The sale and use of human organs after the death of a person is a complex ethical and moral issue that people have decided on in various ways at different times. In traditional cultures, the violation of the human body’s integrity was most often condemned since this was associated with its transition to the afterlife. However, the modern world has allowed the use of human organs after death to bring good and save lives, which has radically changed the balance of power. Thus, contemporary bioethics focuses on solving the moral problems in transplantation, considering the rights of all parties involved.
Discussion
The human organ market is a sensitive topic, as questions immediately arise about whether it can exist and not exploit poor and socially disadvantaged people. On the one hand, there is a significant untapped demand for organs for people who will die without transplants. On the other hand, many desperately poor people worldwide are ready for transplant tourism. Due to deep desperation on both sides, the process loses transparency and goes into the Darknet.
This problem needs to be addressed from several angles. First, posthumous organ donation should be promoted as safe and noble. Second, the countries of the first and third worlds must control the black organ market and tighten control over “transplant tourism.” Unfortunately, at the moment, the free market can only solve the problem of organ shortage through the inevitable exploitation of the poor.
Conclusion
The commercialization of the sale of human organs exposes the unpleasant and ethically complex side of the market system. Capitalism, in principle, often pushes for the manifestation of the worst, especially when life, death, and health are at stake. Inevitably, this state of affairs opens the way to the exploitation of man by man. However, despite this, it must be understood that sick, dying people have the right to relieve pain and suffering and save their lives. The rights of the donor and the recipient must be balanced, taken into account, and protected.
The study of ethics has always captivated many intellectuals, and over the centuries, many ideas have been offered to demonstrate the moral principles that influence human conduct. By describing the origins of occurrences and the reasons behind why something occurs in the way it does, scientific theories aid in human understanding of the material universe. A moral theory, for instance, emphasizes why action is either right or wrong or why an individual or their personality is virtuous or harmful. Numerous moral theories have contributed significantly to the field of bioethics and are still shaping how individuals perceive related matters. Out of three well-known theories, Kantian ethics is the most optimal in terms of considering morality and human conduct, unlike natural law theory and utilitarianism which mainly disregard justice or strive to find the correct reasoning.
Although natural law theory, utilitarianism, and Kantian ethics focus on the topic of morality, they differ substantially. For instance, according to Kantian ethics, a deed is ethical if it is motivated by a sense of obligation and abides by a general, unchanging moral law (Vaughn 41). Kantianism respects the individual and connects to the common experience of humanity. As per this theory, the categorical imperative, a specific ethical principle, may be used to rationally and reflectively deduce human obligations (Vaughn 41). Because Kant’s morality is so simple and grounded in reason, anyone can understand it. The benefits of this theory are that it focuses on human duty and claims that morality is independent of motivations, outcomes, and religious laws (Vaughn 41). Therefore, the concept commands everybody to protect human life and provides universally applicable norms.
In comparison, natural law theory contends different perspectives in terms of morality. According to this theory, only behaviors that adhere to moral principles “discerned in nature through human reason” may be regarded as ethical (Vaughn 56). Therefore, the main responsibility of humans is to direct their life in the way of such universal objectives while following the dictates of natural law (Vaughn 56). The benefit of the natural law idea is that it can be applicable on a broad scale, and it relies on logical thinking. The approach, however, dismisses how society influences conduct (Vaughn 56). Natural law theory does not give a specific moral norm that applies in every circumstance, although it does offer direction through basic moral concepts, some of which are believed to apply unconditionally and globally.
The third theory, utilitarianism, focuses on human happiness yet has shortcomings. The theory holds that the best behaviors are those that produce a balance of good over adverse outcomes for all parties concerned, which is the dominant consequentialist theory (Vaughn 39). The traditional formulation, such as many utilitarian ideologies, calls for a deep sense of objectivity. When fostering well-being and happiness, people must give each person’s requirements and interests an equal priority in addition to considering the satisfaction of all others who may be impacted (Vaughn 39). Nevertheless, utilitarianism disregards fairness and regards immoral deeds that benefit society as a whole as moral if only a small minority suffers as a result (Vaughn 39). In this case, the failure of utilitarianism to pay attention to issues of justice may be its fundamental drawback.
Upon reviewing all three theories, it can be seen that the merits of Kantian ethics outweigh those of utilitarianism and the natural law theory by a wide margin. It holds that moral decisions should not be based in the least on outcomes, value maximization, happiness creation, or the desires and requirements of other people (Vaughn 42). In such a situation, it is the exact opposite of utilitarianism. Unlike the two other theories, Kantian ethics prioritizes following a moral law that is reasonable and relevant to all people and acting entirely out of a sense of responsibility (Vaughn 41). Only when an activity complies with this norm is it morally right, and only when individuals carry out their duties solely out of obligation are they morally acceptable. Thus, equal protection of all individuals is required under Kantian ethics, which effectively eliminates prejudice from decision-making.
Hence, Kantian ethics is the best of the three well-known theories when it comes to taking into account morality and human behavior, as opposed to natural law theory and utilitarianism, which ignore justice or try to arrive at the right thinking. A deed is ethical in Kantian ethics if it is motivated by duty and abides by a universal, unchanging moral rule. In contrast, the natural law approach asserts several moral vantage points. However, the strategy ignores how society affects behavior. The utilitarianism concept, the third theory, focuses on human happiness but has flaws, including ignoring questions of justice. Reviewing these three theories reveals that Kantian ethics has a significant advantage over utilitarianism and the natural law theory. In contrast to the other two theories, Kantian ethics emphasizes behaving only out of a sense of duty and adhering to a moral code that is rational and applicable to everyone.
Work Cited
Vaughn, Lewis. Bioethics: Principles, Issues, and Cases. 5th ed., Oxford University Press, 2022.
Wikipedia encyclopaedia defines Bioethics as the ethics of biological science and medicine. It is concerned with the ethical questions that arise on the relationships among life sciences, biotechnology, medicine, politics, law, philosophy and theology. Abuses of human subjects in biomedical experiments, especially during the Second World War, brought world wide attention to the framework that should guide any scientific research. According to Wikipedia encyclopaedia, in the era of Second World War, during the Nuremberg War Crime Trials, the Nuremberg code was drafted as a set of standards for judging physicians and scientists who had conducted biomedical experiments on concentration camp prisoners. This code is credited with jump starting the interdisciplinary field now called bioethics. Bioethical principals are principles that should underlie the conduct of biomedical and behavioural research involving human subjects. In the United States, a National Commission for the Protection of Human Subjects of Biomedical and Behavioural Research, was set up in 1974 under the National Research Act and was charged with the duty of identifying the basic ethical principles and guidelines that should guide the conduct of biomedical and behavioural research involving human subjects. The guidelines were published in 1979. It further received a boost when President Clinton directed the Advisory Committee to uncover the U.S history of human radiation experiments during the period 1944 to 1974 since first human radiation experiment was carried out tin 1944 and bioethical Act was enacted in 1974.
Why do we need to have bioethics?
One of the criticizers of scientists Merton (1973), said that “scientists are just like normal mortals and do not possess special moral qualities; they are not ‘recruited form the ranks of those who exhibit an unusual degree of moral integrity’” From the onset of scientific researches, it is estimated that human being were used as subject of major medical researches. It can be evidenced by the radiation experiments in the U.S. where it is claimed that radiation was released in the air to see its effects on human being. This amounts to using human subjects prior to informed consent and with little regard to the long term effects. Hence bioethical issued arise due the need to have an institution that governs the methodology of carrying out research on human subjects. Henk Van den Belt says, “One way to overcome the problem of the interpretative flexibility of general norms, at least partially, is to install special bureaucratic agencies that are charged with overseeing the rules and norms that are to be followed. As part of their mandated mission, such agencies will undertake to clarify and more strictly define the pertinent norms”
The scope of Bioethics
Bioethicists focus on using philosophy to analyze issues. However, the scope of bioethics is quite big and the approach of using interdisciplinary approach is sometimes preferred to that of using philosophy. This is because of the diverse interest groups seeking to safeguard human rights as far as research subjects are concerned. Religious Bioethicists have come in and developed rules and guidelines on how to deal with bioethical issues from within the viewpoint of their faiths. There has been disquiet already from the secular Bioethicists arguing that religious Bioethicists don’t have academic degree or training in philosophical subjects of bioethics
Bioethical issues have been classified to three main principles, of respect for autonomy of the person, beneficence and Justice. First, importance is created on the informed consent of the research participants. No person should participate in a research without being informed that he/she is a subject of research. This has been the subject of a court case between the Libyan Government and foreign doctors accused of using the Libyan children of HIV/Aids trials without their informed consent and consequently infecting them with the virus. This has been a long legal battle which ended with the doctors and nurses being convicted of a bioethical crime.
The second focuses on the assessment of risks against benefits of the participants. It is important to analyze the risk exposed to the participants otherwise the long term effect of the research may end up being more costly than the subject of research. The principle of mal-beneficence stress that any research carried out on a subject must not be harmful but rather beneficial.
The other principle deals with fair selection of research subjects. The sample size selected should try to minimize bias as much as possible. It should be a representative of the actual population. Biased research cannot be accurate and considering the magnitude of a biomedical research as the consequences, it must be carried out as accurately as possible.
Have we integrated our bioethical research issues in our researches?
According to Michiel Korhals, science is impersonal, objectives and without values while ethics is seen as the counterpart of science as something personal and subjective. Hence ethics can be helpful to some scientists with pangs of their conscience by giving them some psychic relief. Keulartz et al. (2002), says that between science and ethics there is a very complex, fundamental, problematic, ambivalent and sometimes even dilemmatic relationship that is absolute worthwhile to study. There is difficulty with the liberal position in terms of making decisions determined by the scientific community and ethical attitudes including care, perfectionism and virtue. Human have obligations and rights towards others. Hence there is need for wholistic approach while dealing with scientific matters. This requires social interaction to discuss issues pertaining to the world, profits and people.
However some scientific issues may take personal dimension, with each and everyone taking a different stand. David B. Resnik raises issues concerning human genome and ethical principles emerging with patenting. He says “one of the influential arguments against patenting human DNA is that the human genome is the common heritage of mankind” human genome is a common resource and not a common heritage of mankind. Hence patenting of DNA is morally acceptable as long as that we will honour our moral duties concerning the genome like that of stewardship and justice. According to Iran Pollard, (2005), the manipulation of heredity in medicine and Agriculture for carefully defined purposes and under appropriate supervision, can both be ethically acceptable and socially desirable. It may help in saving the endangered species. Perhaps questions of responsibilities of scientist remain one of the ethical issues up to date. Scientific catastrophes have occurred and caused death in many parts of the world. Starting with the atomic bomb in Hiroshima and Nagasaki during the Second World War to the Kremlin and Chernobyl disasters, many questions remains to be answered about the responsibility of scientist and scientific advancement. I argue about these disasters because to they should also be treated as ethical issues. Do you think the use of biological weapons whether in warfare or not should be treated as an ethical issue? It involves the safety of human beings and animals and hence it should be an ethical issue. The much we talk about the effects of research experiments in line with prior intention, so should we talk about the effects of using biological weapons or the scientific disasters as mentioned above because the effects are all but the same. More complex modern bioethical issues are on the rise creating more heated debates. There is a bioethical debate about treatment decision for gender identity disorder. Somatic treatment as an accepted intervention in managing gender identity disorders has created ethical issues for many psychiatrists. There is a heated debate on the use of the treatment for gender transmutation. What is miscalled “transsexuals” has led to the most tragic betrayal of human expectation in which medicine and modern endocrinology and surgery have been engaged. One psychiatrist had problem in using the proper pronouns while referring to patient who had undergone “vaginoplasty” as a young man and has been living as a woman” Most of the patients undergone this treatment some for hormones and sex reassignment while some it is for entertainment where principle of ‘do no harm or mal-beneficence’ and ‘do not remove a healthy organ’ are put into contradiction. This has been an issue of contest among many psychiatrists. There is also an ethical issue of informed consent when dealing with genital surgery for minors with inborn biological sexual errors like pseudohermaphroditism. Although it is thought that substituted consent by the parent is okay, what about the child conscience reaction when grown up and learn about it?
Although we have made some recognizable strides, we still have a long way to go to integrate our bioethics principles to our biological and social research. We are still to integrate issues concerning warfare, gender role in researches, biotechnology and its effects and the role of human in protecting the environment.
References
Henk Van den Belt. (2000). Applied Philosophy Group. Wageningen University and Research Centre, Hollandsewef, Netherlands
Kleulartz, J., Korthals, M., et al. (eds.), 2002. Pragmatist ethics for a technological culture. Kluwer Academic Publishers, Dordrecht. The International Library of Environmental, Agricultural and Food Ethics no. 3
Merton, R. K., (1973). The normative structure of science (essay orig. public. 1942). In: Storer, N. W. ed. The sociology of science. The University of Chicago Press, Chicago, 267-278
Pollard, I. (2005). Life, Love & Children – A Practical Introduction to Bioscience Ethics & Bioethics.
Current research seeks to make contribution to contemporary debates on bioethics and its realization in public policy. There is no denying the importance of the fact that these issues should be discussed taking into consideration modern development of philosophy.
Main text
There is no denying the importance of the fact that the historical development of bioethics was firmly connected with global technological revolution which deeply transformed religious worldview, the notions of life, death, human reproduction.
First of all, as Kaplan suggests, the development of bioethics went in line with the progress of medical science, biology and gene engineering (Kaplan, 2004). In its turn, being influenced by theology and moral ideology, bioethics quickly developed and became the concern of scientific and public institutions which quickly developed (Annas and Sherman, 2004).
Such organizations as Institutional Biosafety Committees and Hospital Ethics Committees (HECs) deeply influenced the development of bioethics as interdisciplinary field lying on the intersection of politics, morality and law. With the development of gene engineering and growing possibility of using stem cells and genomes for various purposes bioethics received the highest state recognition with President Clinton and Bush creating corresponding councils headed by the best theoreticians and practical specialists. The debates on abortion, cloning, use of stem cells transformed from ordinary scientific debates into mass debates with political flavor.
This research seeks to provide a thorough analysis of the interrelation between stem cells research policies, bioethics and political and public policies and debates.
The basic assumption we pursue is that there exists essential interdependence between science development, public policies and bioethical conceptualizations and debates.
The process of intensive bioethics development started with first in vitro fertilization in 1969 and nationwide legitimization of abortion. Following this central events, public policies were first realized massively at the national level as the federal government prohibited utilization of federal funds for the research and experiments on the human embryos. As of 1995 Human Embryo Research Panel advised Clinton’s administration to give funding on research and experimentation but this advice was decline on ethical and moral basis. This fact shows that bioethics often goes in line with public policy but against the development of science. Some concessions were, however, made thought they were partial. The decision of Clinton’s administration was cemented by the Dickey Amendment which is in law for today.
With the discovery of Human Stem Cells some points of public policies were reconsidered and Clinton administration and Congress even issues an act allowing experimentation if it does not directly cause death of embryo. However, incoming Bush administration decided to reconsider this issue.
Bush administration’s bioethical policies concerning stem cells research made a considerable step forward. Bush administration allowed funding for the already existing embryo experiments though strictly prohibited the financial expansion on the future projects. There is no denying the importance of the fact that this new direction of public policy shows that bioethical issues were compromised with the current development of science which in its turn proved that public policy representatives have great doubts and indefiniteness concerning practical realization of bioethical public policies.
Public policies concerning stem cells experiments on embryos also prove that public policy of Presidential administration goes in line with liberal principle of non-intrusion in private domain. To state plainly, neither administration nor American Congress ever prohibited private funding of embryonic research and gene engineering, although it is evident that private research is even more effective than public initiatives.
The situation has changed dramatically when in 2004 a large group of the moderate Republicans in the Congress signed the letter to G.W. Bush asking him to significantly expand federal expenditures on the research of stem cells and move them beyond the level already supported. As of May 2005, Congress voted for the loosening limitation on federal funding of the stem research including allowing experiments on the frozen embryos based on the permission of donors. However Bush promised that he would veto this Bill he then claimed that this decision is important in terms of national security and development. William Frist, a senate majority leader also welcomed this new public policy vector and said that he would appreciate future increasing of funding for embryonic research.
The Senate bill which passed later in 2006 and allowed utilizing embryonic stem cells and embryos left from Vitro procedures was vetoed by President Bush.
The second Bill passed strictly prohibited and proclaimed as illegal to grow, create and abort human fetuses for the research purposes. The third bill announced would foster the research of isolating embryonic-like stem cells which prevents destruction of the human embryos.
Currently, NIH, that is National Institute of Health has more than 350 financing opportunities for different researchers who are interested in cell research. This institute funded more than 600 million of dollars for the stem cell researches as well as promotion of bioethical studies.
Within the framework of bioethical public policies the US National Academies released in 2005 its authoritative guidelines for the Human Embryonic Stem Cell Research. These guidelines were designed to maintain the integrity and effectiveness of research, creating program for public debates and information provided as well as developing framework for meeting bioethical standards and fostering responsible procedures and practices.
It should be mentioned also that some states implement their autonomous policies concerning stem cell research. This includes creating new institutes for regenerative medicine and funding various research like in California. However, it goes without saying that these initiatives are accompanied by active promotion of bioethical research. Some states imposed additional restrictions or sometimes complete bans on the embryonic research. Among them one should mention such states as Arkansas, Iowa, Louisiana, South Dakota, Virginia and some others.
Summary
To sum it up, the technological and scientific development which caused great progress in cell research creates difficult problems which are to be resolved on the national level. This process is difficult as it includes various ethical and moral issues and is connected with harsh debates over the directions of public policies. It goes without saying that there exists an urgent need of preserving equilibrium between technological development, public policy effectiveness and stability with the need of maintaining moral consolidation of American society and its religious and ethical grounds.
References
Kaplan D. M. Readings in the Philosophy of Technology. Rowman & Littlefield Publishers, Inc., 2004.
Annas G. J., and Sherman E. ‘Politics, morals, and embryos’. Nature 431 2004, pp.19-20.
According to Kant’s philosophy, the distinction between a person and a thing runs through several basic criteria, largely related to independence and dignity. A thing is only a means to finitude, that is, to any completion, while man contains completion in himself. Man differs in his finitude from the infinity of the world, but he is valuable in himself and cannot be used as a means. This determines autonomy, that is, the independence of a person. Implicit autonomy determines the inner ability of a person to do anything and, accordingly, the ability to distinguish between good and evil. According to Kant, a person, in contrast to a thing, has a moral navigator that is common to everyone. It is because of the opportunity to master the concepts of good and evil and use them morally a person differs from a thing. A person cannot be used as a means and therefore, unlike a thing, has no value.
Dignity should be perceived as an innate and inalienable trait of any person, regardless of social institutions, class, and experience. At the same time, dignity is not only an internal concept since it is something that can be given by one person to another, such as respect or favor. This means that the concept of human dignity may not always be strictly intrinsic. Concepts about the transfer or innateness of dignity can have a significant impact on medical practice. A doctor who believes that it is they who give dignity to other people by paying attention to them runs the risk of falling into misconceptions that distort moral representations. At the same time, a physician who professes equal human dignity and believes it is intrinsic is able to respect the patient’s autonomy. However, this, in turn, can create treatment dilemmas if patient autonomy conflicts with the specialist’s professionalism. In any case, a medical worker who professes human dignity as an inalienable value follows key principles of bioethics such as autonomy and justice more closely.
By the uselessness of dignity in medical practice, McLean means that talking about criteria for dignity in bioethics only distracts from the primary immediate goal of treatment. Somerville argues in her book that when dialogue in bioethics comes to a general agreement, the term dignity seems useful and relevant. If it is impossible to agree, the concept of dignity is depreciated and becomes useless. However, the idea of dignity can vary and be distorted in such a way that the very dignity of a person will be humiliated; there will be no dignity in a person. There is a constructionist approach to human perception, in which the personality must meet the criteria to be considered truly human. This is the third use case for this concept, in which the misuse of this view becomes really dangerous.
A person can be determined by a higher awareness and cognitive ability, which determines the knowledge of their goal on Earth and moral criterion. However, some people with mental disabilities may thus actually not fit the criteria for being human. Consequently, their external dignity will be diminished by those who believe that their internal dignity is worthless. This is a terrible mistake in moral judgment and is very dangerous for medical ethics. Moreover, the question of human dignity arises in the case of embryos and embryos, which significantly complicates the issue of moral responsibility and giving dignity to a person in the case of an abortion procedure. Thus, the external dignity of a person comes from the field of social experience and the attitude of other people to a person, which is most valuable in bioethics and medical practice. The pursuit of dignity in each person can help a doctor make truly valuable ethical decisions and can help other professionals make them.
Paul Wolpe has addressed one of the most disputable issues in bioethics. The researcher argues that autonomy has become a “panacea” in solving ethical issues in the USA (Wolpe 38). The researcher reveals advantages and focuses on the disadvantages of the use of autonomy in the US bioethics. It is important to note that in the USA the principle of autonomy has overweighed the rest of the principles suggested by Beauchamp and Childress (Wolpe 41).
This shift can be explained by some cultural peculiarities of Americans. However, it is also necessary to note that this shift in priorities has proved to be misleading (Gert et al. 109). The principle of autonomy is characterized by far too many restrictions and limitations (Wolpe 55). Therefore, it can hardly be applicable in most cases. More so, it is possible to state that it has become a detriment to patient care as patients are often unwilling and incapable of making decisions that could be made only by physicians on the basis of thorough research which is backed up by the physicians’ experience.
Reasons for the Shift of Priorities
Principlism was articulated by Beauchamp and Childress in the late 1970s (Wolpe 41). The researchers revealed four basic principles which were to become the universal guidance for physicians. The researchers pointed out the principles of “autonomy, nonmaleficence, beneficence, and justice” (Wolpe 41). Notably, in the first part of the twentieth century, the medical practice was dominated by principles of nonmaleficence and beneficence.
However, in the middle of the twentieth century, the shift in priorities took place in the United States. Wolpe notes that people “could easily write a modern history of America by tracing the theme of individual liberty” which is “a long-standing and mythologized American value” (Wolpe 53). Admittedly, individual liberty is valued in any aspect of private or social life in the United States, be it politics, education, or medical care. Of course, bioethics could be no exception. Americans have always struggled for their rights, e.g. rights concerning abortion or even assisted suicide. The value of individual liberty has spread to the power of decision making.
Apart from this, Wolpe articulates another possible reason for the shift. The researcher claims that almost “every development in medicine in the post-World War II period distanced the physician and the hospital from the patient and the community” (Wolpe 50).
The researcher comments upon financial differences between physicians and patients. Admittedly, physicians and patients often pertain to different social classes or ethnic groups, etc. This contributes to alienation which in turn leads to bureaucracy in medical care. Highly bureaucratic practices can also be regarded as some of the factors that have led to a shift in priorities. Thus, instead of making decisions physicians are overwhelmed by various bureaucratic practices that should be complied with. These bureaucratic practices also become certain standards accepted by patients.
Many researchers state that the principle of autonomy is the most applicable in real-life settings as it is the most “constitutive” (Engelhardt 107). Engelhardt also claims that it is rather difficult to be objective when it comes to other principles whereas the principle of autonomy can be easy to realize (107). The researcher also argues that the principles are often incompatible. However, the principle of permission (which is another term for the principle of autonomy) can be combined with other principles, e.g. the principle of beneficence (Engelhardt 126).
The principle of autonomy is regarded as a universal principle that can help in any situation. Physicians have particular rules to follow (the rules based on the principle of autonomy) and these rules are accepted by patients. Therefore, the principle suits contemporary medical practice.
However, it is necessary to note that the major reason for the shift in priorities is still the cultural peculiarities of Americans who value individual liberty in every aspect of their lives. Many Americans believe they should have the right to make decisions which can be crucial. Many think that it is their basic right to know the truth and be able to make the necessary decision. Of course, these people disregard many important issues as they are more concerned with their liberties rather than with reasonable and thoughtful decisions. Luckily, at present principlism is being criticized by many. This criticism can become beneficial for the field of bioethics.
Is Autonomy a Detriment or Enhancement of Patient Care?
Admittedly, there are some advantages to the use of the principle of autonomy. For instance, sometimes patients should know the truth. This knowledge can help patients and physicians to make the most acceptable decision for the latter. However, it is also necessary to state that these cases should be regarded as an exclusion rather than a norm. Any other advantages of the use of the principle can hardly be found.
On the contrary, as far as disadvantages are concerned, there are quite many significant drawbacks which can even jeopardize the effectiveness of medical practices. In the first place, as has been mentioned above patients are often unable to make difficult decisions (Wolpe 55). In the majority of cases, patients feel anxiety and stress. They are often incapable of thinking critically. Besides, various diseases affect the way people perceive reality. This factor should also be taken into account as many patients’ decisions should be called into question.
Wolpe also reveals one of the most important factors that confirm that the use of the principle is rather a detriment than a kind of enhancement inpatient care. The researcher claims that
physicians remain the gatekeepers to most medical information in any particular clinical situation and filter that information through their own biases in any presentation of options and risks. (Wolpe 54)
The researcher sheds light upon one of the most conspicuous flaws in the use of the principle of autonomy as there is no complete autonomy. In the first place, the patient is never provided with the complete picture. The data obtained is nothing more than a decision made by the physicians. Thus, the physicians decided on the type of test to carry out, the physician is the one to diagnose, the physician also provides options to be considered by the patient. Admittedly, the patient is never fully informed as the information he/she obtains is based on the knowledge and experience of the physician.
Apart from this, even if the physician gives comprehensive information, the patient is hardly able to make the right decision. Even if the physician explains all possible outcomes of this or that decision, the patient does not have the necessary knowledge and experience to analyze the situation properly. Thus, it is possible to note that the so-called principle of autonomy presupposes a great deal of dependence as the patient has to rely on the physician’s ability to diagnose as well as reveal specific information.
However, this dependence is not confined to the patient’s lack of knowledge. Some researchers also mention one precondition which can secure the right use of the principle. Wolpe sheds light upon the theory that patients should be matched with the physicians as the two parties should have similar backgrounds (55). In this way, physicians can be able to understand real needs of their patients. This can enable physicians to understand what can be right for the patient and what options can be suggested.
Besides, Wolpe points out that medical care in the United States has become too ‘commercialized’. This sector can easily be compared to the business sector as patient care ceased to be the primary concern of hospitals which are managed as any other business. Hospitals can be compared to numerous enterprises which are run in accordance with particular regulations and standards. However, patient care can hardly be standardized as there are far too many cases (or even the majority of cases) which are not ordinary and need specific decisions. Remarkably, the use of the principle of autonomy helps to fully standardize the system. Thus, physicians do not need to seek for the best and winning decisions as it is enough to obtain the patient’s consent.
The use of the principle should be regarded as a detriment. It is possible to regard the use of the principle as a way to relieve physicians of responsibility. Physicians are not responsible for outcomes of their decisions. They suggest some options and it is the patient who should take the responsibility for his/her life. This can eventually lead to really negative outcomes. Physicians can be inclined to seek for fewer options as they will not feel the responsibility for their mistakes. Admittedly, if a decision is really difficult to make, the physician would rather double-check before he/she makes the decision.
Finally, Wolpe also mentions that many Americans have different backgrounds and not all those addressing physicians are able to make any decision due to cultural peculiarities (55). Physicians should pay a lot of attention to the fact that
significant ethnic and religious subpopulations of the United States do not share a fetish for individualized autonomous decision making, believing instead in the primacy of the family in making important medical decisions. (Wolpe 55)
Admittedly, it is important to respect these people and their values as well. It is clear that there are quite many limitations to the use of the principle of autonomy. Therefore, the principle of autonomy cannot be regarded as prior to the other three principles.
Conclusion
Thus, it is possible to conclude that the four principles articulated by Beauchamp and Childress should be equally important. At least, the principle of autonomy cannot be regarded as the most important one. There are far too many disadvantages in reliance on this principle. This can even lead to various negative outcomes and decrease in quality of patient care. Such significant faults as the lack of knowledge or experience on the part of the patient can lead to numerous wrong decisions. More so, physicians can also tend to seek for fewer options as they can be relieved of responsibility. Admittedly, physicians should not be concerned with papers signed by the patient. Instead, physicians should be concerned with the principles of nonmaleficence and beneficence as their primary role is to heal.
Works Cited
Engelhardt, Hugo Tristram. The Foundation of Bioethics. New York: Oxford University Press, 1996. Print.
Gert, Bernard, Charles M. Culver, and K. Danner Clouser. Bioethics: A Systematic Approach. New York: Oxford University Press, 2006. Print.
Wolpe, Paul Root. “The Triumph of Autonomy in American Bioethics: A Sociological View.” Bioethics and Society: Constructing the Ethical Enterprise. Ed. Raymond DeVries and Janardian Subedi. Upper Saddle River, NJ: Prentice Hall, 1998. 38-59. Print.
Current essay provides comprehensive analysis of Starson vs. Swayne case from the point of five of judicial reasoning and bioethical issues. Through careful analysis of legal test of capacity which is important in determining person’s ability to be an active player in the judicial process, we analyze if the court’s decision was justified or not.
Bioethics and law
Bioethics is interdisciplinary field lying at the intersection of many sciences including moral philosophy, medicine, law and other important spheres. There is no denying the importance of the fact that its development was greatly connected with the progress of biology, medicine and anatomy which opened the issues of cloning, genetic transformation. As it was noted above many issues of bioethics are interrelated with law and juridical system in whole (Allegretti, 2002, p. 12). Among them the most notable are death lethal injection, using various medications, defining legal capacity and prescribing judicial medical treatment. Some of these mentioned bioethical issues will be touched and analyzed in this essay on the example of Starson vs. Swayne test.
But before proceeding to this analysis it is needed to analyze the interrelation between law and bioethics. As Schneider claims, these two spheres are greatly interconnected as we see that many bioethicists are lawyers and vice versa. It should be noted that bioethics has much to do with politics than with academic institutionalized disciplines and hence it speaks on the language of prescriptions and orders which is so characteristic of law (Capron, 1999, 295; Schneider, 1994)). The issues raised by bioethics are close to those which are rise in law proceeding concerning the multi-faceted and various issues of judicial medicine, regulation of patients’ treatment etc (Washington times, 2004).
Bioethics, generally saying refers to the study of various ethical issues which related to the health care and starting from deciding on how doctor and patients should act to the issues of how national system of health should be organized in general.
Such issues as the analyzed case will shows are extremely difficult and rise controversies between person’s interests and his autonomy to decide on his future life, between free will and medical care of incapable people, the rights and responsibilities of medical workers, the scope of their possibilities etc. As these issues touch the problems of morality and intersect with the development of science they are controversial and results in long legal proceedings and permanent appellation by their actors (O’Neill, 2002). To treat positively these issues means consolidating efforts and griping on modern trends in law, science and ethics. These issues demand the regime of the rules and flexibility, language of duties and responsibilities, strong and effective public policy analytical actions and private preferences. The choice is very wide-spread and controversial lying between deontology, the rigorous character of economics and philosophy (Neuhaus, 2007).
Ethical issues in Starson’s case
As Starson’s case suggest he was a physician who was diagnosed to have mental disorder including manic psychosis and schizophrenia. After that he was put for a certain time in psychiatric facilities. After he was freed from them he committed aggressive insults on the tenants in his house threatening to kill them but during the judicial process was said to be ‘incapable’ and mentally ill and was ordered to pass mental treatment in psychiatric facilities where he had to use mental transforming medications which were prescribed by the doctors. However Starson appealed to Superior Court and it produced the ruling that he is capable of making his own decision on whether take mental medicines or avoid using them.
The contradiction itself became evident when his own mother claimed that she is afraid of his health and said that he really has mental disorder and thinks he is ‘alien’. She also said that she was afraid of his future and that devastates her. Starson considered using mental medications as dangerous for him for he thought that it might transform him into ‘normal’ person which he always thought was like death to him.
From the analysis of the case we see that Starson’s was a renowned physic with many publications in his sphere and the potential for professional growth. Therefore, it should be claimed that’ from the ethical point of view taking these mentally transforming medicines was dangerous and threatening to him as he could loose his brain and thinking capacities. Court who took the decision of Starson legal capacity proceeded from the test and medical results which could not rule out positively whether Starson was mentally ill or not. Therefore, the indeterminacy between his ‘capacity’ and the real state of his health existed. Here, we can observe the wide-spread controversy concerning bioethical issues which lie at the intersection of different ideologies (morality, liberalism), sciences and law rules and prejudices.
The controversy in this case and the set of bioethical issues it raises is bets exemplified by the contradiction between legal capacity and autonomy and his ‘best interests’.
Before analyze this, it is necessary to strictly define what is legal capacity. There is no denying the importance of the fact that the terms legal capacity refers to the person’s ability to make will. If the opposite is true, then it is said that a person lacks legal capacity and is senile, insane etc. This means that he is not responsible for his deeds and should be posited to some psychiatric institutions (Matare, 1999).
In Starson’s case there exists indeterminate situation as can not be declared absolutely incapable and at the same time there exists well-grounded evidence from medical specialists that he is suffering some kind of mental disorder which is also confirmed by Starson’s mother’.
In this situation the judges of Superior Court take liberal point of view claiming that ensuring Starson’s personal autonomy and decision-making is more important that guaranteeing his ‘best interests’. There is no denying the importance of the fact that this ruling and its formulating does have liberal ethical grounds and is no based on real facts being absolutist moral inscription. Another good evidence for this is that Superior Court’s judges denounce medical specialists’ conclusions as being ‘paternalistic’, that is meaning that they lack the respect for personal autonomy and creativity which are guaranteed by liberal ideology (Schaub, 2004).
In this situation it is difficult to say whether Superior Court or medical decision was right on mere ground of their bioethical characteristics. There is no denying the importance of the fact, the Court’s decision is grounded as protecting human autonomy and medical decision – as protecting person’s best interests and health.
Another contradiction lie within the sphere of personal perception of illness which is important in this particular case. There is no denying the importance of the fact that medical specialists who diagnosed Starson said that however he claims that is absolutely normal and healthy, it proves that their diagnosis is true and he should take necessary medications for improving his conditions. Superior Court ruling stated that since Starson declared that he is abnormal and said that he feels good with it and it even helps his scientific career, he is full aware of his illness and hence should take his own autonomous decisions on whether continue medical career and or listen to medical prescriptions or not.
It should be said that this contradiction is tied with the already analyzed one. If the medical specialists can not resolve the issue positively showing total Starson’s incapacity, then Superior Court claims that on the basis of Starson conscious recognition of his partial ‘abnormality’, he is eligible to take necessary steps and actions.
Besides this, Superior Court also used well-grounded argument that medical interference and treatment had not bring positive results and enhancements so far, so there exists no adequate reasons for continuing treatment based on the previous system. Besides this, Court judges claimed that their ruling goes in line with ensuring person’s ‘best interests’ because it allows Starson to continue his scientific studies.
However, this contradiction had proved to be resolved by ruling’s consequences. As the Starson’s case suggests, being in hospital he refused to eat and drink and was at the brink of total mental disorder and even death. In this difficult situation, Superior Court had to recognize that its decision was short-sighted and led to negative consequences and ruled to continue treatment with medications prescribed by medical specialists.
After passing necessary procedures Starson felt the considerable enhancement of his health and mental conditions and even recognized that he has some symptoms which may be attributed to mental illness.
Conclusion
As the Starson’s case analysis shows the issues of bioethics and their implication for judicial practice are very difficult and controversial as they raise multi-faceted spectrum of issues concerning human consciousness, illness, free will, moral and personal autonomy, as well as competency and responsibilities of medical institutions and specialists. There is no denying the importance of the fact that as this case proves sometimes judicial ruling that are focused on some kind of ideological belief may harm real interests of a person and hence the position of medical specialists should be taken into consideration.
As the case showed, however Superior Court had positive and grounded arguments which proceeded from the basic liberal rights of human autonomy, the possibility to decide and act, they neglected important sphere of scientific argumentation provided by medical specialists which claimed that the Court’s position is ruinous for Starson’s health and future scientific activities and that he need urgent medical treatment.
The rightness of medical specialists’ position was proved after the Court’s decision came into action and after Starson suffered deterioration of his mental condition which finally led to his refusing to eat and drink.
References
Andre, J. (2002). Bioethics as Practice. Chapel Hill, NC: University of North Carolina Press.
Allegretti, J. (2002). The Role of a Lawyer’s Morals and Religion When Counseling Clients in Bioethics. Fordham Urban Law Journal, 30(1), 9-35.
Andre, J. (2002). Bioethics as Practice. Chapel Hill, NC: University of North Carolina Press.
Capron, A. M. (1999). What Contributions Have Social Science and the Law Made to the Development of Policy on Bioethics?. Daedalus, 128(4), 295.
Fantasy Doctors Meet Bioethics; Reflections on Science and Morality. (2004, April 8). The Washington Times, p. A19.
Lauritzen, P. (2007, June 1). Daniel Callahan & Bioethics: Where the Best Arguments Take Him. Commonweal, 134, 8-28.
Levinson, R. & Reiss, M. J. (Eds.). (2003). Key Issues in Bioethics: A Guide for Teachers. New York: Routledge Falmer.
Lin, O. (2004). Rehabilitating Bioethics: Recontextualizing in Vitro Fertilization outside Contractual Autonomy. Duke Law Journal, 54(2), 485-511.
Matare, H. F. (1999). Bioethics: The Ethics of Evolution and Genetic Interference. Westport, CT: Bergin & Garvey.
Neuhaus, R. J. (2007, November). The Politics of Bioethics. First Things: A Monthly Journal of Religion and Public Life, 23-56.
O’Neill, O. (2002). Autonomy and Trust in Bioethics. Cambridge, England: Cambridge University Press.
Schaub, D. (2004, Summer). Bioethics and the Constitution. Public Interest 51-76.
Schneider, C. E. (1994). Bioethics in the Language of the Law. The Hastings Center Report, 24(4), 16-46.
Sunstein, C. R. (1994). Incommensurability and Valuation in Law. Michigan Law Review, 92(4), 779-861.
Sykes, A. O. (2002). New Directions in Law and Economics. American Economist, 46(1), 10-38.
Registered nurses (RNs) are supposed to assume an active role, particularly in instances where the fundamental rights of the patient are endangered. This advocacy paper assesses a hypothetical health condition from the RNs’ standpoint. The rights of patients will be assessed in detail and the impact of their infringement appraised. Moreover, the endeavors of other health professionals will be thoroughly deliberated with the application of the Bioethical Decision-Making Model in the discussed case (Piryani, Piryani, Poudel, & Sharma, 2016). The paper will discuss nursing support in the health situation while specifying the role of the nurse as the patients’ advocate. Modern nurses are supposed to carefully mull over the rights of patients and avert any possible threat.
In the definition of the dilemma, a given RN often accomplishes all the set functions appropriately and values patient autonomy, in addition to other associated rights. Informed consent is deemed one of the main factors in the operations of RNs. Nonetheless, at times, healthcare providers may fail to function in line with the ethics of informed consent (Cheng & Lin, 2017). In the hypothetical situation employed in this paper, nurses operating in a hospital in the United States failed to seek the patient’s permission prior to beginning their intervention. Regardless of the nurses’ actions having been elicited by positive intentions, they contravened patients’ rights because they knew that informed consent was necessitated by all directives under patient care regulations. Nonetheless, the health professionals did not acquire complete informed consent from the patient in question and went ahead to initiate their intervention. The RNs only became cognizant of the fact after a few minutes into the practice. There is a need for the establishment of an optimal strategy for addressing such an occurrence, in addition to the avoidance of similar issues in the future.
In the identification of the medical facts, the health professionals introduced medical interventions devoid of seeking informed consent from the patient. Moreover, the nurse manager did not prevent such an error from occurring. Since nurses cannot guarantee positive outcomes in medical situations, informed consent makes sure that patients comprehend the risks and side-effects of possible treatment approaches (Cheng & Lin, 2017). When patients approve a treatment practice, they should sign to show that they understand underlying treatment aspects and authorize healthcare providers to embark on the necessary life-saving measures. With respect to the identification of non-medical facts, the role of the nurse as the advocate may vary in line with patients’ requirements and preferences. In all situations, nurses should respect the human dignity of patients irrespective of their psychological state, physical conditions, culture, religion, or socio-economic situation. In terms of external influences, healthcare providers who violate rights of patients should be punished accordingly. Furthermore, practice acts, organizational policies, federal and state laws, and code of ethics should implement stringent measures for the prevention of similar violations in the future. Health professionals who infringe on the rights of patients may be fined and made to experience further sanctions from their healthcare organizations.
Some of the items that need clarification include the formulation of rebuttal and exceptions. The set regulations should be strictly implemented, and the rights of patients safeguarded. Nevertheless, some exemptions may be permitted under extreme cases. For instance, when there is no time to consult with some health professionals, there is a likelihood of abandoning some components of the set strategy. This, however, does not supersede patient autonomy in any event. In the identification of decision-makers, if the patient is an adult who can make their choices, their contribution is vital for the generation of an autonomy-supportive setting (Nibbelink & Brewer, 2018). Nonetheless, if the patient is a child or in a critical condition that hinders their ability to make choices, the parent, guardian, or a close family member may give informed consent on their behalf. Such a person is selected based on the views of other members of the family and in support of the past relationship with the patient.
In line with underlying ethical principles, some of the major values have not been adhered to by the nurses. Beneficence is tackled since treatment options are assessed from the consideration of the patient and for their benefit. Nonmaleficence is not adhered to in this case because the treatment intervention was not negotiated with the patient, and they are not conscious of the possible risks of different choices. Similarly, patient autonomy is not upheld since the necessities of achieving informed consent were not followed correctly (Cheng & Lin, 2017). Moreover, the principle of justice was undertaken constantly because the welfare and policies of health professionals and requirements of patients were balanced with each other. The alternative necessary to avoid the occurrence of the problem in the future entails requiring nurses to consult with the nurse manager and not instigate any intervention without approval. Although this might have the burden of overloading the nurse manager with additional tasks, it has the benefit of ensuring that the set guidelines are always met. Follow-up is essential to ascertain that established policies are successfully applied. The nurse manager should thoroughly evaluate operations of nurses regularly, for example, once in a fortnight, to make sure that nurses have successfully adjusted the behaviors and strategies.
RNs should assume an active function, mainly in instances where the essential rights of the patient are imperiled. Nurses are supposed to cautiously mull over the rights of patients and avoid any possible threat. The alternative needed to evade the occurrence of mistakes during treatment entails requiring nurses to check with the nurse manager and not prompt any intervention devoid of approval.
References
Cheng, C. T., & Lin, C. C. (2017). The use of informed consent in clinical nursing practice. The Journal of Nursing, 64(1), 98-100.
Nibbelink, C. W., & Brewer, B. B. (2018). Decision‐making in nursing practice: An integrative literature review. Journal of Clinical Nursing, 27(5-6), 917-928.
Piryani, R. M., Piryani, S., Poudel, R. S., & Sharma, M. (2016). Needs assessment for teaching/learning nursing ethics for master of nursing students. Asian Bioethics Review, 8(2), 134-142.
Withdrawing Treatment for Severely Deformed Infants
One of the most controversial questions in biomedical ethics today is whether severely deformed infants should be given access to the medical care they need or not. Advocates for the withdrawal of treatment for severely deformed infants base their arguments on the fact that treatment for severely deformed infants is futile. This means that severely deformed infants have no chance of surviving due to their medical condition. Consequently, there is no need to continue giving them medication (Jacobs & Taylor, 2005). However, some medical practitioners and human rights activists are against withdrawing treatment for severely deformed infants.
Their arguments are based on the value of human life (Porter, Johnson, & Warren, 2005). The ethical dilemma in deciding on whether treatment for severely deformed infants should be withdrawn or not is found on the justification of the decision made. This is because withdrawing the treatment could lead to the death of the infants. Consequently, there is a need to study the validity of the reasons that have been used to justify the withdrawal of such treatment. This will help medical practitioners to understand the basis of making decisions relating to the treatment of the severely deformed infants (American Nurses Association, 2001).
In order to achieve this objective, the validity of the concept of medical futility has to be tested. This paper argues for the premise that medical futility is a void concept and thus severely deformed infants should be given access to ordinary healthcare.
Reasons for Withdrawing Treatment for Severely Deformed Infants
To understand the ethical dilemma involved in this case, it is important to highlight the reasons used by the advocates of withdrawing treatment for severely deformed infants to justify their position on the issue.
Those who advocate for the withdrawal of the treatment use the concept of medical futility to justify their position. Medical futility refers to a situation in which the medication that is expected to improve the health of the patient is predicted to be ineffective based on the available evidence (Jacobs & Taylor, 2005). This means that the medical practitioners will use their past experiences with patients who had similar medical conditions to decide on whether to withdraw treatment or not. Thus if a given therapy did not succeed in benefiting the health of a given number of patients in the past, then such therapy will be considered to be futile (Jacobs & Taylor, 2005). Consequently, the therapy will be withdrawn as a treatment measure for patients in the future.
The concept is applied as follows in explaining the reasons why treatment for severely deformed infants should be withdrawn. First, some infants have severe deformation of vital organs such as the lungs, the heart, the nerve system and even the brain. Thus such infants have limited ability to interact with the environment on their own without the support of life-saving machines. This means that such infants cannot respond effectively to stimuli especially in cases where the brain is severely deformed. Due to these conditions, those who advocate for the withdrawal of treatment for severely deformed infants consider the infants to be incapacitated.
They believe that infants are as good as dead. Besides, they believe that no treatment can be used to reverse the infants’ conditions (Jacobs & Taylor, 2005). This implies that severely deformed infants are not persons due to their health conditions. Consequently, they do not have a right to medication and this informs the decision to withdraw the treatments given to them.
Second, the condition of most severely deformed infants cannot be treated or be reversed completely. This is due to the lack of appropriate medication or therapy that can help in solving the health problem of the infants. Thus the infants will have to live with the pain attributed to their health condition for the rest of their lives. Those who advocate for the withdrawal of treatment for severely deformed infants assume that the infants are not willing to live with their health conditions for long (Porter, Johnson, & Warren, 2005).
This means that the infants are not interested in continuing to live. Therefore, the infants do not have a right to any medication because they are not interested in continuing to live. The healthcare practitioners in this case will thus withdraw the treatment on the ground that it does not add any value to the health of the patient (Fry & Veatch, 2006). By withdrawing the treatment, the infant will have the opportunity to die. The death will therefore save them the pain that they would have suffered by continuing to live (Porter, Johnson, & Warren, 2005).
Finally, those who advocate for the withdrawal of treatment for severely deformed infants use the level of utility associated with the treatment of the infants to support their decisions (Jacobs & Taylor, 2005). In most cases, the treatment used in response to the health conditions of severely deformed infants has little effect or is slow in improving the conditions of the patients. Thus the patients are deriving little utility from the treatment and this might not be helpful for their well-being in the long term (Fry & Veatch, 2006).
The medical practitioners and healthcare providers are also deriving little utility by treating severely deformed infants. This is because they use a lot of resources in terms of cash and time to treat the patients. However, the outcome of their efforts to improve the health of severely deformed infants does not translate to the expected results. Consequently, the practitioners, in this case, deem it fit to withdraw the treatment to save on the scarce resources. The severely deformed infants are left to die as the resources are used to treat those whose health conditions can be reversed.
Analysis of the Reasons for Withdrawing Treatment
Those who are against withdrawing treatment for severely deformed infants identify several weaknesses in the concept of medical futility which forms the basis for withdrawing treatment. An analysis of the above reasons reveals the following weaknesses in the concept of medical futility. First, severely deformed infants are not considered persons due to their health conditions. This particularly happens in cases whereby the infant’s brain is severely deformed and the development of the infant’s personality is threatened. While this can be true, it is not easy to tell the extent of the infant’s brain deformation at early stages in life.
This is because most symptoms of brain malfunctioning are exhibited at later stages. This means that what might seem to be a severe deformation of the brain might not be the case when the infant grows up. Thus it will be a mistake to terminate the life of the infant by withdrawing the treatment they need to survive (Beauchamp & Childress, 2009). Today, the use of electroencephalography tests is used to determine whether a person is dead or not. According to this test, a person is dead if the test does not reveal any brain activity in 48 hours (Jacobs & Taylor, 2005). Thus the result of this test is used to withdraw the benefits of life support machines to the patients.
However, this definition of death is only limited to the brain. Medical research shows that even with lack of brain activity, the body of the patient can still maintain functions such as blood circulation, breathing, filtering of waste, and digesting food (Jacobs & Taylor, 2005). This shows that the body is not dead and can live longer if well maintained through medical support. Thus severely deformed infants are still human beings even if their brains are deformed. What they need is medical support to survive.
The concept of medical futility uses assumptions that if a particular medication did not succeed in improving the lives of a given number of patients in the past then such medication is futile (Jacobs & Taylor, 2005). Consequently, the use of the medication will be withdrawn for all patients. This reasoning fails to consider the fact that every patient is unique (Fry & Veatch, 2006). Thus it is not granted that the medication that has failed in some patients will fail in each and every individual.
Besides, patients respond to medication with varying levels of success. Consequently, there is no universal cut-off point for determining the success or failure of a given medication in improving the health of the patients. This means that withdrawing treatment for the infants is not justified simply because such treatments failed to help infants who had the same conditions in the past (Beauchamp & Childress, 2009). Instead of withdrawing treatment, the practitioners should consider alternative approaches to handling the infants’ conditions (American Nurses Association, 2001).
The other weakness of the concept of medical futility is found in the fact that the health practitioners have all the powers to make decisions regarding the lives of patients (Jacobs & Taylor, 2005). The advocates of the concept of medical futility argue that the practitioners are generally guided by the profession’s standards of care instead of a whim (American Nurses Association, 2001). However, personal prejudices and biases can interfere with the decisions of the practitioners regarding the lives of the infants (Fry & Veatch, 2006). When the responsibility to decide the life of the patient is fully given to the physician then the right of the patient to determine what they want for their lives is at risk (Porter, Johnson, & Warren, 2005). The law gives the patients the right to accept or decline treatment.
Thus the patients have to be involved in the making of decisions relating to withdrawal of treatment (Beauchamp & Childress, 2009). In the case of infants who cannot communicate, the decision can be made on their behalf by their parents. Consequently, the assumption that severely deformed infants do not have their lives at the best of their interest is nullified. This is because the opinion on the infants’ interests in their lives should come from the infants or their parents but not from the practitioners. Therefore, the infants should be given medication until at such a time when they are able to explicitly declare their lack of interest in their lives.
The concept of medical futility does not consider religious perspectives concerning life (Jacobs & Taylor, 2005). Every society subscribes to a religious ideology that upholds the dignity of life. Thus no one has a right to take the life of the other irrespective of the quality of the life in question (American Nurses Association, 2001). By withdrawing treatment for the severely deformed infants, the physicians are literally terminating the lives of the infants and this is against society’s moral standards. While religious ideologies should not interfere with the practice of medicine, practitioners cannot be effective without nurturing the values of society concerning life (American Nurses Association, 2001).
Religion gives physicians the best opportunity to understand the value of human life. This means that euthanasia is not allowed in society (Fry & Veatch, 2006). This is because for the physician to have authority to terminate the lives of the severely deformed infants at will by withdrawing treatment there has to be a law that gives them such authority (Porter, Johnson, & Warren, 2005). Currently there is no such law and this means that the severely deformed infants should be given all the necessary treatment that they require to live.
Severely deformed infants have always been denied medication since their treatment does not maximize utility (Jacobs & Taylor, 2005). However, the allocation of resources in healthcare cannot be based purely on utility. This is due to the fact that it is not possible to achieve maximum utility in treating all patients. Using utility as the basis for healthcare resource allocation will lead to inequality and alienation in the society. Besides, there are many options for addressing the low utilities associated with treating severely deformed infants. These options include improving the quality of compassionate care for the infants and the purchase of insurance cover to compensate for the financial resources used in the treatment (Porter, Johnson, & Warren, 2005). These options justify the need to offer treatment to severely deformed infants.
Finally, the general public is yet to understand the circumstances under which treatment should be withdrawn according to the concept of medical futility. While the proponents of the concept suggest that the information regarding withdrawal of medication should be available to the public, little progress has been achieved in implementing the suggestion (Jacobs & Taylor, 2005). Besides, the debate on withdrawal of treatment cannot be settled easily.
This is because a lot of funds and time will be needed to educate the public on the concept of medical futility. However, such education on the concept of medical futility will not be important if it is not possible to achieve consensus on the topic. Thus there will never be consensus on the topic even if more efforts are put into convincing the public to accept the concept of medical futility. Thus it will be more economical to focus on treating the severely deformed infants as compared to funding the debate on withdrawal of treatment.
Conclusion
The main dilemma in deciding whether to withdraw treatment for severely deformed infants is found in the justification of the decision made (Beauchamp & Childress, 2009). Those who advocate for the withdrawal of the treatment use the concept of medical futility to justify their arguments. Medical futility refers to the situation in which the treatment that is expected to improve the health condition of a patient is predicted to be ineffective based on available evidence. Severely deformed infants are denied treatment on the assumption that their health conditions cannot be reversed. Thus it is not important to make an effort to treat them.
However, medical research indicates that treating severely deformed infants can at least prolong their lives (Jacobs & Taylor, 2005). The main weakness of medical futility is that it relies on the assumption that treatment that failed on some patients in the past will fail in all subsequent patients (Jacobs & Taylor, 2005). This assumption does not hold in all circumstances as discussed above. Thus medical futility is a void concept and severely deformed infants should be given access to ordinary healthcare.
References
American Nurses Association. (2001). Code of ethics for nurses. Silver Spring,MD: American Nurses Association.
Beauchamp, L., & Childress, F. (2009). Principles of biomedical ethics. New York: Oxford Press.
Fry, J., & Veatch, M. (2006). Case studies in nursing ethics. Boston: Jones and Bartlett Publishers.
Jacobs, B., & Taylor, C. (2005). Medical Futility in the natural attitude. Advances in Nursing Science, vol. 28 (4) , 288-305.
Porter, T., Johnson, P., & Warren, N. (2005). Bioethical issues concerning death: death, dying and end-off life rights. Crit Care Nurs Q, vol. 28 (1) , 85-92.
Commerce plays a significant role in our day-to-day life. We are constantly in trade amongst ourselves and with the corporation for food, clothing, accessories, and cosmetics among various things. All these in a bid make us better and more comfortable (Lewis, Tamparo, and Tatro 2012). For the last three decades, this has expanded to the trade and commercialization of human body parts. An especially tricky area that has spurred the debate between non-malfeasance and beneficence, one having to not harm and the other the moral obligation to do what is right. It is indeed interesting as it engages all stakeholders in the dilemma (Anton, Silberglitt, and Schneider 2012). This memo discusses policies advocating proper bioethics.
Opinion
I chose this method because I’m a firm believer in individual rights freedoms and liberties. For this reason, I believe that I may not always agree with the opinion of another person. Nevertheless, for the simple reason that they have the right and freedom to express themselves, they should under no circumstance remain victimized, or their rights undermined. For this reason, if a person wishes to have their organs harvested they should be allowed to do so, and if they don’t wish the same, their wishes should be respected at all costs.
Statement of the Problem
The government has the moral obligation to ensure human dignity and at the same time, it is struggling with the implementation of a person’s democratic right to freedom and liberty. In the current capitalistic setup, engaging in business for profit is good since there are willing buyers and sellers (Lewis, Tamparo, and Tatro 2012). Medical practitioners are also facing the same dilemma between ethics and moral duty. The patients on the other hand also are confronting the same dilemma and to them, it’s probably worse as they are the ones the worst affected by this debate both directly and indirectly.
Literature review
The commercialization of body parts is now a booming trade that covers all areas of the globe. Body parts get commercialized for cosmetic value and health purposes (Finegold 2005). The countries where most of this takes place are Brazil, Indonesia, the Philippines, and Venezuela amongst others. It should be noted that the practice is a worldwide affair; all countries participate in this relationship on some level. The moral and ethical debates have played a big role in shaping the environment in which this business takes place. Due to legislation some of these transplants are limited to specific locations and conditions under which they happen. (Lewis, Tamparo and Tatro 2012).
Cosmetic surgeries are those performed to enhance the appearance of a person. Major examples of this cosmetic surgery include making physical enhancements through injections, using silicone implants –Botox and also using transplant of body parts. It is mostly illegal in most countries due to health regulations and legal requirements that deem these transplants as unfit as they are risky, and most of them are unsanctioned thus exposing the patients to unforeseen health risks. When performed for cosmetic purposes, the practice of surgery and especially transplant surgery has come to be viewed adversely (Anton, Silberglitt, and Schneider 2012).
Uproar follows from churches and other religious organizations that consider the alterations of the human physical form as blasphemy. The other type of transplants is that which get warranted by a prevailing health condition or deemed necessary by a physician to save a person’s life. It becomes required for the well-being of the patient. These include procedures such as kidney transplants, liver transplants amongst others that a patient’s life may be dependent on (Steinbock, Arras, and London 2009).
The mandate for this type of surgery is overwhelming as there are various patents and candidates for the different transplants. Waiting lists of certain types of surgeries go as far as three years. It forces the patient to risk underground operations in third-world countries or countries whose restrictions of the transplant are not that restrictive or limiting. Therefore, it presents a lot of health and safety risks to the patient who has been forced out of desperation from the prevailing health condition to resort to the surgeries (Steinbock, Arras and London 2009). They may end up being given defective body parts that cause more dire effects or might not get adequate care during operations providing bigger problems to the patient. The entire backdoor transplant is made possible by the presence of a black market for body parts. This black market provides an adequate supply of fresh body parts, and the commodities in this market include kidneys, hearts, livers skin, blood, and hormones amongst others (Anton, Silberglitt, and Schneider 2012).
Comparison and contrasting issues
Considering the commodity being in demand from this transplant is often obtained using questionable tactics. Such tactics include organ harvesting, organ theft, coercion, donations, and gifting, voluntary transplants, and barter trading parts (Finegold 2005). In a sense, this sums up the modern organ procurement transactions. Some get obtained for research in science and medicine. The parts get donated to science for study and analysis, and then the research can be used to gather some scientific understanding or thought (Anton, Silberglitt, and Schneider 2012). The theft of human body parts has been growing steadily, especially in third-world countries. It is because of the rampant insecurity that renders the locals to the unscrupulous body part dealers who steal their body parts to settle demand in the first world.
There are cases in such countries as Thailand, where persons get drugged during a night out with friends and wake up the next day without a kidney and lack the memory of how they lost it. These stolen body parts find their way to the wider and more global black market where they end up being transplanted to a client or patient in Brazil. There is also coercion whereby a person is forced to offer his body part for operation on the pain of death or while being held at ransom as this does not get done out of the individual’s volition. This theft and black market trades on human parts contribute to the bulk of the cases of body parts in circulation (Anton, Silberglitt, and Schneider 2012).
These dealings have evoked the establishment of the field of bioethics that works to try to mitigate the emerging problems associated with transplants. There are also just and fair manners to obtain body parts to use in operations. These include voluntarism whereby a person may forfeit a part of their body to someone else for transplant. It often happens in kidney transplant cases where a person can donate one of their two kidneys to another person who is in need (Steinbock, Arras, and London 2009). It is of the donor’s free volition without any pressure to donate to a patient in need.
There is also another donation of body parts that are often incorporated in a person’s will. It requires them to be a registered organ donor and in this scenario, a person’s viable body parts can be harvested should they pass on. In this case, the state is the one that benefits from these body parts and uses them to distribute to areas of need (Finegold 2005). As discussed above, there is the commitment of one’s body upon death to research towards science and medicine for experimentation and anatomical analysis. In essence, is to further the understanding of this field for future references.
The reduction of body parts to a commodity is the major problem that comes forth due to the establishment of international organ markets. It has essentially put a price tag on all of human life (Steinbock, Arras, and London 2009). With the valuation of the various body parts, meaning that they can get traded, stolen, sold, and bought at with the prevailing supply and demand model of business. In essence, this raises the different ethical issues that envisage social justice and go to the core of the human traditions and fundamental beliefs about the sanctity of human life. Thus, it works to create the dilemma that would get observed above, especially on the legal front (Anton, Silberglitt, and Schneider 2012).
Strengths and weaknesses
Human beings endeavor to be successful and this is a basic human right that has remained protected in all the constitutions of the world. It creates quite a jargon as this productivity in a bid to achieve self-actualization needs to conform to the laid down rules about the sanctity of life. In this day and age, there existed various debates at the time of when life initiates and when It ends and especially in our context. The discussion takes the turn to the necessity to uphold such views of human dignity even after persons are dead (Finegold 2005).
Some people think that everyone has a moral obligation to upon death provide their body for organ harvesting. It gets based on the simple argument that once dead, instead of letting the otherwise useful parts get discarded, they can be used to save and safeguard another life. There also exist those who are of the considerations that are more conservatism, and that seek to protect the body of the dead from being harvested for boy parts (Finegold 2005).
This view gets associated with the religious movement that seeks to preserve the natural form of the thing and most especially the human for even and most especially after death (Steinbock, Arras and London 2009). The third group is a divided lot whose view on the subject hinges upon the fact that body parts are a property of the person. Until and unless the person provides it freely and of his volition, there should be no authority to take them. In this case, they agree that transplants can be done, but they are only carried out with the express permission of those affected by the operation. For instance, the donor and the recipient of the body parts (Steinbock, Arras, and London 2009). Of the three policies available above, I would like to choose the one where the operation takes place only and strictly with the express permission of the donor in this case as they are the ones most affected.
All this would be either in writing or verbal permission just as long as there is express permission. In this case, the person’s liberties are being observed in the saving of another person’s life (Finegold 2005). It provides a solution to the dilemma while preserving the freedom of an individual and their integrity at the same time. The other policies are unfavorable as they do not take into consideration the opinion and the wishes of the donor. But this one is accorded adequate respect to the donor concerning the right of the individual.
Conclusion
In finality, there are various ways to create consensus over the different methodologies of use in solving this dilemma. The most effective one is where there is a compromise on both sides of the divide while ensuring that the freedom and liberties of the person donating the body part are respected. It can ensure that both sides are happy and satisfied. For it to be understood, compromise is essential and thus for this reason there is a consensus. The role of transplant surgery in saving lives is critical to improving the quality of life, and it is essential also to ensure that ethics and moral values remain duly observed at the same time.
References
Anton, P., Silberglitt, R., and Schneider, J. (2012). The Global Technology Revolution. Santa Monica: RAND.
Finegold, D. (2005). Bioindustry Ethics. Amsterdam: Elsevier Academic Press.
Lewis, M., Tamparo, C., and Tatro, B. (2012). Medical Law, Ethics and Bioethics for the Health Professions. Philadelphia: Davis Company.
Steinbock, B., Arras, J., and London, A. (2009). Ethical Issues in Modern Medicine. Boston: McGraw-Hill.