Medical Ethics Essay, Research Paper
Medical EthicsMedical ethics, the implementation of ethics towards medicine is a necessary tool for enumerating the various ethical and moral propositions and clarifying their positions. “… Medical ethics is simply ethics applied to a particular area of our lives… medicine… “(Clouser pp 384). Medical ethics has two roles, one is that of sensitizing. “… It is a consciousness-raising enterprise, alerting us from grossest injustice to subtlest nuance..”(Clouser pp 385) The other of which is structuring of the medical issues. “… This is the second item I would isolate in describint what medical ethics is up to. I call this structuring the issues. The morally relevant strands of a complex situation are based out.”(Clouser pp 385) The advice of the expert, the medical doctor, and the ethicists have a synergistic effect on the moral agent; they allow the agent to make a desision.that is informed and ethical. The medical ethicists has the foundations established by Emanuel Kant, A.J. Ayres, and Socrates to allow him to delineate the many facets of a situation in terms of the Twins philophicalal traditions. The two traditions beget points of view which are ethical and easy to comprehend. “… A medical ethicist cannot be appealing to speacial theories and remote lines of reasonning and simply delivering his conclusions to us, which we must accept because he is the expert.. Rationale people must be able to see, follow, and judge the points made.”(Clouser pp 386). The medical ethicists must frame all issues terms of the twin philosphical traditions. The twins philosphical traditions, absolute truth and situational ethics, applies not only to medical ethics but infiltrates every strata of our existance, from politics to education. Absolute truth is the notion of fixed immutable principles that exists outside the human condition, unchanging with geography and causality. Situational ethics, on the other hand, is the belief that all of ethics are within the human condition; the only reality is the process and change is the only absolute. These principles oppose each other and appear to act as state functions rather than as a continum. However there exists a bridge that connects the two tradtions and represents the mid-point within the ethical continuim. That is, there exists fix immutable truths which exists inside the human condition a priori, within the mind. These truths of fixed immutable origins can be applied using deductive reasonning to situations.The catholic nature of absolute truth, as established by the early greek philosphers like Socrates view the absolute as being outside the human condition. These ideals include justice, self-control, and holiness. “…is there such a thing as justice… I think so… virtue resembles knowledge or justice…”( Plato s The Protagoras pp 55). Since virtue, knowledge, justice, and courage resemble holiness and vice versa, as with holiness, virtue, knowledge, and justice must exist outside the human condition. “… (to) be a good man – which is what you were speaking of, Pittacus – is impossible and super-human. This is the previlege of a god alone…”(Plato s The Protagoras pp 79) Humans cannot be noble, just, and couragous but must strive to become these, that is, to live grounded within the rules of absolute truth. “… To live pleasurably is good, to live painfully bad… knowledge is a fine thing quite capable of ruling a man, and that if he can distinguish good from evil, nothing will force him to act otherwise…”( Plato s The Protagoras pp 89). According to the philosphers of this genra, the sancity of life is also an absolute. ” I swear by Apollo, the physician, and Aslepius…I will give no deadly medicine to anyone if asked, nor suggest any such counsel…”(The Oath of Hippocrates). Plato premised that knowledge and wisdom are the highest states of being(352 C. D. Menno). Plato had also reasoned that knowledge was virtue and being like virtue knowledge is an absolute principle. The mode to acquiring knowledge is existance, life and thus life must be protected as an absolute. In accordance to this philosphical tradtion, a medical ethicist, viewing a situation through absolute truth, would have to tailor his point of view through immutable truths, such as the sanctity of life. A situational ethicist, viewing the world through sensibility would argue that the general principles for viewing ethical points of view are grounded in human experience and the only absolute truth is change itself. A. J. Ayres, the philosphical father of situational ethics, would argue that the criteria for an ethical course of action are logic, validity of data, and the consequnces. “… We have to know what the situation is in which we are likely to be. If, for example, we think it right to try to maximize human happiness, a scientific approach to the practical problems may instruct us how best to set about it…”(A. J. Ayres The Central Quenstions of Philosophy pp. 226). Unlike the believers in catholic truth, A. J. Ayre does not believe that their exists only one moral stand-point which is superior to all others. “…In the end, it is a matter of finding principles which one is prepared to stand by and when they conflict… of giving more weight to one or the another according to the circumstances of the particular case…”(A. J. Ayres The Central Questions of Philosophy pp 266) However, this does not mean that all moral standpoints are to regarded as equal to one another. “… one can argue ad hominem. One may be able to show that their principles are based on factual assumptions which are false, or that they are the product of bad reasoning, or that they lead to consequences which their advocates are not prepared to stand by…”(Ayres pp 227). So, all ethical perspectives which are logicall y consistent should not necessarily be treated as equal to each other. In viewing the ethical point of view, no reference frame can be proven to have a preferred bias to any other reference frame provided that the reference frame is self consistent (lacking inconsistancies). A.J Ayres, as with other situational ethicists, views this criteria (logic, validity of data, and the consequences) as an acceptable substitute for “objective” standards. A medical ethicists, viewing a circumstance through situational ethics, would make a decision using A.J. Ayres criteria giving equal weight to views which might contradict the absolute ideals equally with those that don t. The reconciliation of the world of ideals ( absolute truth), and the world of sensiblity (situational ethics) is attempted by Kant. “…. the narrow footpath of freedom is the only one on which it is possible to make use of reason in our conduct….”(Kants Kritik s of Judgement pp 73) This suggests that the freedom of the will entails the use of rationalizing to make choices and moral decissions. “…we think of man in a different sense and relation when we call him free, and when we regard him as subject to the laws of nature as being to the laws of nature… but both must be thought as necessarily united …” (Kant p73). Freedom of the will, an absolute ideal of objective truth, is inseperable with the laws of nature, the world of sensiblity and situational ethics. This is analgous to the photon which has a dicotamy of both particle and wave like behaviors infused within it. The wave like characteristics being independant of the particle like characteristics yet coallescing in the photon. Because reflective Judgement from the emperical Laws (situational ethics) to the Universal (Absolute truths) can be established by a priori knowledge, it follows that the Universal, the ground of actuallity for the universe s existence is containined within us and is inherent in the emperical laws, the data (situational ethics). “… But if only the particular be given for which the universal has to be found, the judgement is merely reflective… The reflective Judgement, which is obliged to ascend from the particular in a nature to the universal, requires on that account a principle it cannot borrow from experience” (Kant pp 17)”… the principles of Judgement, in respect of the form of things to nature under emperical laws generally, is the purposiveness of nature… The purposiveness of nature is therefore a particular concept, a priori which has its origin solely in the reflective Judgement.”(Kant pp 19). When transversing from an idea ,a priori, to a moral decision the vehicle used can be logic and pure reasonning. The diacotomy between the absolute truth and emperical data allows the use of A. J. Ayres criteria , from the absolute which can be derived from the emperical laws, to make moral decissions. The medical ethicist can use a combination of Absolute truth and situational ethics to determin a moral stance.
When examining the issue of fetal abuse, the ethicist can employ either of the two stances, the rights of the fetus to enter the world with sound mind and body, and the womans rights to privacy, that is, the right not to have her body and life intruded upon. The rights of the fetus can be viewed through either situational ethics of absolute truth, however, the rights of mother can only be viewed through situational ethics. The rights of the fetus, from absolute truth, must be protected. The fetus must be recognized as human right after conceptualiziation. “… legal writers, taking note of scientific and medical advances, have urged that the enactment of laws to directly recognize the unborn as a person…”(Landwirth pp 510). As a person, the unborn is separate from the mother. “…a woman s right to abuse her own body and threaten her own health should not extend to the fetus”(Landwirth pp. 511) The protection of the fetus must be such that it protects the right of the fetus to be born healthy over that of the maternal rights. “… rights of children to be born healthy may override maternal rights, including otherwise protected rights of privacy.. This principle has its close analogue in the rationale for state intervention in cases of child abuse…”(Landwirth pp 511). The fetus, like a child, is an individual whose interests must be protected. In viewing the right of privacy of the mother to the right of the fetus, the proponents of absolute truth would view,”… the pregnant mother merely (as) as vessel for the incubating egg and subbordinate to the fetus…”(Landwirth pp 513). The absolute right to life must be protected by the mother and the mother must be held acculpable for the actions she knowingly takes to cause harm to the fetus. The situational ethicist would consider both the perspectives of the mother and the fetus and apply A. J. Ayres criteria to determin the ethical stance to be taken. The mother has a right to protect the rights of the fetus not because of the absolute sancity life but rather because the mother decided to carry the fetus to term. “… it has been argues that, not withstanding her strong interests, once she decides to forego abortion, a woman may lose her freedom to act in ways that would harm the fetus… [A] fetus has no right to be conceived… or once concieved, to be carried to viability. “(Landwirth pp 512). When the mother decides to bear the fetus, she accepts the role of the parent and thus must protect her “child” as any mother should.The rights of the mother can also be viewed through situational ethics. Some people view the fetus merely as an extension of the body. “… A wanted (or accepted) fetus is as much a part of a woman as any other part of her body…”(Landwirth pp 512) As long as the fetus is attatched to the mother, the organic unity prevents the seperation of mother and the fetus. Apply A. J. Ayres criteria of consequence, Hubbard, a propent for maternal rights, fears that justification for individual surveillance and controll of pregnant women may eventually encompass all women of childbearing age whose “potential fetus” might be adversly affected by their behavior.(Landwirth pp 512). The resolution to fetal health care by Hubbard is for society to ensure that pregnant women have access to good nutrition, health care, housing, education, and safe work place rather than implementing social control.Using the criteria of A J. Ayres, namely the validity of data, it is clear that the position shared by Hubbard are based on factual assumptions which are false. The fetus is itself in individual entity and is separate from the mother, the fetus s blood does not mix with the mother blood. Genetically the fetus is distinct from the mother and their exists about as much of a unity as that of a child dependant on the care of the mother. Being based on factual assumptions, Hubbards position cannot be treated as equal to the position of fetus. A. J. Ayre would argue that the rights of the fetus must preclude the rights of the mother, except in situations where the mother s life might be in danger. In another medical situation, when examining the conitued medical support given to Antonio we can frame the issues into the twins philosphical traditions ( Antonio is a 16 year old teen-ager viewed in the wards at UCLA PICU who is comatose, lacking most of his brain function, and whose prognosis is death within several weeks. By the insitance of the mother, Antonio was left on the resperator without a DNR. ) Again the tradition of absolute truth would rely on the sancitiy of life and justify the continued medical support. Though the mother, the moral agent, is the ultimate decision maker, the moral agent can ensure that all the issues are culptivated. The situational ethicist, using the criteria established by A. J. Ayres could not justify the medical resources used on Anthonio. Life is an absolute right, as would be argued by Socrates and other followers of absolute truth. An absolute truth cannot be dependant on the situation at hand, if it could, it would cease to be absolute. In viewing the perspective of the mother, the ethicist of ecumencal truths would argue with the position that the moral agent has taken. In other words, the moral agent has opted to take the stance of universal truth. On the other hand, the situational ethicisit would argue that the perspectives of the mother cannot be more morally justified than that of society. A. J. Ayres would argue that the perspective of the mother is based on factual assumptions which are false, and thus fail to meet his criteria for a given course of action. A. J. Ayres might argue that criterion of the human condition is the ability to respond freely to choices given, that is, the possession of a free-will. Since Antonio lacks any cognitive capacity to make choices, and to make choices freely, Antonio lacks free-will. Antonio is infact metaphysically dead, though biologically alive. The biological preservation of Antonio is only analogous to connecting a cadaver to a respirator and giving it a pulse. The assumption made by the moral agent that the preservation of Antonio s life is maintained by life support is false. Because societies vested interest in using the resources else where is a consistant point of view, logical and free from unacceptable consequences, it can be viewed greater than that of the moral agent. In this case, the situational ethics, using A. J. Ayres criteria is an acceptable substitute for objective standards. Because the cost/benefit ratio in this case is sided towards societies vested interest, the object standard can be substituted for A. J. Ayres criteria : Antonio will eventually be pronounced medically dead within several weeks, is alreally dead metaphysically, and is straining the medical resources which is already limiting . The medical ethicist can delinate the principles underlying a general medical dillema as fetal abuse to a specific case such as Antonio s existance using the twin traditions. It is important to realize that medical ethics has two limitations. One being,”… ethics is a very blunt instrument… It can be precise and rigorous, but does not determine one and only one action that recieves the moral seal of approval…”(Clouser pp 385.) The other ,”… many of the key notions really must be referred to expertise outside ethics…”(Clouser pp 385). It is for these two reasons that decissions are based on a moral agent with the help of the ethicists and the experts. Without the implementation of the twins philosphical traditions we are left with nihillism., amorality, and catastrophies. This can be readily seen by the failure of Semmelweis s peers to view the contagion theory as incorrect without repeating his work. (Semmelweis was a man who had the potential of saving thousands of lives during his life-time but could not because his contagion theory was dismissed by his colleges) Instead of implementing the scientific method to test the validity of the data (one of A. J. Ayres criteria), or feeling the necessity to his results for the absolute duty to their patients (Absolute truth; Plato and Hippocrates) they dismissed it. Driven by acts of huberous and bias rather than by moral standards, Semmelweis peers caused the death of thousands of bed fever patients, directly or indirectly. Any point of view that cannot be in the context of either situational ethics, absolute truth, or a combination of them must be viewed as erroneous and discared.