Introduction
Advances in medical technology and modern medicine ensure that life expectancy is extended and the natural course of death is altered. Although modern medicine and technological advances have not reached the point of curing chronic diseases, they prolong life by offering secondary support to patients such as respiratory support and nutrition (Akdeniz et al., 2021). Death is an inevitability for all people but some patients at the end of life experience difficulties and suffering. Close family members also experience a range of mental, psychological, and other problems. As one the primary caregivers, family members are often distraught when one of their own is diagnosed with a fatal condition and may on behalf of the patient seek life-sustaining interventions to prolong the life of one of their own. Further, a patient can, on their initiative, insist on life-sustaining interventions. Whether sought by the patient, family member, or physician, decisions on life-sustaining interventions are morally, emotionally, and ethically challenging.
From an ethical viewpoint, decisions on life-sustaining interventions should be made by the patient. However, in most instances, a patient is usually not in the right frame of mind to make such decisions. In such cases, it is the prerogative of a family member, proxy, or physician to decide on whether to prolong the patient’s life by keeping them on life-support. Family members who have to make such decisions on behalf of their loved ones can feel lost and unable to decide especially when they have different views on life-sustaining interventions (Akdeniz et al., 2021). Others may want everything done to ensure they extend the patient’s life as much as possible but be unable to make the decision and thus expect a physician to decide for them. In such circumstances, the physician faces an ethical dilemma because they have to balance the wishes of the family members with the goals of alleviating suffering for the patient and provision of comfort until death.
Stakeholders and Contextual Factors
Various stakeholders hold different views on life-sustaining interventions by patients or doctors. For instance, religious authorities oppose life-sustaining interventions if they would not provide qualitative benefits to a patient. Instead, they advocate for pain relief for dying patients and letting nature take its natural course. Every religion accepts death as an integral step in the life cycle and has structures, laws, and prayers that guide the artificial shortening or prolonging of a patient’s life (Vermeulen & Krabbe, 2018). Christianity unequivocally opposes euthanasia and physician-assisted suicide. However, Christians can accept life-sustaining interventions if such interventions lead to the patient’s qualitative improvement. If there is no qualitative improvement, Christians should let the natural course of events take place. According to the Catholic Church, patients can forgo life-sustaining interventions that only minimally prolong life without hope of spiritual or physical benefit.
Additionally, various cultures globally perceive the end of life differently, and depending on their view they may favor prolonging a patient’s life or letting nature take its course. Western nations where healthcare systems are more advanced and life expectancy is higher favor extending a patient’s life while in the developing world, letting nature take its course is often preferred. Thus, the improvement of healthcare systems and an increasing life expectancy demand an exploration of all health interventions. In the medical profession, professional identity is perceived as an important part of personal identity and a prerequisite for professional identity (Kristoffersen, 2021). In this regard, due to the complexities of life-sustaining interventions and the subjective nature of the decisions, deciding whether to put a patient on life-support is impacted by the physician’s personal identity. Thus, where one physical may feel obligated to put a patient on life-support, another physician may oppose such a decision on personal grounds.
Analysis – Moral Theories and Ethical Principles
Moral theories assist physicians to reflect and make ethical decisions but while they may help make ethical decisions, they are not predictive. Some of the most common moral theories are utilitarian theory, Kantian theory, rights theory, and virtue theory. According to the utilitarian theory, the point of an ethical decision is to maximize the amount of happiness with each decision (Grace, 2018). Thus, if the pain of one individual can lead to several lives being saved, the physician’s decision must lead to maximum utility. For life-sustaining intervention, the patient or physician must consider the well-being and welfare of family members and friends before deciding on an intervention. The Kantian theory emphasizes the consequences of actions. Thus, a decision is righteous if it leads to the desired consequences. This theory also stresses the wrongfulness of using the human body as an instrument and emphasizes that the righteousness of an action depends on its maxim. Thus, a decision to extend life-sustaining intervention will be considered righteous if its maxim is righteous.
The virtual theory posits that the virtuous act in any situation constitutes what a virtuous individual would do in such circumstances. Thus, doing what a good person would do constitutes an ethical action. The core intent of medicine is to improve patients’ lives. Working as a physician requires plenty of skills and care for the patient’s welfare. Thus, good physicians offer the best care to the best of their abilities and skills. According to rights theory, patients have rights as one of their intrinsic features (Grace, 2018). These rights must be recognized and respected by caregivers. Thus, in deciding on life-sustaining interventions, a patient’s rights must be considered.
In addition to the moral theories, the four principles of nonmaleficence, beneficence, autonomy, and justice offer a framework for deciding medical ethical and moral dilemmas. The principle of fair access implies that patients should have access to all healthcare resources no matter what. On the other hand, autonomy means that patients can be able to make independent decisions and have their confidential information protected. Beneficence denotes the moral duty that physicians have to ensure that they provide the best care possible for their patients (Beauchamp & Childress, 2019). Finally, nonmaleficence is a direct translation of the Hippocratic injunction to not harm. These four principles capture essential elements of any decision that medical practitioners will be required to make throughout their careers. They provide a framework for moral deliberations and justify moral medical decisions. Thus, in deciding on a particular life-sustaining intervention, a medical professional must understand and follow the four ethical principles such that the ultimate decision reflects nonmaleficence, beneficence, autonomy, and justice.
Physicians often make decisions about prolonging a patient’s life. These decisions involve more than selecting the appropriate life-sustaining intervention. Consequently, ethics is an inseparable part of medicine because doctors are ethically obligated to provide care that benefits the patient, mitigate, avoid, or reduce harm to a patient, and honor the wishes and preferences of a patient. Thus, a physician is duty-bound to these obligations which often leads to ethical dilemmas. When faced with an ethical dilemma due to the thin line physicians have to walk to fulfill a patient’s needs and be ethical, ethical theories and principles act as a point of reference. For example, when deciding on a life-sustaining intervention, a physician will follow one of the four ethical theories and the four ethical principles. Depending on the choice of an ethical theory, a physician may decline or accept a request by a patient or their family members to put them on life support.
Conclusion
As medical technology and modern medicine advance, doctors have several options available to sustain human life despite not adding any qualitative value. The decision to recommend life-sustaining interventions is challenging and follows serious moral and ethical reasoning by the physician or the patient. When a physician, due to the inability of family members and the patient, is expected to decide on a life-sustaining intervention for a patient, they could apply the utilitarian theory, Kantian theory, rights theory, and virtue theory to help in decision making. The utilitarian theory posits that an ethical decision yields maximum benefit for the maximum number of people. The Kantian theory emphasizes the maxims, the rights theory underscores the legal rights of a patient, and the virtual theory argues that an ethical decision resembles one that would be made by a good person. In addition to the ethical theories, the ethical principles of nonmaleficence, beneficence, autonomy, and justice provide medical practitioners with a framework for ethical decision-making.
References
Akdeniz, M., Yardımcı, B., & Kavukcu, E. (2021). Ethical considerations at the end-of-life care.SAGE Open Medicine, 9, 205031212110009. Web.
Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.
Grace, P. J. (2018). Nursing ethics and professional responsibility in advanced practice (3rd ed.). Jones and Bartlett Publishers.
Kristoffersen, M. (2021). Does professional identity play a critical role in the choice to remain in the nursing profession?Nursing Open, 8(4), 1928–1936. Web.
Vermeulen, K. M., & Krabbe, P. F. (2018). Value judgment of health interventions from different perspectives: Arguments and criteria.Cost-Effectiveness and Resource Allocation, 16(1). Web.