Many healthcare professionals believe that medicine and ethics are integrated. I agree with this concept. To do good medicine, one must also do good ethics, and to do good ethics, one must also do very good medicine. The two simply cannot be removed from each other.
In today's society, the demands of medicine are so great, and the tendency is so real to allow medicine to become routine and to lose sight of the phenomenal value of humanity. Therefore, healthcare professionals must consider how they can sustain a commitment to patients that truly puts their interests above our own. A fundamental aspect of the ethical life in medicine is to somehow be adequately motivated to do what is good and right for patients, especially in a world where, in many cases, no one else will be. This paper will describe why healthcare professionals should be exclusively concerned with doing as much good as possible, and how they can realize this goal by studying medical ethics.
For hundreds of years, mankind has struggled with issues of life, preservation of life, old age, death and dying, and how to achieve a good death (Stanton, 2003). Ancient Greeks offered lethal poisons to society's elderly, ill, and injured if requested, while the early Christians viewed life as a gift from God, believing suicide to be a mortal sin. The German Reich used active euthanasia to eliminate the unwanted from society. Today, the struggle continues with modern medicine's capability of preserving life and terminating life by artificial means.
Significant advances in medical technology have greatly increased the estimated average life expectancy in the United States from 47.3 years in 1900 to 76.5 years in 1997 (National Vital Statistics Report, 2001). With the successes of medical technology and increased life expectancy comes the burden of choice, especially regarding old age and chronic illness. Choices require healthcare professionals and patients to make important decisions.
In 1900, there were few options for the ill because there were few medications and minimal surgical techniques (Stanton, 2003). Many illnesses resulted in death. However, with modern technology, death is no longer the inevitable outcome of illness. Today, many choices of treatments, including simple antibiotic treatment and aggressive life-sustaining treatments, exist. As the end of life nears, there are a variety of choices, including futility, withholding or withdrawing life-sustaining treatments, euthanasia, and physician-assisted suicide. Healthcare professionals are asked to participate in making these difficult choices on a daily basis. Families and patients ask, "What do you think?" "What would you do if this were your father?"
Sound decision-making practices that consider moral and ethical principles, professional standards, societal law, and the rights, values, and beliefs of the individuals involved assist healthcare professionals, patients and families in making these choices. Thus, in order to place the importance of doing good above all else, healthcare professionals must understand basic ethical principles and practical decision-making tools that can be utilized to assist patients and families in making important healthcare choices.
A variety of basic universal principles of ethics should be considered when making decisions regarding healthcare (Stanton, 2003). These principles or duties can assist in determining how to "do good" and consider the best interests of the patient. For instance, when dealing with a patient at the end of his life, healthcare professionals can use these principles to help answer the question of whether they are prolonging life or prolonging the process of dying. In addition, healthcare professionals need to know their own personal beliefs and values for moral decision-making and actions.
Value of Life
Thiroux (2001, pp. 162-163) describes the value-of-life principle as a fundamental element of all ethical systems. He describes it as the preservation and protection of human life, "Human beings should revere life and accept death." Thiroux adds "that an individual's right to his own life and death is a basic concept."
While many would agree that life is preferred over death, good healthcare professionals understand that human beings are mortal (Stanton, 2003). Thus, when considering end-of-life decisions, healthcare professionals should not fail to heed that death is final and irrevocable and the decision to terminate life-sustaining care should not be taken lightly. The survivors, the families and caretakers of the deceased will live with the consequences of their decisions. In this case, the healthcare professional must understand that "doing good" means taking the family, patient and individual circumstances into consideration.
Beneficence refers to doing good and assisting in and promoting the welfare of patients (Stanton, 2003). This principle describes the intentional positive act of helping others. Beauchamp and Childress (2001) suggest that healthcare professionals are obligated "to confer benefits, to prevent and remove harms, and to weigh and balance an action's possible goods against its costs and possible harm (p. 166)."
This principle directs reflective decision making toward the individual patient's best interest. Questions to ask would include: What are the patient's values and beliefs? What would he or she have wanted? If the patient cannot speak, it is our duty to preserve the patient's autonomous wishes. Comparing the risks and benefits of various treatment options "by considering pain and suffering, and by evaluating restoration or loss of functioning (p. 102)" can help in determining the individual's best interest.
This principle extends the concept of beneficence (Stanton, 2003). If you cannot do good, at least do no harm (Marquis and Huston, 2000) The Hippocratic oath pushes the obligation of healthcare professionals toward beneficence and nonmaleficence: "I will use treatment to help the sick according to my ability and judgment, but I will never use it to injure or wrong them (Beauchamp and Childress, p. 113) This means that healthcare professionals have a primary obligation to protect patients against harm, as well as avoid causing harm. Harm includes killing, causing pain or suffering, or disrespecting a patient's autonomy.
The principles of beneficence and nonmaleficence may conflict, making it difficult for healthcare professional to determine whether or not they are doing good. For example, inserting an intravenous (IV) needle may cause pain or harm but an IV can provide the fluids or medications needed to restore health. Thus, considering the benefits and burdens of treatment must be considered in making healthcare decisions.
A major problem with the application of the principles of beneficence and non-malfeasance is concerned with how the benefits and harms are to be assessed -- what counts as well-being, what counts as harm and whose concept of harm and benefit are healthcare professionals and patients to consider? A doctor's concept of what counts as a harm or benefit might well differ from the view held by the patient who is under his care.
It is important when considering this scope of problems to recognize that well-being and harm are evaluative terms. Harms and benefits are not things that can objectively be determined as present. It is not like determining how many people are standing in a room or whether a light is turned on or off. Rather, it depends on an individual's evaluation of the situation. Infliction of death, which might be perceived as the greatest harm for an individual, might be viewed by some people in some situations as a benefit. For example, requests for euthanasia indicate that the patient's evaluation of their own life leads them to view death as a benefit rather than harm.
In a less extreme case, a surgical procedure to amputate a hand may be considered, since the alternative of trying to save it will involve great pain and will also put the rest of the arm at risk. In terms of probabilities of success indicated by similar cases in the past, the best course of action will be to amputate the hand. However, what is needed is the patient's own assessment of what these alternatives mean to his life. A concert pianist may think it worth the risk of trying to avoid amputation because of his or her lifestyle. This case illustrates two points:
First, that benefits and harms need to be weighed against each other.
Second, that the conclusion reached as a result of this weighing might well differ from individual to individual depending on how they view what counts as well-being for them.
These situations demonstrate the importance of ethics in healthcare. When we look at the importance of individuals rather than money or prestige, it is apparent that the true goal of the healthcare industry is to do as much good as possible, viewing all involved as important members of humanity.
When concerning himself or herself with "doing good," justice plays a key role for healthcare professionals (Stanton, 2003). Justice or fairness refers to the obligation to be fair to all involved. This means that equals must be treated equally and unequals should be treated according to their differences. Distributive justice is the utilization of limited resources and benefits on a just and fair basis. For example, mechanical ventilation, medications, and organ transplantation are costly…