical scenario of a local hospice-type inpatient care facility resolving the moral dilemma surrounding euthanasia. The essay is a valuable academic piece, raising current ethical issues and examining current standards defining the parties’ responsibilities in this case.

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Primarily, a brief description of the case proposed for analysis should be given in order to summarize the material and form a framed vision. Inpatient M. J., who is a regional hospice patient, has expressed a personal desire for physician-assisted suicide (PAS) procedure. Obviously, such a program raises essential moral and documentary issues since the decision to assisted suicide, regardless of the person’s condition or wishes, must be carefully considered and coordinated with local law. More specifically, under the current provisions of the U.S. Health Care Act, M. J. has a full civil right to request such a program as it relates to the human right to die (Baksheev et al., 2018). Every individual is guaranteed the inherent freedom to choose the manner in which their life ends, including suicide, euthanasia, or PAS. Nevertheless, guided by personal considerations about morality, the clinic’s professional reputation, and humanitarianism, the doctors and nurses at the local hospice initially refused to assist the patient in this procedure. Indeed, from a jurisdictional standpoint, this refusal seems a direct violation of M. J.’s civil rights, which in turn has the potential to create a public conflict in the local community, initiated by the press.

It should be noted that this scenario is not ordinary and instead raises a number of important issues and vulnerabilities of public morality and rules. In addition, even in the description of the case study, there are some nuances that may also influence the final decision. First of all, there is no discussion of the psychomental state of the patient, but it is indicated that the decision to exercise the right to PAS was reached after a discussion with a brother who is a champion of the right to euthanasia. Consequently, the possibility of a pressuring effect of a close relative biased on the issue cannot be ruled out. The second pressuring effect in the scenario comes from medical staff members who are so unprepared to assist in clinical suicide that they are willing to lose their jobs instead. Obviously, if a hospice chief physician is faced with the question of firing a dozen employees or denying a questionable PAS procedure, he or she will choose the latter. Finally, the press serves as another nuance that catalyzes the scenario. Without the lack of publicity, it is highly likely that the medical staff and psychologists would have been able to negotiate at M. J. for a transfer to better facilities and treatment, but this now seems unlikely. Three of these factors further weighed on the critical analysis of morality in the local hospice case study.

The question must first be examined from the perspective of civic ethics, which defines the basis of social relations in a population. Human rights are recognized as fundamental, and ignoring them is a criminal, inhumane act. John Locke argued that when states were formed, governments assumed the function of restricting certain inalienable freedoms of the individual (Ward, 2017). Consequently, state power can address the most critical conflicts of constitutional human rights, and that includes the right to die. In a case study, the patient expresses his or her own consent to the procedure, and it is then the task of the hospice to realize this right. Assisted suicide must be performed in accordance with the patient’s will in order to satisfy his civil right and to inhibit the development of the conflict in society.

It should be understood, however, that this procedure is not performed at the first request of the terminally ill patient but rather requires careful investigation and documentation. At moments of weakness or heightened stress, a patient may express such a wish, but this expression does not mean an actual desire to end life by clinical suicide. In order for the entire procedure to proceed according to established regulations, a committee, including a psychologist, must be invited to the patient to assess the individual’s capacity to make critical decisions. Only after the patient has signed a self-declaration of will does the expert committee examine the patient’s medical history and analyze the patient’s treatment prospects. In the absence of any optimistic scenarios for the development of treatment, a decision is made about the clinical suicide of the patient (Chhikara, 2017). Thus, the PAS procedure itself is not straightforward and requires outside, expert opinions to create a framed solution to such an acute problem.

Nevertheless, the above decision to allow the PAS procedure, while reflective of the hospice’s civic responsibility, has little to do with the case study. The institution’s board of directors declares the need to seek a Christian solution that is biblically affirmed. In particular, the appeal to sacred texts makes clear that an essential value of Christianity is human life given by God. Consequently, only God has the will to give or take that life, and deliberately interfering with it is a sin comparable to murder (Montaguti et al., 2018). Thus, it can even be stated that the PAS procedure is an admission of the absence of divine power, and therefore this possibility is ruled out by the Christian Church altogether.

In addition, the final decision must support a code of Ethics relevant to the U.S. health care system as a whole. Such a relevant body is the American Medical Association (AMA), which provides quite unequivocal answers to the assisted suicide dilemma. In more detail, the AMA expresses a firm rejection of such a procedure because it is not primarily compatible with the physician’s role as a disease healer (or palliative role) (AMA, 2021). In fact, the decision to commit suicide at the will of the individual can be seen as a weakness in the work of a professional physician who cannot provide the best treatment. On the other hand, the vulnerability of PAS lies in the difficulty of controlling such a sensitive mechanism. Because approval of such a decision takes time, there is an increased likelihood of corrupt schemes and errors that result in human death. Given these problems, the AMA unequivocally opposes physician-assisted suicide, forming its code of ethics.

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Hence, taking into account the above aspects, the Christian point of view, and the position of the AMA Code of Ethics, it is appropriate to state the refusal to implement the PAS procedure at the will of M. J. Nevertheless, such a refusal is not unequivocal evidence of a lack of professional support or low interest in the patient’s problems. On the contrary, the local hospice is so strongly supportive of the interests of the terminally ill patient that it cannot go down the most straightforward path of deliberate deprivation of life (ACHE, 2017). In addition, it should also be clarified that the decision to deny will inevitably lead to the development of the conflict in public and the press, as from the outside, it may appear that this response ignores the civil liberties of M. J. As a consequence, it is the task of local hospice leadership to organize a strategic vision for the decision that can inhibit any conflicts and uphold the values of the health care facility.

To implement this strategy, the manager must arrange procedures for psychological conversations for the patient with members of the academic community, bishops, and family members. First, qualified psychologists should feel out the man’s feelings and motives for his decision to die. Perhaps a critical reflection on his own motivating forces will be sufficient for him to abandon PAS. Second, representatives of the Christian diocese can interview the terminally ill man to tell him about the Bible’s view of the decision. It is likely that when M. J. learns of the high sinfulness of such an action and the responsibility before God that he wants to pass on to doctors, the patient will refuse. However, the invitation of a member of the religious community should be considered carefully because if M. J. is not a Christian, inviting a bishop might complicate the situation. Finally, having a conversation with the family (including the brother) is necessary because the patient must have different perspectives on his problem. In addition, family involvement in such difficult decisions is vital in order to assess the patient’s autonomy and capacity. Moreover, at this point, there are no specific expectations for the outcome of the family meeting.

As a result, the solution to the described moral dilemma of physician-assisted suicide lies in the patient’s prior guidance to stay alive. Local hospice leadership supports the view of PAS rejection, guided by Christian ideals of the sanctity of life and the sinfulness of its taking. Psychological support for the patient should include interviews with a qualified psychologist, a representative of the patient’s religious denomination, and family members in order to determine the true motives behind this important decision and to test the individual’s capacity. However, it should be noted that the final rejection will undoubtedly initiate the development of a conflict in society catalyzed by the press. It is the task of the hospice director to publicize the medical institution’s position on the problem clearly and to describe the specific countermeasures that will be carried out in lieu of a decision to die. Among others, such methods should include transferring the terminally ill to better living conditions, fully meeting their needs, and diversifying their leisure time to bring former pleasure into the patient’s life..

References

AMA. (2021). Physician-assisted suicide [PDF document]. Web.

ACHE. (2017). Code of ethics [PDF document]. Web.

Baksheev, A. I., Turchina, Z. E., Mineev, V. V., Maksimov, S. V., Rakhinsky, D. V., & Aisner, L. Y. (2018). Euthanasia in modern society: the topicality, practicability, and medical aspect of the problem. Journal of Pharmaceutical Sciences and Research, 10(6), 1360-1363.

Chhikara, N. (2017). Extending the practice of physician‐assisted suicide to competent minors. Family Court Review, 55(3), 430-443.

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Kruijtbosch, M., Göttgens-Jansen, W., Floor-Schreudering, A., van Leeuwen, E., & Bouvy, M. L. (2018). Moral dilemmas of community pharmacists: A narrative study. International Journal of Clinical Pharmacy, 40(1), 74-83.

Montaguti, E., Jox, R. J., Zwick, E., & Picozzi, M. (2018). From the concept of “good death” in the ancient world to the modern concept of euthanasia. Medicina Historica, 2(2), 1-6.

Ward, L. (2017). Thomas Hobbes and John Locke on a liberal right of secession. Political Research Quarterly, 70(4), 876-888.

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