Deontology Theory's Application to DNR

The term ‘deontology’ has its roots in the Greek language – ‘deon’ being the Greek word for ‘duty’ and ‘logos’ meaning ‘study/ science of’. Within the context of modern ethical philosophy, the normative theory of deontology involves prohibited, allowed, or ethically incumbent choices.

That is, deontology is categorized under those ethical theories which drive and evaluate one’s choice of what one should do (i.e., deontic theories), as opposed to virtue/aretaic theories which drive and evaluate the type of individual one is or ought to be. In the context of ethical theories involving choice assessment, deontologists and consequentialists maintain opposite stands (Stanford Encyclopedia of Philosophy, 2016).

Deontological Ethics or Deontology represents an ethical approach which concentrates on how right or wrong an action is, as against how right or wrong its effects or consequences are (Consequentialism) or the player’s behavior and traits (Virtue Ethics). Therefore, for deontologists, the decision on whether any given situation is bad or good is governed by whether its underlying action is wrong or right. In simpler terms, a choice is considered to be "right" if it conforms to an ethical norm: Right must be prioritized over good.

If, for instance, an individual puts forward the idea that all life forms presently inhabiting the world but not supporting agriculture ought to be eliminated for ending the malice of starvation, deontologists would oppose the idea, claiming a world from which starvation has been eliminated is not a good situation owing to how this situation came into being in the first place (Alexander & Moore, 2007).

As deontological theories of ethics are best grasped as opposed to those that are put forward by consequentialists, a quick glance at consequentialism, in addition to analyzing associated issues which spur deontologists, offers a useful run- up to analyzing deontological models themselves. According to consequentialists, preferences, purposes and actions must be evaluated from an ethical standpoint, based solely on the consequences or situations they lead to.

Hence, a consequentialist needs to identify, at first, the situations or conditions which are of intrinsic value, typically collectively labeled “the Good.” Subsequently, they can claim that the choices which increase or lead to more good are ethically correct and should be made and implemented (Alexander & Moore, 2007). At times, deontology might be in line with the theory of Moral Absolutism (which holds that certain actions have to be considered ethically incorrect irrespective of the consequences they lead to), but this is not necessary.

Consider, for example, Immanuel Kant’s famous argument that lying is always unethical, even if one is faced with a killer who seeks the hiding place of his soon- to- be victim. However, according to some others, the outcome of lying or a similar seemingly unethical act might, on occasion, make it right to lie – a theory termed ‘moral relativism’ or ‘obligations/ duty- based’ ethics, as, according to deontologists, ethical principles bind individuals to their obligations (Karnik & Kanekar, 2016).

Deontological theories come under the ‘normative theories’ category. They don’t presume any distinct stance on moral epistemology or moral ontology. Deontologists may be presumed to be ethical realists of the non- natural (moral attributes aren’t natural attributes in themselves, despite non- reductively being linked to natural ones) or natural (natural and moral attributes are identical) groups. Or deontologists may be constructivists, conventionalists, divine command theoreticians, expressivists, or transcendentalists when it comes to ethicality’s nature.

Similarly, deontologists may claim to know, intuitively, the contents of deontological ethicality, or to know them via Kantian reflections on a particular normative condition, or through arriving at reflective balance between ethical judgments and theories (i.e., models of intuition) developed for explaining them (Stanford Encyclopedia of Philosophy, 2016). DNR or ‘Do Not Resuscitate’ decisions are often reached within the hematology and oncology care settings, with nursing professionals and doctors experiencing associated moral quandaries.

Ethics has been regarded as a fundamental healthcare competence; within the healthcare setting, it has been described as the capability of dealing ethically and satisfactorily with a particular task posing a moral predicament. One ethical competence model for healthcare workers involves the following three key components: doing, knowing, and being, indicating that moral competence necessitates abilities of action, knowledge and character. Moral competence may be acquired by means of education, experience, and communication.

A supportive climate is needed to maintain a superior ethical competence level (Pettersson, Hedström & Höglund, 2018). ` In case of conflict between patients/ surrogates and the healthcare practitioner when it comes to choices involving end- of- life care, they may take proper steps through instituting a moral committee for tackling this legal or moral problem and documenting its proceedings.

The managements of healthcare organizations may compile policies for introducing, promoting, and discussing advanced directives’ application as a procedure of admittance (Pettersson, Hedström & Höglund, 2018). Kant claims one ought to take into account what would occur if everybody in the world did this (i.e., was given life support or not). If imagining this is rationally impossible, it ought not to be done.

Furthermore, the agent (i.e., patient) ought to envisage a world in which this is done by all, though, this time around, posing the question of whether they would desire to live in such a world or not. If this question’s answer is not in the affirmative, it ought not to be done. The Formula of End is the subsequent formulation to be taken into consideration. According to Kant, one ought to invariably regard other people as the ends, rather than solely the means to attain an end.

Others shouldn’t ever be used without taking into consideration their autonomy. Lastly comes the Formula of a Kingdom of Ends (Dolgoff, Harrington & Loewenberg, 2012).  According to Kant, one ought to act as though one is a lawmaker of a Kingdom of Ends. All individuals ought to be accorded respect and nobody should be abused or exploited. The patient ought to choose what action they would take in such a Utopian world.

Further, Kant is of the view that one needs to act out of duty and not inclination. A religious patient or one with strong opinions against DNR ought not to do it. However, if they are aware that resuscitation will result in a good life for them, they could feel obliged to live and utilize the most precious gift of life (Alexander & Moore, 2007). Ethical requirements seem to be unfathomable or subjective except through reference to duties.

In truth, the decisions one makes are governed by several other determinants and whether or not duty is a good motive as indicated by Kant is really questionable.

To what extent can good motives or goodwill end up mitigating devastating results? Moreover, do we genuinely desire to understand duty or ethical conduct’s form or simply wish to find out more regarding its content? Will doing our duty without being able to understand the reasons for a particular action make us satisfied? The universalizability principle taken to its rational extremity is ridiculous (Alexander & Moore, 2007).

Kant asserts that what’s ‘good’ is what one should do, whilst what’s ‘intrinsically right’ and ‘inherently good’ is how one should behave for everybody’s good, regardless of the outcome. In this regard, Kant’s critics reproach him for his naturalistic fallacy – transforming something that ‘is’ into something that ‘ought’.

Though the Kantian approach circumvents the issues linked to emotivism (that personal preferences give rise to all ethical conduct), it can lead to the other extremity, as Kant does not make any allowance for sympathy or kind-heartedness to drive human action. Individuals’ feelings with regard to morality are genuinely important; ethicality ought to certainly be connected, to some extent, to what actually takes place and what can be broadly and officially universalized. Real experience results in real morality. What may be realistically universalized has no potential limits.

Though the claim that taking one’s own life ought to be considered a categorical imperative might appear illogical, it might be logical for one suffering from chronic depression (Alexander & Moore, 2007). Motivation has more significance than consequences that are not within our control. Unpredictable good outcomes cannot justify an unethical motive, whilst good motives are worthy of being valued. This is a humanitarian norm where everyone is.