SUMMARY OF APPLIED ETHICS

Define Euthanasia and discuss these technical expressions: ‘assisted suicide, withdrawal of nutrition or hydration, persistent vegetative stage, ventilator dependent patient, ‘do-not-resuscitate’ order, advance direction, hospice and palliative care.

Euthanasia is the intentional causing or hastening of death in a person with a medical condition that is judged to be serious. The patient may be either alert, and aware, and competent to make their own decisions and able to communicate; or the patient may have decreased alertness (due to encephalopathy or coma), diminished awareness (retardation, dementia, vegetative state) and be incompetent to make their own decisions or be unable to communicate due to aphasia, or inability to speak.

We can see euthanasia from two perspectives: voluntary and involuntary. Euthanasia is voluntary when an alert, aware, competent person agrees to it being performed; and euthanasia is involuntary when it is performed on a patient without the patient’s clear understanding and agreement.

Assisted suicide: This is when a physician assists a person to commit suicide by providing them with the means to kill themselves. This may be by prescribing a lethal dose of oral medication for a person which the patient then takes at a later time. Alternatively, the physician may play a more active role by providing a person with a machine that once set in action, automatically introduce a large intravenous dose of sedative (like barbiturate) followed by a drug such as large dose of potassium, that stops the heart. The first drug puts the person to sleep, the second drug kills them. A physician may also assist suicide by withdrawing food and water, from a patient at the patient’s request.

Withdrawal of nutrition or hydration: discontinuation of food and water is a form of euthanasia that is increasingly practised. The most frequent targets are patients who are in coma and are unable to swallow, or patients with advanced dementia who cannot feed themselves. These patients have to be temporarily fed by a feeding tube through the stomach or permanently fed by a tube inserted into the stomach through the skin. Most of these patients are not competent to be involved in the immediate decision to discontinue food or water but may have made an advance directive that they do not want life support measure taken if they become critically ill. Provision of food and water is however, the most fundamental of nursing duties. Food and water are necessary to maintain lifeand the withdrawal with the intent to hasten death is euthanasia.

Persistent vegetative State: this is a permanent condition in which severe brain damage causes the patient to have reduced awareness and an inability to respond meaningfully to the environment. The patient with PVS is typically one who suffers severe head injury, a prolonged cardiac arrest or multiple strokes. The patient with PVS is able to open their eyes and look like they are awake but seem to be totally unresponsive to their surroundings. The patient may be able to breathe on their own or need a ventilator. The patient is usually unable to swallow and need a feeding tube. When PVS is established, it is usually permanent.

Ventilator-Dependent Patient: patients are not normally put on ventilator unless there is a strong chance that they will get better and be able to breathe again without the machine. Patients with acute reversible respiratory or brain conditions are most likely to benefit from a ventilator. Often, ventilator is the only treatment that will save a patient’s life and thre is pressure from relatives to use this treatment. The severe brain or lung disease is not cured by the machine but the patient may be kept alive by being on the machine but not be able to breathe sufficiently by themselves if taken off the ventilator. This is called a ventilator dependent patient. A patient can breathe using a ventilator for an unlimited period of time, and there are many portable types of ventilator and many people live at home with the help of a ventilator.

Do-not-resuscitate order: this is an order placed in a patient’s hospital chart telling the doctor not to resuscitate the patient if the patient is in imminent danger of death. When signing a DNR order, a patient is usually about being connected to a ventilator. The decision to sign a DNR order usually means that the patient or surrogate has decided that resuscitation would cause the patient unnecessary suffering and would not alleviate the underlying illness.  DNR orders are important for protecting a patient against excessive medical interventions which often cause needless suffering in the terminally sick and elderly.

Advance directives: this is a legal document drawn up by a patient stipulating their preferences with regard to end-of-life care should they become sick and unable to express these preferences themselves. The advance directives usually state that if the perform has a terminal illness that they do not wish an extraordinary resuscitative measure to be taken.

Hospice and Palliative care: palliative care refers to the treatments of patients of patients with terminal condition such as cancer, with a therapy that will not cure the patient but will make what remains of their lives easier. Palliative care is very important in management of any incurable illness, particularly if the patient is distressed in pain. Unfortunately, since the goal of palliative care is primarily to reduce suffering, many people now consider palliative care to include hastening of death in order to suffering.

At the centre of hospice and palliative care is the belief that each of us has the right to die pain-free and with dignity, and that our family will receive the necessary support in taking care of the sick family member.

Abortion Debate

Introduction

Abortion is an issue not foreign to us. The rationale behind this discussion is as a result of the sanctity of human life. Hence abortion is defined by Marriam-Webster used to end a pregnancy and cause the death of foetus. It can also be said to be the pre-mature birth before the child can survive outside the womb. Abortion can be voluntary or involuntary.

The abortion debate is in two parts (polarization)

The pro-life – those against abortion at whatever stage of development. They argue based on sanctity of life. E.g. Pope John Paul II wrote a letter, “Questiones De Abortu”.

The pro-choice – those in favour of abortion. They argue for the right of the human person.

The beginning of personhood

·                The pro-life: the beginning of personhood is one of the major issue in the abortion debate. For the pro-lifers, they contend that the foetus actually becomes a person from the moment of conception to birth. They posit that as soon as conception takes place, the soul is infused (known as ensoulment).

The foetus is a full/complete human being still undergoing growth. Though the foetus is in the life of the mother, it is alive as a dependent human being.

They argue that all human being has the right to life at any given point in time whether born or in the womb. 

·         The Pro-choice: they argue that the foetus is not yet viable or a human being.

It has not yet attained rationality

The foetus is only a cluster of cells

They are not conscious.

Their position is that ensoulment takes place within the third trimester when the zygote grows into foetus (delayed hominization).

The foetus does not have any sense to feel pain.

The cluster of properties that characterizes a person

Mary Ann Warren, a renowned pro-choice activist lists a cluster of properties that characterize a person to help make distinction between persons and biological human.

a.       Consciousnes: most important deals with the ability to feel pain

b.      Reasoning: ability to solve problem whether difficult or simple problem.

c.       Self-motivated activity: ability to act independently from bacterial control

d.      Capacity to communicate

e.       The presence of self-concepts and awareness

Thus for her, whoever has these five characteristics is a person and if it has none or one it is not a person. Since the foetus has only one (consciousness) it is not a person and so lacks the right to life and can be exterminated.

·         Pro-life: the pro-life activists raised two analogies to object the claims of Warren

a.       Comatose patient objection: which claims that patients in coma do not satisfy all of Warrens criteria, especially consciousness, and should lack the right to life- but this is not morally practiced.

b.      Infanticide objection: points out that infants up to about one year of age (since it is only around then that they begin to outstrip the ability of non-human animal) have only one of Warren’s characteristics consciousness and so would have to be considered as non-person on her view. Thus, her view would permit not only abortion but infanticide.

Rights

·                     Pro-life: they advocate that the foetus is a person and so has a universal right to life.Therefore since life is sacred, there is no room for abortion to be allowed.

Pro-choice: they advocate a woman’s presumed right to control her body. Judith Javis Thomson states said that even if the foetus is a person and has a right to life, abortion is still morally permitted.

Circumstances of conception

Pro-life: They argue that abortion is not permissible in any circumstances of life, be it rape, incest, poor or non-existent birth control.

Pro-choice: they advocated that abortion is morally right when certain circumstances of conception like rape, incest, poverty or non-existent birth control is involved.

Alternative to abortion

·       Pro-life: they argue that instead of abortion that deprives the foetus of a valuable future, it can be given the right to life by allowing it to be adopted after birth. Poverty should not be reason to carry out abortion.

·       Pro-choice: many of some pro-choice rule out the consideration of abortion but insist on it if the woman so chooses; for she has the right o her body.

Limit of Government authority (extent a government should be allowed to interfere with a woman’s reproduction)

Pro-life: argues that because the foetus is a person, abortion violates its constitutional right. Because the right of right is more important than the right of privacy, the government should protect should protect the foetus right to life than its mother’s right to privacy.

Pro-choice: They argue that the foetus is not a person and so the government has not duty to protect its life. Abortion for them is a private medical decision that cannot be made by the government, and to do this is an infringement on the woman’s right by the government.

Hunger and Population explosion are existential realities in our contemporary universe. What moral or ethical calculus would you propose, as an algorithm for addressing these challenges?

Anna McKenzie defines hunger to means insufficient food at a given time and uncertainty of getting the next meals

Many maintain that the citizens of rich nations have a moral obligation to help poor nations. Some have argued that all persons have a moral obligation to prevent harm when doing so would not cause comparable harm to themselves. It is clear that suffering and death from starvation are harms. It is also clear that minor financial sacrifices on the part of people of rich nations can prevent massive amounts of suffering and death from starvation. Then they concluded, people in rich countries have a moral obligation to aid poor nations.

Personalizing the argument, Peter Singer, a contemporary philosopher, applied a utilitarian theory to the issue. According to him, giving aid to the poor in other nations may require some inconveniences or some sacrifice of luxury on the part of people of rich nations, but to ignore the plight of starving people is as morally reprehensible as failing to save a drawing child in a pool because of the inconvenience of getting one’s clothes wet. In fact, according to Singer, allowing a person to die of hunger when it is easy within one’s means to prevent it is no different, morally speaking, from killing another human being. Saving a life will always carry more utility than whatever sacrifice we have to make to save life.

One of the greatest paradoxes of our time is that the developed countries that are in the position to support a rapidly growing population, maintain low birth rate, while those who are least able, have a high birth rate. As an outcome, the under-developed countries are over-populated. Their standard of living is very low. Food available in these countries is inadequate.

Some have argued against the notion that aiding a poor nation will produce more suffering than happiness, since there will be increased birth on the side of the poor nations. First, they argue that there is no evidence to support the charge that aiding poor nations will lead to rapid population growth in these nations, thus straining the world resource supply. Research shows that as poverty decreases, fertility rates decline. When people are economically secure, they have less need to have more children to ensure against the likelihood that some will die. With more aid then, there is a chance that population will be brought under control.

Cf. Dowel, Nigel. World Poverty (In Singer, Peter ed. A companion to ethics)

What is Capital Punishment? Explain the plurality of perspectives surrounding its putative moral values and disvalues, saying which position you would support and why?

Capital punishment is a punishment of execution administered to someone legally convicted of a capital crime. Crimes that result in a death penalty are called capital crimes or offences, such as first degree murder, terrorism and espionage.

Argument for Capital Punishment

·       Deterrence: society has always used death penalty to discourage would-be criminals from unlawful actions. Since society has the highest interest in preventing murder, it should use the highest punishment available to deter murder, and that is death penalty. If murderers are sentenced to death and executed, potential murderers will think twice before killing for fear of losing their own life.

Ernest van den Haag, a professor of jurisprudent at Fordham University asserts that capital punishment is likely to deter more than other punishments because people fear death more than anything else. Whatever people fear most is likely to deter most. Hence, the threat of death penalty may deter some criminals who otherwise would not have been deterred.  Both as deterrent and a form of permanent incapacitation, the death penalty help to prevent future crime.

Although penalties can be unwise, repulsive and inappropriate, and those punished can be pitiable, in a sense the infliction of legal punishment on a guilty person cannot be unjust. By committing the crime, the criminal volunteered to assume the risk of receiving a legal punishment, he voluntarily risked suffering. Therefore, the death penalty cannot be unjust to the guilty criminal.

·         Retributive: when someone takes a life, the balance of justice is distorted. Unless the balance is restored, society succumbs to rule of violence. Only the taking of the murderer’s life restores balance and allows society to show convincingly that murder is an intolerable crime which will be punished in kind. Retribution has its basis in religious values, which has historically maintained that it is proper to take ‘an eye for an eye’ and a life for a life’.

·         Prof. Louis Pojman (in his book, The Death Penalty: For and Against), argues in favour of retributive justice saying that just as the state has the authority to act justly in allocating scarce resources, in meeting the basic need of its citizens, in defending its citizens from violence and crime, so too does it have the authority, flowing from its mission to promote justice and the good of its citizens, to punish the criminal. If the criminal as one who has forfeited the right to life, deserves to be executed, especially if it would likely deter would-be murderers, the state has a duty to execute those convicted of first degree murder.

Arguments against Death Penalty

Rebuttal to Deterrence

Those who believe that deterrence justifies the execution of certain offenders bear the burden of proving that death penalty is a deterrent. In fact, some criminology, such as William Bowers of North-eastern University, maintains that the death penalty has the opposite effect; that is, society is brutalized by the use of the death penalty, and this increase the likelihood of more murder. Even most supporters of the death penalty now place little or no weight on deterrence as a serious as a serious justification for its continued use. According to New York Times report in September 22 2000, States in the United States that do not employ the death penalty generally have lower murder case than those who do.

The death penalty is not a deterrent because most people who commit murder either do not expect to be caught or do not weigh the difference between a possible execution and life in prison before they act. Frequently, murders are committed in moments of passion or anger, or by criminals who are substance abusers and acted impulsively.

There is no conclusive proof that the death penalty act as a better deterrent than the threat of life imprisonment. Once in prison, those serving life sentences often settle into a routine and are less of a threat to commit violence than other prisoners.

Austin Fletcher argues in The Case against Death Penalty, that when crime is planned, the criminal ordinarily concentrates on escaping detection, arrest and conviction. The threat of even the severest punishment will not discourage those who expect to escape detection and arrest. It is impossible to imagine how a threat to any punishment could prevent a crime that is not premeditated.

Rebuttal to Retribution

The emotional impulse for revenge is not a sufficient justification for invoking a system of capital punishment, with all its accompanying problems and risks. Our laws and criminal justice system should lead us to higher principles that demonstrates a complete respect for life, even the life of a murderer. Encouraging our basest motive of revenge which rest in another killing, extends the chain of violence. Allowing executions sanction killing as a form of pay-back. Vengeance is a strong and natural emotion. But it has no place in our justice system.

The statements of The Reform and Conservative Movements in Judaism and of the US Catholic Bishops Conference sums it up by positing that the increasing reliance in the death penalty diminishes all of us and is a sign of growing disrespect for human life. We cannot overcome crimes by simply convicting criminals, nor can we restore the lives of the innocents by ending the lives of those convicted of their murders. The death penalty offers the illusion that we can defend life by taking life.

Innocence

The death penalty alone imposes and irrevocable sentence. Once an inmate is executed, nothing can be done to make amends if a mistake has been made. There is considerable evidence that many mistakes have been made in sentencing people to death. Our capital punishment system is unreliable. In certain DNA testing has exonerated death row inmates. Here too, the death, the justice system had concluded that the defendants were guilty and deserving of death penalty. If the testing had not been discovered, many of these inmates would have been executed.

Society takes risks in which innocent lives can be lost. But wrongful execution is a preventable risk. By substituting a sentence of life without parole, we meet society’s need of punishment and protection without running the risk of an erroneous irrevocable punishment.

Having exposed the various arguments in favour and against capital punishment, I shall pitch my opinion is siding the opposing party. Reasons for my non-supportive of death penalty are as follows;

There is hope that even the worst murderer can be reformed and bring to alignment with the societal norms and ethics. Again we cannot have adequate evidence that capital punishment deters potential criminals better than life imprisonment.

Moreover, capital punishment brings with it a number of severe utilitarian evils, that is, it degrades the administration of justice, it is inflicted discriminatorily in certain areas against minority and it is occasionally retributive and revenge in death penalty.

Finally, I believe firmly that a society that respect life does not deliberately kill human being, it is the worst possible example to set for the citizenry and especially children.