The quest for stabilizing the complexities of the clinical environment in the issues of moral and ethical dilemmas is remarkably elucidated by the immense contentions that surround the domains of the health care providers, the patients, and the society as well. Making the “right decision” might not be right for others yet might be virtuous for the beholder as it is influenced by the personal and individual’s ethical perspective. Incorporating cultural diversity in a place that dissects the dilemma emerging from each individuals’ point of view, religion, beliefs, values, and experiences create a huge challenge on the ethical and on the medical views as well (Levin, 2010).
To provide an explicit presentation of these intricated subjects, this piece of work had been outlined to transpire the discrete ethical quandaries and to present the advantageous facets in the field of each ethical issue. Additionally, this is to convey the picture of the potential perplexities to allow the readers judge the moral issues that were presented in this work.
Issues with End of Life
The challenge to the issues of end of life is enormous and ubiquitous and propose a great concern to the majority of the major stakeholders in the situational dispute of what is ethically or legally right. The furtherance of medical science wherein the prolongation of life is made doable and the tweaking of the standard occurrence of natural death submit a potential disarray in the field of ethics (Karnik & Kanekar, 2016). Sustaining human lives under a nebulous chance of maintaining a quality of life in cases of irreversible conditions and absence of worthwhile existence have become a target of ethical dilemmas for the patients, caregivers, and the physicians who are involved in the care (Karnik & Kanekar, 2016).
Patient’s Right for Autonomy
The patient’s right to make for his/her own decision regarding the end of life care is legally and ethically recognized, nevertheless, in the presence of certain limitations (Karnik & Kanekar, 2016). In 1990, the Patient Self Determination Act (PDSA) catalyzed the promulgation of the patient’s choice of treatment and the discernment of what is best for the patient, and the physician should honor and respect the patient’s autonomy while protecting and upholding the ground rule of beneficence and nonmaleficence (Karnik & Kanekar, 2016).
Through “advance directives”, a competent individual can design and outline the wishes in cases of terminal illness, or the incapability to make a reasonable decision related to the execution of the patient’s preferences (Karnik & Kanekar, 2016). In addition, advance directives likewise fulfill the patient’s wishes to delegate the responsibility to another competent person or caregiver who is capable of making an upright decision on behalf of the patient (Karnik & Kanekar, 2016).
Physician’s Job with a Greater Responsibility
It is not a question that the patient’s autonomy should be accepted and acknowledged, it is the issue of physicians’ balancing acts of the legal and ethical norms of the situation. The concept of a rightful performance of duty relies on the detailed and truthful conveyance of information regarding the benefits, limitations, and disadvantages of the desired treatment (Karnik & Kanekar, 2016).
Although the patient has the right for self-determination and may elect to undergo a medically advanced treatment to prolong life, or to abjure ineffectual treatment, it is the uttermost responsibility of the physician to explain the facts from both aspects and not to leave any gap for confusion (Karnik & Kanekar, 2016). Furthermore, the physician has an obligation to conserve patient’s life, however, that duty is not to be perplexed with irrelevant use of resources and foisting more harm than good to the patient by incessantly imposing medically useless treatment (Karnik & Kanekar, 2016).
Family or Caregivers’ Potential Dilemma
The family or the caregiver occupies a major position in ensuring that the patient’s wishes regarding end of life care are delivered carefully and appropriately (Karnik & Kanekar, 2016). In the event that the scheme of advance directive is vague and unclear, and the family is to infer on the actual medical situation, the potential dilemma is unavoidable (Karnik & Kanekar, 2016). Generally, if family members are emotionally attached to the patient, inherent noble interest is typically directed to the life preservation and oftentimes, lead to unjustifiable actions on whether are beneficial to the quality of life of the patient (Pozgar, 2013). Integrating the ethical committee to provide guidance and education to the family or to the caregiver is a key for a better understanding of the situational dilemma.
Allowing and Assisting Patients to Die
Allowing and assisting a patient to die have been a huge ethical and legal issue of debate. In a layman’s perspective, there is no difference between the two as both actions are directed to the patient’s death (Pozgar, 2013). However, from the legal and the medical perspectives, these differentiations draw a line to the main duties and the accountabilities of the physicians regarding the rationality of the actions (Pozgar, 2013).
Allowing a Patient to Die
The abstraction of allowing a patient to die is the act of permitting the death under the protection of the law, beneath the patient’s interest or the caregiver’s judgment to discontinue the treatment that is foreseen as harmful or disadvantageous to the patient’s quality of life (Garrard & Wilkinson, 2005). The physician’s intention is not to precipitate death but to safeguard the patient from undue burden or harm (Garrard & Wilkinson, 2005). In addition, passive euthanasia establishes three vital conditions wherein there is an involvement of withdrawing or withholding life-prolonging treatment such as the ventilator support, the principal purpose of the withdrawal is to facilitate dignified death, and that action must base on the patient’s own best interests (Garrard & Wilkinson, 2005).
Physician-Assisted Suicide
According to Pozgar (2013) and Snyder Sulmasy and Mueller (2017), physician-assisted suicide is the provision of medical support by a physician to deliberately aids a patient’s willful and conscious act to bring about own death such as by dispensing prescriptions for medication to end his/her own life (Pozgar, 2013; Snyder-Sulmasy & Mueller, 2017). In the State of Oregon, the Death and Dignity Act of 1997 permits a residence of 18 years of age or older, who are terminally ill and whose lifespan would be six months or less, as determined by the physician and who had freely indicated an aim to die, to procure a fatal dose of drugs to facilitate the process of death (Pozgar, 2013).
Caregiver’s Rights to Privacy and Confidentiality vs Patient’s Right to Know
Disclosure of the information regarding HIV/AIDS is a battle in the field of ethics. Do patients have the right to know whether their caregivers have HIV or AIDS? According to The Center for HIV Law & Policy (2008), most of the states require a case to case basis on the policy of notification of patients regarding a case of a medical worker having AIDS (The Center for HIV Law & Policy, 2008). In New Hampshire, it is mandated for health care workers with AIDS to apply to the commissioner if the HCW is proceeding to participate in any invasive procedure (The Center for HIV Law & Policy, 2008). In addition, as indicated in the article of O. Blatchford, O’Brien, M. Blatchford and Taylor (2000), “The American Medical Association has issued guidance that HIV infected practitioner undertaking exposure-prone procedure must either disclose this to their patients, obtaining their informed consent prior to treatment or must withdraw from the treatment” (O. Blatchford, O Brien, M. Blatchford, & Taylor, 2000). In the context of obtaining an informed consent from a patient, the principle of veracity is a fundamental part to acknowledge the patient’s right for autonomy, for a patient to make an accurate decision based on the honest and genuine information of the situation (Blatchford, O Brien, Blatchford, & Taylor, 2000). Provision of truthful facts including the level of risk is significant as it exhibits a dutiful and a deferential provider-patient relationship (Blatchford, O Brien, Blatchford, & Taylor, 2000).
Wrongful Birth, Wrongful Life, and Wrongful Conception
The moral dilemmas from these unwarranted situations transpire from the psychological torments and the financial hardships of parents from giving birth to genetically defected offspring versus the commencing to undertake the termination of pregnancy in the early phase of conception (Frati et al., 2017). The argument of obtaining an adequate information and a proper guidance from the medical provider through counseling or genetic testing to determine any congenital abnormalities in the fetal development in utero allows the parents to choose whether to proceed with abortion or to keep the fetus for an ethical reason (Donovan, 1984).
Wrongful Birth
As defined in the article of Frati et al. (2017), a wrongful birth is a delivery of a child with birth defects as an outcome of the failure of the medical providers to furnish sufficient information resulted in a parent’s deficient understanding concerning the probable and actual risks of conceiving a child with genetic or congenital anomalies (Frati et al., 2017). This situation consequently increased the cost to sustain the disabled offspring and intensified the moral and emotional suffering of the mother or parents, in which the possible alternative should have been proposed to provide the mother a choice in deciding what is best for her and her conception (Frati et al., 2017).
Wrongful Life
The concept of wrongful life is derived on the basis of a child’s unfit biological existence and having to bear the sufferings and the miseries brought about by the disability which has a great impact on the quality life of the incapacitated child (Frati et al., 2017). The wrongful life claims are commonly instituted by parents or the child, however, because there is no sanctioned for legal right not to be born, this type of contention is ubiquitously not successful (Pozgar, 2013).
Wrongful Conception
The representation of this concept is directed towards the unexpected conception of a mother due to a careless and remiss sterilization procedure or a flaw in the devices’ integrity to prevent impregnation (Pozgar, 2013). The argument of carrying the burden and agony related with gestation and birth, with the financial hardships of the additional member of the family, or harm from a child born with disabilities is evidently vexed (Pozgar, 2013).
Partial Birth Abortion
This topic is a long debated one as it involves valid arguments from both sides of the coin, the pros and cons. Since the legalization of abortion in the United States 44 years ago and approximated 59 million unborn children have lost their lives, it is still a battle on top of the table (National Right to Life, 2017). The arguments of the viability of the fetus, that is after 20 weeks of gestation and the nature of the procedure is itself a threat to the moral and ethical conduct of the society. In addition, it has been argued that the termination of pregnancy beyond that fetal age constitute an act of feticide due to the well-developed function of life. Furthermore, late term abortion positions a woman with complex physical and psychological issues such as succeeding preterm birth and mental health problems (Johnson, 2015).
On the other hand, the question of insufficient genetic testing at the early phase of fetus life, before 20 weeks of gestation, to promptly determine the potential and the actual defects of the fetus is a valid argument as it touches the foreseen sufferings of the parents and the child as well because of the delay in the diagnosis (Johnson, 2015). Moreover, the nationwide legalization of late term abortion is vague and does draw a line in favor of maternal life and maternal health but not rape and incest (Vermont Legislative Research Shop, n.d.).
Controversy Over Genetic Markers and Stem Cell Research
Advances in medical science in some degree created distinct and ample ethical and moral dilemmas because of the complexity of nature of genetic markers and stem cell research as it is considered as scientifically promising and ethically challenging (King & Perrin, 2014). The issue of permissible and non-permissible actions has lie on the principles of informed consent, confidentiality and justice, and the uncertainty of commercialization (King & Perrin, 2014).
Some of the core issues or targets of dispute is the uniqueness of the individual as a human being, that has a soul and has distinct characteristics, and that integrity of existence must be protected and safeguarded or a question of “is it an assemblage of cells that will be saved to be part of humanity in the future?” (Genetics and Stem Cell Research, n.d.). Diversely, it is known that stem cell therapy holds an auspicious approach in the treatment of diseases such as cardiovascular diseases and it plays an important aspect in the advancement of medicines (Goradel et al, 2017). These foreseen advantages are obviously at hand, however, there should be a sense of equilibrium of ethics and medicine to delineate this advancement.
Conclusion
The continuous advancement of science provides the world with copious promising benefits and advantages, however, coping with this growing trend also meant a bracket of potential ethical and moral dilemmas that the society needs to deal with. As a health care provider, it is a must to fully understand the internal aspects of the situation and to identify the dimensions of own values and beliefs to counterbalance the pros and cons of the ethical and the scientific objectives transported by these medical advancements. In the course of these significant developments, there must be a sturdy set of policies and regulations to counteract the effect of undesirable actions governing these complex growths of science. Indeed, technological advances are unavoidable, it is essentially equitable to create a fair blend of justified rights that is aligned to the moral and ethical norms of oneself and the society.
