The process and decision matter when deciding the overall

 

 

 

 

 

 

The
Combined Theories Metaethic and
End-of-Life Care

Nicole
T. Buchan

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December
21, 2017

Capstone
Essay

ETHC101-D12

 

 

 

 

 

 

 

 

 

 

 

 

Table of Contents

 

I.                   
Introduction
—————————————————————————————–
3

 

II.                
The Combined Theories Metaethic ————————————————————–
4

 

III.             
End-of-Life Care ———————————————————————————–
6

 

IV.             
Conclusion
——————————————————————————————
9

 

V.               
Bibliography
—————————————————————————————
11

 

 

 

 

 

Introduction

In this paper I will attempt to
answer the question, “Should End-of-Life Care prolong life when the situation
is almost certain that death will occur soon?” I find two sub-questions that
come of this question, “Is it ethical to allow people to die?” and “Is it
ethical to prolong someone’s life when it is almost certain that they will not
recover?”. My Combined Theories metaethic
will attempt to apply several ethical theories to a given situation. This
allows us to weigh multiple views of the circumstances and argue for ourselves
the morality and ethicality of the circumstances and final decision.  With the application of several theories, I will describe several possible
motivations for a certain thought process such as, does the prolonged care of a
terminally ill benefit the patient, the community, both, or neither? Does
either prolonging life or not preventing death conform to Christian values and
beliefs, consequentialist beliefs, or others? Does the patient’s thought
process and decision matter when deciding the overall ethicality or morality of
the situation?  Approaching these
questions and the situation at large is best done from multiple viewpoints,
with a large emphasis on what teachings we can pull from the Christian
religion.

            There
will be two parts to answering this dilemma. First, I will describe the process that I use to approach ethical and
moral issues small and large. Then, I will talk through the application of my
ethical theory in an attempt to answer if we should actively prolong one’s end
of life timeline or if we should not prevent death from occurring. I hope to
provide a clear argument against prolonging life when someone is inevitably
dying.

 

 

 

The
Combined Theories Metaethic

It is my belief that the best method
for assessing the ethicality or morality of a given situation is to approach
the subject by combining many ethical theories and deducing the average of all
theories. Included in the Combined Theories Metaethic
are List Metaethics, Consequentialist Metaethics, and Duty Ethics.

I believe using
this combination of ethical theories one can identify several different ideas
about the situation at hand. While it can be argued that all ethical and moral
principles can be settled wholly looking to God, scripture and the Christian
view, I do not think that that means there is not a legitimate application of
the theories I use within the Bible, and Christian religion. There are many
examples of these ethical principles used by God, Jesus, and many prophets
within the Christian religion. I think all of these theories are relevant when
maintaining a Christian ethical viewpoint because to some degree they have been
used, maybe not explicitly but definitely implicitly, throughout the teachings
of the Christian faith.

The List Metaethic that I use is heavily influenced by
The Ten Commandments. My List Metaethic
includes all the commandments and then a couple additional hard-set rules. This
is an extremely useful list of influential commands that, when used properly, set the groundwork for the ethical and moral
conversation that follows. I cannot and will not argue any ethical viewpoint
that goes directly against The Ten Commandments, as the commandments are
defined by God himself. As a Christian, any opposing view to these statements
would undermine Christian ethical viewpoint moving forward.

The
Consequentialist Metaethic is useful to our ethical situation because it expands our critical thinking process when
dealing with complex ethical or moral dilemmas. This metaethic can remain in
line with a Christian values system because it does not always require one to
deviate from Christian values. The Bible
teaches, in many different ways, that looking at the potential outcomes of a
decision is required in order to ensure we are living up to our Christian
values. We are people full of sin, and living spiritually for the Lord requires
conscious and active thought processes, this being necessary to avoid and even
turn away from when presented with the temptations of sin. Likewise, conscious
and active thought given to moral and ethical situations is required in order
to decide the appropriate conclusion. The consequences of our actions need to
be assessed in order to identify the righteous path forward. God specifically
gives us free will and recognizes one’s intent in order for us to decide the
path of good or evil. This lends credibility to
the Christion viewpoint of using the Consequentialist Theory to conclude for
ourselves the best path forward which will keep faith with God’s message.

Lastly, we can use
Duty Ethics as a basis for developing our thought process for most ethical or
moral questions. Duty ethics is described as an ethical principal rooted in the
basis that must be done based on some obligation or bounding circumstance. An idea
which I think is deeply rooted in scripture. If you look at the abstract of
this ethical theory and apply the Christian view to it you come away with some
ideas that I think are truths. As Christian, we have a multitude of duties and
obligations. It is our duty to obey God, to follow the Ten Commandments. There
are many other examples of responsibilities that cannot be shirked as a result of being a Christian. As a
caution though, I say it should be used not wholly as a basis for action, but
as a tool to start or end a thought process, or as an additional basis for
judgment when we reach certain conclusions using previous theories.

 

 

 

End-of-Life
Care

As an exercise of ethical theory
application, I have chosen to address end-of-life care. Specifically, should we
extend the life of an individual or should we not actively extend the life of
someone when it has been determined that there will be no meaningful course of
action to rehabilitate or resuscitate someone.  To me, this question is very difficult to
answer from the hip. It is only within the last 80 years or so that humanity
has had the ability to meaningfully extend someone’s physical life. Many sub-questions arise and we are faced with the
need to define some ground rules.

            When
I talk about “meaningfully extend someone’s physical life”, I am talking about
the ability to regain a previous state of life or something similar thereof.
Examples of this include when someone is in a comatose state and medical
professionals have no courses of treatment available to resuscitate someone If
you are diagnosed with a brain tumor or cancer that cannot be operated on and
will with great certainty be the mechanism of your death. If a medical
treatment or surgery goes wrong and the person cannot regain motor function,
the ability to care for themselves, or will, to a great degree of certainty,
die because there is nothing that can be done to help. These are only some of
the situations that can arise. I leave the situations vague because the
specificity of the medical diagnosis is not the most important aspect of the
ethical issue at hand. The question of what is the moral or ethical decision to
make when weighing the option of extending the life of someone past the point
that they would have died naturally is the core topic here.

In the current age, medical professionals can, with enough
resources, keep a person physically alive for a long time past their natural
expiration date, much longer than what would have historically been the end of
the road for that person. This is the reason we have to ponder this situation
in the first place. There are some obvious confounding issues here that need to
be discussed. Issues that must be considered include: the will of the person
dying. What do they currently want to do about their situation if they are capable of indicating a decision?
Has the patient identified a plan prior to the circumstances? The ability to
pay or afford continued care. Can it be argued that someone is acting immorally or unethically, or the
inverse, if they are unable to afford continued care? Then there are issues
like the inaccuracies that still exist in the diagnosis and prognosis phase of
care. How much longer does someone really have until succumbing to their
ailment? Is the person suffering from the perceived condition, do they need a
second and third opinion to confirm the case? When a doctor says “You have X
days/months/years/ to live”, is that realistic? Is it Accurate? Is it
Definitive? These all are issues that need to be discussed, and they need to be
discussed prior to the day of reckoning. The choice you make on the last day
will not be more or less ethical or moral than if you had thought about and
made a choice months or years before.

Using List
Metaethics as our initial method of analysis we can at least rule out that the
issue is simple in nature. Looking at the 10 Commandments, the only one which
needs to be addressed is “Though shalt not kill”. When we apply this to the
question of extending one’s life we must look much deeper into the background
and interpretation of this commandment. One might argue that letting someone
die under your care is similar if not the same as killing them. Does it mean
that we should make every attempt to keep someone alive while under the care of
a doctor? I don’t think that was the intent. 
If we look at the original text in Hebrew the text is translated to
“You shall not murder”. Murdering requires intent, therefore, it is not
applicable to our argument of morality or ethicality.

Taking it a step further in our discussion, I talked about weighing the
question of what does the patient want? If the patient has a pre-defined course
of action in a given circumstance then it definitely does not fit the mold of
murder. If the person is incapacitated beyond cognitive ability then we
generally look to the eligible caretaker as defined by local law. In this circumstance, we must decide if allowing the
person to die is the same as killing them with intent. I do not believe it is
the same, but there is one thing to be clear about, the 10 Commandments talk
about “Thou shall not covet”, and it is this word that becomes important in
this circumstance. Coveting is a mental act. Having immoral thoughts goes into
the real of intent to kill. With that being said, when a caregiver, medical
professional, or anyone with the appropriate influence to make a decision to
allow the person to die or to continue supporting them has the mental intent to
end their life then we see that this goes against the 10 Commandments. This
extrapolation is not far-fetched. It is the very essence of three of the 10
Commandments.

Using
Consequentialist Metaethics, or at least the core of its intent, we can deduce
some very insightful decision points about prolonged end-of-life care. What are
the possible outcomes of the decision to extend the end life of a patient? In the case of someone that has been
debilitated to the point of a vegetative state,
we can look at several issues. Not all of these issues revolve around the
Christian viewpoint, but I think that as long as none of them specifically go
against any spiritual or religious doctrine that we are taught then I think
this metaethics can apply just as meaningfully as ones deep-rooted in Christianity. Does is the person able to live
meaningfully? In this scenario, no. How about if someone is terminally ill with
cancer, but remains functional, or at least conscious enough to do something
productive? If yes, then we have to, once again, weigh some of the prior
questions. What does the individual want? Are they in extreme pain? If they are
in pain is there a way to ease that pain? You will notice that my argument at
this point is accounting for the patient’s wants and needs. Would it be ethical
or morally sound to go against a patient’s wants or needs? I don’t think that
to be true.

If one was to take
action to end the life of someone early than we cross the line into active
euthanasia, and I am not at all advocating for that. If one takes action to
prolong someone’s life when the outlook is extremely bleak, then I think that
also has a consequence of being immoral. I do not think anyone has the ability
to decide for you that you should continue to live in pain or suffering.

Lastly, we can
look at this from the Duty Ethics point of view. Similar to the previous
Consequentialist Ethics outcome, I believe it is the caretaker and medical
professional’s duty to obey the wants and needs of the patient. This is the
ethic where I introduce the concept of prior planning for one’s death. While it may be a grim subject, it
is an inevitable subject that all should be prepared for. If the patient states he wants to continue fighting then
I think it is our duty to oblige their request. If the patient is
incapacitated, this decision falls on the legally identified representative for
care. The same can be said for someone who has an Advance Directive, also known
as a Living Will. These are legally recognized documents stating the intents of
a patient should they become incapacitated. Would it be ethical or moral to go
against that patient’s stated wants? I doubt anyone would disagree. 

 

Conclusion

End-of-life care is an issue that
will present itself to the great majority
of people. Even though medical care will only get better in the future, death
will eventually come to everyone. What we do for those dying will be an ethical
question then, just as it is now. In this paper,
I have endeavored to apply my Combined Theories Ethic to this issue in order to
discover an ethical conclusion on end-of-life care. My conclusion is that we
should view extended end-of-life care as unethical when it goes against the
wishes of the patient or caregiver. We should not extend someone’s natural
death just because modern medicine is capable of
doing so. However, since this is an extremely complex topic, I believe
everyone should devise a definitive plan of action for themselves that is in
their best interest.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bibliography

Jones, Michael S. Moral
Reasoning: An Intentional Approach to Distinguishing Right from Wrong.
Dubuque, IA: Kendall Hunt, 2017.

 

Stivers, Laura A.,
Christine E. Gudorf, and James B. Martin-Schramm. Christian
Ethics: A Case Method Approach, 4th ed. Maryknoll, NY: Orbis Books,
2012.

 

Karnik, Sameera, and Amar Kanekar. Ethical Issues Surrounding End-of-Life Care:
A Narrative Review. National Center for Biotechnology Information. May 5,
2016. Accessed December 21, 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934577/