Does respect for autonomy mean that a patient can request treatment that the clinician does not think is in his/her best interests, or treatment that is futile? In these situations the principle of respect for autonomy comes into conflict with other ethical considerations, such as preventing or avoiding harm, or distributive justice.Ī duty to act in the patient’s best interest (Beneficence) Should respect for autonomy mean that a person can request assistance in ending his/her life? Some would argue that this is the case but as assisted suicide is currently illegal in the UK this is not an issue that a clinical ethics committee should need to consider. Thus a competent person should be able to refuse life saving treatment in both current situations and future foreseeable situations. The principle for respect for autonomy acknowledges the right of a patient to have control over his or her own life, including decisions about how his/her life should end.
Current practice in palliative medicine and the range of drugs available may reduce the appropriateness of this doctrine. The intention is to relieve pain and the foreseen but unintended consequence is that the patient’s life will be shortened. Prescribing pain relieving drugs which in large doses shorten the life of a terminally ill patient is often used as an example of double effect. The doctrine of double effect allows that performing an act that brings about a good consequence may be morally right even though the good consequence can only be achieved at the risk of a harmful side effect. The doctrine of double effect argues that there is a moral distinction between acting with the intention to bring about a person’s death and performing an act where death is a foreseen but unintended consequence. For example, it might be permissible not to ventilate a patient if he/she was in chronic respiratory failure, or not to use tube feeding if he/she was in a permanent vegetative state. Withholding treatment would only be permissible if the patient’s quality of life was so poor, and the burden of treatment so great, that it would not to be in the patient’s best interests to continue treatment.
In a medical context this distinction would mean that a doctor could not give a patient a lethal injection to end his/her life, whatever the circumstances, but could, withhold treatment that may sustain it.
Thus it is morally wrong to push someone into a river to their death but we may not have a moral duty to leap into the river to save someone who is drowning. This distinction argues that there is a difference between actively killing someone and refraining from an action that may save or preserve that person’s life. Some ethical arguments have been developed to address this challenge. There may be some circumstances where a person’s quality of life, however defined, is so poor that it should not be maintained even if it is possible to do so. However, this problem does not remove the challenge to the sanctity of life doctrine. An objective view of someone’s life may be very different to the view of the person who is living that life. Is there no place for consideration of quality of life? One of the problems with considering quality of life is the question of how this is defined and by whom. One challenge to this principle in the context of health care is to ask should life be preserved at all costs. This is in keeping with both traditional codes of medical ethics and a general perception of what doctors and other health professionals should do, that is save and preserve life. The argument underpinning this doctrine is that all human life has worth and therefore it is wrong to take steps to end a person’s life, directly or indirectly, no matter what the quality of that life. Ethical Issues - End of life decisions Ethical ConsiderationsĪ number of ethical theories and principles are relevant when considering treatment decisions at the end of life.
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