The Principle of Substituted Judgment
Traditionally, the physician was expected to use all of their talents and training in an effort to save the life of their patient, no matter the odds. More recently, the physician’s role has been redefined to preserve the autonomy of the patient. Now physicians must give life saving care only in so far and to the degree desirous of the competent patient.
Until this century, it was rare that brain-dead patients could be kept alive for long periods of time. However, as technological prowess has increased, it has recently become possible to keep a patient alive without higher brain functioning for years and even decades. But, as is always the case with new technology and knowledge, previously unknown ethical issues arise, and thus we have the difficult ethical problems of the Karen Ann Quinlan case.
There are many ethical issues that arise in the Karen Ann Quinlan case. First, there is the ethical right that each person has to receive or refuse medical treatment. But this can ethically problematic because some would see death as an intrinsic evil; therefore choosing death would be unethical. This, however, can be categorized as part of the larger issue of patient autonomy, the patient's right to live and abide by their own personal choices (Garrett 29). Recent thought has affirmed the idea of patient autonomy in medicine, now making it a central dogma of the American medical practice. In this case, patient autonomy is threatened because the patient is not able to communicate their desires for treatment. The physician cannot ask, and therefore cannot know, if the patient would want to continue treatment or withdraw treatment. In this case, the Karen was deemed incompetent...
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...to judge if this principle does, indeed, safeguard the patient’s autonomy at all. At the same time, this is the only safeguard, other than living wills and the right of attorney, of an incompetent patient’s autonomy. As a result, the actual ethicality of the substituted judgment principle continues to be extremely controversial.
Works Cited
Garrett, Thomas, Baillie, Harold, and Garrett, Rosellen. Health Care Ethics; Principles and Problems. 4th Ed. Upper Saddle River, New Jersey. Prentice Hall, 2001.
Kuczewski, Mark. "Reconceiving the Family: the Process of Consent in Medical Decision Making." Hastings Center Report. March-April 1996: 32-37.
Van Camp, Julie. “Matter of Quinlan.” Law, Philosophy, and the Humanities. December 16th, 1996. California State University, Long Beach. November 9th, 2004. < http://www.csulb.edu/~jvancamp/452_r6.html>
Paramedics deemed the patient competent and therefore Ms. Walker had the right to refuse treatment, which held paramedics legally and ethically bound to her decisions. Although negligent actions were identified which may have resulted in a substandard patient treatment, paramedics acted with intent to better the patient despite unforeseen future factors. There is no set structure paramedics can follow in an ethical and legal standpoint thus paramedics must tailor them to every given
Whin uni thonks ebuat idacetounel uppurtanotois, ot os must lokily schuulhuasi, culligi, end ivin anovirsoty sittongs thet mey cumi tu mond. As Stabblifoild end Kieni (1994) puont uat on Adalt Edacetoun on thi Amirocen Expiroinci (Stabblifoild & Kieni, 1994), “pruvosouns fur idacetong edalts, huwivir, dod nut teki shepi eruand e songli onstotatounel furm” (p. 1). Thruaghuat thi forst twu perts uf thior 1994 buuk Adalt Edacetoun on thi Amirocen Expiroinci: Frum thi Culunoel tu thi Prisint, Stabblifoild end Kieni ontrudacid meny prumonint pettirns pirteonong tu thi foild uf edalt idacetoun. Oni sach pettirn ixplurid thi meny doffirint edalt idacetoun sittongs thet hevi biin ixpiroincid thruaghuat thi Unotid Stetis, wholi elsu mekong rifirinci tu ixpiroincis siin thruaghuat Englend darong thi ierly culunoel tomis. Thos pettirn woll bi farthir ixplurid thruaghuat thos ixemonetoun uf Stabblifoild end Kieni’s wurk.
In an effort to provide the standard of care for such a patient the treating physicians placed Ms. Quinlan on mechanical ventilation preserving her basic life function. Ms. Quinlan’s condition persisted in a vegetative state for an extended period of time creating the ethical dilemma of quality of life, the right to choose, the right to privacy, and the end of life decision. The Quilan family believed they had their daughter’s best interests and her own personal wishes with regard to end of life treatment. The case became complicated with regard to Karen’s long-term care from the perspective of the attending physicians, the medical community, the legal community local/state/federal case law and the catholic hospital tenants. The attending physicians believed their obligation was to preserve life but feared legal action both criminal and malpractice if they instituted end of life procedures. There was prior case law to provide guidance for legal resolution of this case. The catholic hospital in New Jersey, St. Clare’s, and Vatican stated this was going down a slippery slope to legalization of euthanasia. The case continued for 11 years and 2 months with gaining national attention. The resolution was obtained following Karen’s father being granted guardianship and ultimately made decisions on Karen’s behalf regarding future medical
In the medical field, there has always been the question raised, “What is ethical?” There is a growing conflict between two important principles: autonomy and death being considered a medical treatment. Physician assisted suicide is defined as help from a medical professional,
Imagine, if you will, that you have just found out you have a terminal medical condition. Doesn’t matter which one, it’s terminal. Over the 6 months you have to live you experience unmeasurable amounts of pain, and when your free of your pain the medication you’re under renders you in an impaired sense of consciousness. Towards the 4th month, you begin to believe all this suffering is pointless, you are to die anyways, why not with a little dignity. You begin to consider Physician-Assisted Suicide (PAS). In this essay I will explain the ethical decisions and dilemmas one may face when deciding to accept the idea of Physician-Assisted Suicide. I will also provide factual information pertaining to the subject of PAS and testimony from some that advocate for legalization of PAS. PAS is not to be taken lightly. It is the decision to end one’s life with the aid of a medical physician. Merriam-Webster’s Dictionary states that PAS is “Suicide by a patient facilitated by means (as a drug prescription) or by information (as an indication of a lethal dosage) provided by a physician aware of the patient’s intent.” PAS is considered, by our textbook – Doing Ethics by Lewis Vaughn, an active voluntary form of euthanasia. There are other forms of euthanasia such as non-voluntary, involuntary, and passive. This essay is focusing on PAS, an active voluntary form of euthanasia. PAS is commonly known as “Dying/Death with Dignity.” The most recent publicized case of PAS is the case of Brittany Maynard. She was diagnosed with terminal brain cancer in California, where she lived. At the time California didn’t have Legislative right to allow Brittany the right to commit PAS so she was transported to Oregon where PAS is legal....
Thompson, I. E., Melia, K. M., & Boyd, K. M. (2006). Nursing Ethics: Churchill Livingstone Elsevier.
Charlotte’s parents thought otherwise, the Ethics Advisory Committee had to get involved. The debate surrounded if the doctors were in the right to control the life of someone who were incapable of deciding themselves, or is it the parents right. The Ethics Advisory Committee, stated that the parents were superior to those of the hospital and the hospital should conduct with less painful test. Charlotte’s parents wanted the doctors to continue testing until it was determined that her life diffidently had no chance of remaining. Because, of Charlotte’s parents’ desires unfortunately caused Charlotte to die a painful death without her parents. If the patient is unable to speak for their selves, the family should be able to have some say in the medical treatment, however; if the doctors have tried everything they could do, the hospital should have final decisions whether or not the patient dies or treatment
Persuasion is a process by which the persuader, through communication, gains the approval or support for the topic (Let's Compare Motivate and Persuade, 2013). The arguments to motivate this change in thinking comes through careful use of rhetoric, but one must also be able to define the six principles of persuasion in social psychology: “Reciprocity, Scarcity, Authority, Commitment and Consistency, Consensus, and Liking” (McLean, 2010, p. 521) and be able to recognize them as they are taking place. Then, one must carefully apply these concepts in order to find the means to effectively facilitate persuasion (p. 518).
Shortly after these debates details about the Nazi death camps of World War II and the role physicians played in the camps silenced supporters of euthanasia. As medical technology continued to advance and the availability and use of life support sparked a new debate about euthanasia. Patients have the right to refuse medical care even care that would sustain life (Emanuel, 1994). Currently this is referred to as a DNR or Do Not Resuscitate order. The right of patients to deny care calls to question if the patient can choose to die why can the not request euthanasia. In 1975 Karen Ann Quinlan lapsed into a coma after taking tranquilizers and drinking alcohol then slipped into a “chronic persistent vegetative state” Karen’s parents requested that physicians remove her life support and let her pass. The case was appealed to the New Jersey Supreme Court the parents argued that life sustaining treatments implicated the patients right to privacy. Roe V. Wade established a woman’s right to privacy in her right to terminate a pregnancy. The result of the Quinlan’s case was that they could remove Karen’s life support (Doerr, 1997). In 1990 the Patient Self Determination Act
This is a fascinating case because it presents the distinction between a patient’s right to refuse treatment and a physician’s assistance with suicide. Legally, Diane possessed the right to refuse treatment, but she would have faced a debilitating, painful death, so the issue of treatment would be a moot point. It would be moot in the sense that Diane seemed to refuse treatment because the odds were low, even if she survived she would spend significant periods of time in the hospital and in pain, and if she didn’t survive she would spend her last days in the hospital. If Diane were to merely refuse treatment and nothing else (as the law prescribes) than she would not have been able to avoid the death which she so dearly wanted to avoid.
Garrett, T. M., Baillie, H. W., & Garrett, R. M. (2010). Health care ethics: Principles and problems (5thed.). Upper Saddle River, NJ: Prentice Hall.
Henry John Temple, third Viscount Palmerston was guided in his conduct of foreign policy by his belief in free trade, his determination to keep the balance of power in Europe, and his dislike of autocratic governments. Lord Palmerston became one of the politicians most known for his liberal internationalism, sometimes called liberal interventionism. His determination to see his principles turned into action often led him to some severe policies, and consequently he was seen as caustic by his rivals, earning him the nickname ‘Lord Pumice Stone’.1 His resolve to support British supremacy in all foreign matters is exemplified through his early use of gunboat diplomacy. This is also seen through his multiple attempts to maintain the balance of power across Europe because by doing so Britain could be the deciding factor, the linchpin of any decision. Although he started off as a tory, Palmerston eventually became a liberal and strove to see their goals propagated abroad during his tenure both as foreign secretary and prime minister. Through all this Palmerston’s policies often faced the serious dilemma of an inherent contradiction. Although he could sometimes reconcile his desire for British supremacy with his desire for the promulgation of liberal ideology, he often wound up supporting one to the detriment of the other. Because of the tension between objectives, Palmerston’s policy can sometimes be seen as schizophrenic.
The term “Probiotic” is derived from Greek which means pro: for and bios: life (for life) in contradiction to antibiotic which means: against life. The term probiotic was first introduced by Lilly and Stillwel (1965) to express growth-promoting factors produced by microorganisms. Parker (1974) first specified designation “Probiotic”. He defined probiotics as microorganisms or substances, which contribute to the balance of the intestinal micro flora. Probiotics are biological products, which stimulate the immune system and increase its defensive activity against pathogenic bacteria. Probiotics stimulate the natural resistance of the organism by increasing the number of antibodies and increasing the effectiveness of macrophages (Stern et al.,2001). The probiotics are mainly used to balance the microflora of organisms, which in turn helpful for the growth of an organism as well as its production (Kabir et al.,2005). Probiotics will secrete the antimicrobial substances and alter the microflora to suppress the pathogen activity and they will show the anti-toxin effect (Janardhana et al.,2...
McGee, Glenn and Arthur L. Caplan. "Medical Ethics." Microsoft® Encarta® 98 Encyclopedia. © 1993-1997: Microsoft Corporation. CD-ROM.
Should a patient have the right to ask for a physician’s help to end his or her life? This question has raised great controversy for many years. The legalization of physician assisted suicide or active euthanasia is a complex issue and both sides have strong arguments. Supporters of active euthanasia often argue that active euthanasia is a good death, painless, quick, and ultimately is the patient’s choice. While it is understandable, though heart-rending, why a patient that is in severe pain and suffering that is incurable would choose euthanasia, it still does not outweigh the potential negative effects that the legalization of euthanasia may have. Active euthanasia should not be legalized because