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Healthcare Ethics: Physician-Assisted Death

Physician-Assisted Death

Physician-assisted death refers to the process where a physician facilitates the patient’s death by providing the required information or materials necessary to end their life. Patients facing chronic conditions, debilitating illnesses or suffering in pain, may opt to end their life by seeking assistance from their physicians (Quill, Back, & Block, 2016). The principle of nonmaleficence requires practitioners to never perform any actions that could lead to harm to their patients, family, or society at large (Beauchamp & Childress, 2009). Consequently, this must be the guiding principle for any physician when dealing with dilemmas regarding requests for assisted suicide. Therefore, physician-assisted death should be illegal since the goal of healthcare must be to maintain treatment that sustains life for patients, by seeking alternatives in palliative care.

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Physicians must consider the overall goal of care since a decision meant to benefit the patient may negatively harm others related to them. Illness in patients may cause a depletion of mental capacity and distortion in judgment, leading to such decisions (Carlin, 2019). Therefore, healthcare providers must weigh the options available to ensure that the benefits of procedures, such as withdrawal or withholding of treatment, are taken with the patient’s best outcomes in mind. Nonmaleficence forms the basis for all treatment of patients, hence, a very important ethical principle when dealing with patients with severe sickness.

Providing an easier way out for patients takes away the struggles of physicians who aim to help all their patients. The legalization of physician-assisted death brings up future problems since physicians would have the authority to determine the level of suffering that justifies death. Giving individuals such power also increases the possibility of misuse in the medical industry, hence, it should not be legalized.

Individual Autonomy in the State of Quarantine

Public health policy overrides personal autonomy in the case of pandemics such as COVID-19. This ensures that the greater good of the population is protected from a few individuals who pose a significant risk. As a result, Public Health Acts put the different states and federal governments in charge of controlling populations in cases of outbreaks. The introduction of quarantine restricts the movements of identified individuals, as the necessary health authorities run tests to determine their status. For instance, the Centers for Disease Control and Prevention (CDC) have the power to detain, test and release any person perceived to be infected with a communicable disease (Cetron & Landwirth, 2005). These actions affect individual autonomy in most cases since the individuals are taken into isolated areas without proper information and consent.

However, in cases where the threat to the public increases significantly, the liberty of individuals may be restricted to prevent undue damage to the public health system. It is, however, imperative to ensure that the preparation and implementation of such policies and laws are undertaken in a transparent manner with public participation. This warrants that the use of quarantine, when necessary, receives support from the general public, guaranteeing a successful response. Since quarantines are temporary measures to reduce the effects of communicable diseases on an area, governments can implement them in cases where it forms the best option. In such cases, public health overrides individual autonomy to protect the greater good of society.

Brain Death

Brain death refers to the stage where an individual can no longer regain consciousness or breathe without a life support machine. This means that brain functions have ceased, thus, the chances of recovery become very minimal. In such cases, most health institutions can declare the individual legally dead due to the irreversibility of this stage. Consequently, the brain stem which regulates automatic functions such as breathing, heartbeat and blood pressure ceases functioning.

Clinical examinations are required to perform tests that determine brain death including neurological examinations using CT scans. Furthermore, tests on motor responses, pupillary responses, gag reflexes and caloric reflexes are performed to confirm whether an individual is brain dead (Wijdicks, 2001). Completion of these tests with no response leads to the decision to confirm the death of the individual.

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However, while such neurological criteria can be legally used to determine death, individuals may still possess some neurological functioning. Spontaneous movements of the chest cavity that may occur during events such as the apnea test may be perceived as signs of life. More so, muscle movements may also cause the flexing of arms and feet. Therefore, determining the cessation of consciousness becomes difficult in such perspectives hence withdrawing life-sustaining measures may cause an ethical issue.

Since people across cultures perceive consciousness and personhood differently, brain death confirmation through neurological tests becomes a problem. Family members and relatives can thus refuse to remove the individual from life support, hoping for better news on their kin in cases where they consider the person to be spiritually present.

Healthcare Ethics in the COVID-19 Pandemic

The COVID-19 pandemic brought about a number of issues in healthcare involving health care. The nature of the pandemic led to increased pressure on health facilities thus overwhelming healthcare providers. As a result, hospitals started turning away patients who needed emergency services based on a criterion of saving the healthiest and those more likely to survive. As a result, the elderly and those with underlying conditions were less likely to receive treatments since the possibility of survival in their case was minimal. This went against the principle of justice which requires fairness in medical decisions.

Additionally, this principle further required decisions to be made fairly with regard to scarce resources and treatment procedures. This posed a dilemma to the medical fraternity since the number of patients was increasingly surpassing the availability of space and the number of clinicians to attend to them (Churchill, King, & Henderson, 2020). The decision to turn away some patients based on their background was difficult but could be perceived as necessary to increase the survival of younger and healthier patients.

Apart from that, the principle of beneficence required providers to make decisions aimed at benefiting the patient at all times. This means that recommended treatments should always try to benefit the patient by considering the individual circumstances of each patient. However, the pandemic being a new coronavirus never experienced in the history of human beings, new experimental treatments had to be implemented to try and save the lives of patients. Providers, thus, had to use their limited knowledge to diagnose and provide treatment options, which led to the loss of lives based on the little knowledge of the virus. This was a necessary process required to develop evidence-based knowledge on the best procedures to be used to effectively treat patients.

The Story of Henrietta Lacks

The story of Henrietta Lacks shows the importance of consent since her sample cells were given to a researcher without her knowledge. Being a black American, treatment options were limited and John Hopkins was one of the few facilities with the capabilities to offer treatment to her cancer. The identification of her cells capability to reproduce indefinitely and survive over time was a breakthrough in the medical field at the time.

As a result, modern medicine has been built around the HeLa cells that originated form Lack’s sample. However, while her sample has contributed significantly to the medical field, several companies that have profited from it have never passed back any of the funds to the family. This shows a significant problem in the research and healthcare system with regard to minorities in the United States (Kelleher, 2014). Furthermore, the researchers using the HeLa cells have never asked for consent from the family regarding the use and publishing of the research including the genome of her cells.

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The problem of autonomy raises questions since the continued use of the sample despite its benefits to society, was initially marred with ethical questions. In this case, the use of the sample was legal at the time, though Lacks did not have a say in its distribution. Consequently, Lacks did not have a say in how her cells would be used meaning that the researchers acted without her knowledge. More so, an acknowledgement of the history of the HeLa cells can play a role in truth-telling by showing the roots of the sample that has helped revolutionize the medica field. In this case, the truth of the matter lies in the continued usage and distribution of the cells without recognition of Lacks and her descendants. More so, the revealing of the personal genome further posed a problem since family were not informed despite such actions directly affecting them.

References

Beauchamp, T. L., & Childress, J. F. (2009). Principles of biomedical ethics. Oxford, England: Oxford University Press.

Carlin, N. (2019). Nonmaleficence and the circus clown. In N. Carlin, Pastoral aesthetics: A theological perspective on principlist bioethics (pp. 60-84). Oxford, England: Oxford University Press.

Cetron, M., & Landwirth, J. (2005). Public health and ethical considerations in planning for quarantine. Yale Journal of Biology and Medicine, 78(5), 325-330.

Churchill, L. R., King, N. M., & Henderson, G. E. (2020). The future of bioethics: It shouldn’t take a pandemic. Hastings Center Report, 50(3), 54-56. Web.

Kelleher, J. P. (2014). Beneficence, justice, and health care. Kennedy Institute of Ethics Journal, 24(1), 27-49. Web.

Quill, T. E., Back, A. L., & Block, S. D. (2016). Responding to patients requesting physician-assisted death physician involvement at the very end of life. JAMA, 315(3), 245-246. Web.

Wijdicks, E. F. (2001). The diagnosis of brain death. New England Journal of Medicine, 344(16), 1215-1221. Web.

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