The End of Life: Ethical Considerations - The Future Of Medical Ethics

Robert B. Mellert, a professor of philosophy and religious studies at Brookdale Community College in New Jersey, claims that "medical ethics is troubled today." In "Cure or Care? The Future of Medical Ethics" (The Futurist, vol. 31, no. 4, July–August 1997), Professor Mellert observes that the state of medical ethics "is merely a reflection of the fact that we are all troubled today by the complexity of technology, by the innumerable options and choices, and by the larger questions about the purpose of being alive."

Professor Mellert claims that debates on medical ethics center on two theories about the nature of health care:

• "Curing" approach—based on the traditional ethical principle that traces its roots to the Hippocratic Oath. The role of medicine, which is to heal, ties in with the traditional Western religious ethic of preserving life. Patients must trust their doctors' judgment and decision to sustain life. Doctors must abstain from doing anything to shorten or end life even if the patient is suffering. The physician, therefore, acts as a "health care provider."
• "Caring" approach—based on the principle that the fundamental values of human existence are "the maximization of pleasure and the minimization of pain." The role of medicine, which is to minimize pain, stresses the importance of the quality of life. The physician, acting as a "medical consultant," discusses with the patient his or her options, possible treatments and their effects, complications, and costs. The patient weighs his or her options and decides on a course of action, which the physician carries out, whether the physician agrees with that decision or not.

TABLE 3.3
Independent patient-related factors associated with physicians honoring a request for hastened death by lethal injection or lethal prescription, 2003

	Odds ratio
Lethal injection
Patient depressed at time of request	0.1
Patient in severe discomfort other than pain	3.8
Patient life expectancy <1 month	12.9
Lethal prescription
Patient depressed at time of request	0.12
Patient in severe pain	9.3
Patient in severe discomfort other than pain	21.4
Duration of physician-patient relationship	1.1
Note: Responses from physicians who stated that they would not honor a patient's request for assistance in dying under any circumstances were excluded from the analysis.
SOURCE: Diane E. Meier, et al., "Table 3. Independent Patient-Related Factors Associated with Physicians Honoring a Request for a Hastened Death by Lethal Injection or Lethal Prescription," Archives of Internal Medicine, vol. 163, July 14, 2003

Future Choices

Professor Mellert predicts that solutions to controversies in medical ethics will not be forthcoming any time soon. Autonomous patients will have to be prepared to learn enough about their illnesses to make their own decisions. This is a tremendous task for lay people, especially since medical science is advancing so rapidly. Professor Mellert believes that in the long run patients will have to trust their physicians.

Whichever approach patients choose, cure or care, they need to make their basic philosophical values known. Some questions patients may wish to consider are:

• How do I view my life at this stage and under these conditions?
• What do I see as the continuing purpose of my existence?
• Under what conditions do I wish to exercise my right to maintain my life?
• Are there conditions in which I would not wish to continue?
• What do I want my physician to do for me then?

Physicians also must make choices. Do they comply with a patient's wishes, perform the standard medical treatments to avoid lawsuits, or follow their own best medical judgment? Supporting patient autonomy requires physicians and other health care clinicians to provide the maximum benefit to patients without compromising their own moral convictions.