Some regard paternalism to always be a negative presence because it’s nature of being something that takes away autonomy. However, paternalism is not a morally wrong because it takes away autonomy away; some situations, as shown by Thaler and Sunstein benefit the individual thus making the presence of paternalism morally defensible. Thaler and Sunstein propose a different kind of paternalism, which they call libertarian paternalism that encompasses a libertarian approach to paternalism. In order to showcase why libertarian paternalism works, there must be some discussion of autonomy.

As Beauchamp and Childress have stated, autonomy is about someone being able to govern their own actions free of impediments like illness, coercion, or misinformation (101). A key phrasing in the definition is that autonomy is ones “own actions”, meaning they do not come from elsewhere, even if the intentions are good. With that stated, not every violation of autonomy is a bad thing, and can garner positive results. In libertarian paternalism it signifies having paternalistic interventions that even the most fervent libertarian would accept (Thaler 386). Thaler and Sunstein laid out their reasoning and examples of why this paternalism is acceptable. For this discussion I want to focus on the aspect of autonomy being taken from a person and how that is not always immoral.

People may argue that autonomy being a very basal common morality that any violation of it is automatically harmful. This assumption is not true when regarding autonomy. For instance, if an employment agency forces their employees to get yearly check-ups in order to keep their jobs that is an exercise of paternalism. However, if as a result of this check up employees were seen to be healthier on average, the paternalistic approach had positive result and would be justifiable. Another example, given by Thaler and Sunstein is when employees are “forcibly enrolled in 401K programs, something that is beneficial a majority of the time (388). Although autonomy is violated it was violated with the employees benefit in mind and does favor them in the end.

I agree heavily with the notion that people are not always making choices in their best interest. One would assumed that someone who is of sound mind and body would theoretically always be making the choice that benefits them; but as Thaler and Sunstein point out this is not the case (387). Now this is not to say that people purposefully make the wrong choice and therefore they cannot be trusted to make their own decisions ever. Sometimes someone may make a choice that they anticipated to be best for them at the moment and it turned out it really set them back. The aforementioned individuals decision was certainly autonomous but it ended up being harmful to them. If a libertarian paternal decision had been made for the individual in their choices stead that had a positive impact is that not morally acceptable? If a paternalistic decision is made with the goal of avoidance of harm or bringing of benefit to the individual there is not wrong being done. Both those distinctions go along with principles of non- maleficence and beneficence. It is the default for everyone autonomous wants to be respected, but sometimes that should be disregarded. The reason being, that people are not always making the best choices.

There is room for a slippery slope rebuttal, in that in justifying libertarian paternalism, we may end up having all of our autonomous choice taken from us. With that fear, Liberian paternalism is not a pass for all free choice to gone from the individual; it merely is an indication that autonomy can be violated with non-malicious intentions that supply a better result than autonomous choice. That stated, libertarian paternalism should never be carried out with coercion or malicious intention.

Works Cited

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New

York: Oxford UP, 2009. Print.

Thaler, Richard H., and Cass R. Sunstein. “BEHAVIORAL ECONOMICS, PUBLIC POLICY,

AND PATERNALISM: LIBERTARIAN PATERNALISM.” Arguing about Bioethics. New York: Routeledge, 2012. 386-391. Web.

When looking at physician-assisted death from a legal perspective, most governments would deem it is as wrong; there are only 5 out of the 50 states in the Unites states that allow such a practice. However, despite the law, from a moral standpoint, someone of full cognitive capabilities choosing to die should only be viewed as right. The reason for this goes back to the moral principles of autonomy and moral status.

As an autonomous person your, “personal autonomy encompasses self-rule that is free from both controlling interference by others and limitations that prevent meaningful choice such as lack of understanding” (101). With autonomy you are capable of self-government as long as nothing is impeding your choices like an illness or a lack of understanding. I know I just mentioned illness and one might argue that individuals that opt to die by the hand of a physician are ill and cannot make that choice autonomously. To that argument, I would say it does not apply in situations where someone is fully in control of all cognitive capabilities but also happens to have a terminal disease. Also, it is important to distinguish between illness and disease. It is possible for one to have a disease and not be ill. Essentially illness is a subjective state of being that manifested from a disease. While a disease is the presence of a pathological systemic issue that can result in illness (Illness). Thus, when someone is merely diseased but not yet ill, their autonomy is not hindered by their mental state. In fact, in their capable mental state they are making the decision to not get to a point where disease transitions into illness. At that point, the physician has a moral obligation to respect a patients autonomous decision to avoid suffering leading up to their inevitable painful death.

In the stipulations for a physician’s assisting someone’s death, it mentioned that there should be a voluntary request and unacceptable suffering (Beauchamp 184). The aforementioned two stand out because they indicate a person’s consent as well as an indication they do not desire the quality of life that lay ahead. Beauchamp and Childress claim:

If a person freely authorizes death, making an autonomous judgment that cessation of pain and suffering through death constitute a personal benefit rather than a setback to interests, then active aid-in-dying at the person’s request involves neither harming nor wronging (182).

There is not moral wrongdoing when someone is of sound mind and sees more benefit in ending their life early instead of dragging it out to end with suffering. From the physicians perspective it is wrong of them to knowingly leave a patient to be in pain or a low quality of life against their will. Take for example to case of Sue Rodriguez, she felt the law compelling her to stay alive through her debilitating disease was hindering her rights to life, liberty, and equal protection of the laws. However, her requests were denied on the grounds that suicidal practices were not legal. That stated, those previously mentioned facts of the case are about laws and not morals. Morally, a physician has a duty of non-maleficence and a need to respect patient autonomy, if they are capable. A patient being forced to live in pain is a harm, which is keeping them from the goods of life. This may be part of the reason why when Ms. Rodriguez took her life neither of the parties that assisted her was punished. Regardless of what the law says, it’s the individual who should be in control of their life and how they want to die if diagnose with a fatal disease.

P.S.

One other thing that interested me outside of the moral standing of physician-assisted death was the discrepancies in judgment of the Kevorkian case. Most bioethics writers have condemned Dr. Kevorkian but the physician and friend in the Rodriguez case were not. Are these not very similar incidents? I am curious to know what people think.

Works Cited

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New

York: Oxford UP, 2009. Print.

Illness, Sickness, and Disease | Primer on Public Health Population.” Illness, Sickness,

and Disease | Primer on Public Health Population. The Association of Medicine

Canada. Web. 13 Mar. 2015. < http://phprimer.afmc.ca/Part1-TheoryThinkingAboutHealth/Chapter1ConceptsOfHealthAndIllness/IllnessSicknessandDisease>.

Thomas, John E., and Wilfrid J. Waluchow. “Case 8:3 Sue Rodriguez: “Please Help Me

Die”” Well and Good: A Case Study Approach to Biomedical Ethics. 3rd ed. Peterborough: Broadview, 1998. Print.

One of a physician’s prime objectives is to do no harm to their patients. So, based on that requirement and the principle of beneficence a physician administering a placebo treatment is not morally compromising. In administering placebo the physician limits and often times eliminates suffering with no major side effects to the patient (551 Lichtenberg et al). Looking only at the placebo being a substance that does not have active ingredients is missing its true purpose. As Lichtenberg et al imply, one must look beyond the biomedical perspective of healing in order to understand the placebo’s place in medicine. With the ethical guidelines Lichtenberg et al laid out for using placebo in mind, a placebo treatment is morally sound. That stated, I wanted to address the particular case where the physician did not administer a placebo as the more moral action to take.

In the second vignette from the Lichtenberg et al article it tells of a house call made to a 40 year old man diagnosed with gastroenteritis. The patient’s wife insisted her husband be given a shot of penicillin for his ailments despite the apprehension of the physician. Ultimately, the physician is able to leave without administering the antibiotics with a promise to come back if the patient wasn’t relieved in 24 hours. In this case it would have been highly unethical for the physician to use a placebo treatment because of the possible negative effects.

Gastroenteritis, otherwise known as the stomach flu involves your stomach and intestines being inflamed and irritated. The stomach flu has nothing to do with influenza (flu) and the cause of infection can either be viral or bacterial. If the cause is bacterial then it is caused by microbes, which are infectious microscopic single-celled organisms. Theses organisms can go undetected on foods and surfaces until they begin to cause infections in one’s body. Whereas, viral infections are also cause by microbes but these have an outer protein coat, which incases a DNA core that requires other cells to replicate. To treat a bacterial infection, most physicians prescribe antibiotics because they can kill bacteria and/or stop them from reproducing. However treating with antibiotics for viral infections has no effect on the actual virus and can cause antibiotic resistance. Antibiotics flush your system of bacteria both good and bad, but the full prescription must be taken in order to do this. If a patient does not take the full regimen of antibiotics the body can build a tolerance to antibiotics with the bacteria that remains. In the case of treating viruses, since there are no infectious bacteria to clear out the chances of your body building immunity to the antibiotics is much higher. As a result, an even stronger dose of antibiotics will be required for the next time an infection occurs or worst-case antibiotics become ineffective. Thus, future infections will be harder to treat and cause longer suffering for the patient.

Given the above information, if that physician were to administer penicillin, an antibiotic, in this instance to the patient he would have been enacting harm. Being antibiotic resistant is a problem for the medical field and detrimental to patients. In this case, the penicillin’s sole purpose would have been to mollify the patient, which Lichtenberg et al point out as unethical use of placebo. So some might argue that the physician had a dilemma of whether to acquiesce to the spouses request or not. However, with the potential of all that could go wrong with irresponsible use of antibiotics his choice is clear. Therefore, the physician – and any for that matter – would be violating his moral obligations in using antibiotics as placebo.

Works Cited

“Bacterial vs. Viral Infections: Causes and Treatments.” WebMD. WebMD. Web. 13 Feb.

2015. <http://www.webmd.com/a-to-z-guides/bacterial-and-viral infections?page=2>.

“Gastroenteritis (Stomach Flu): Symptoms, Causes, Treatments.” WebMD. WebMD.

Web. 13 Feb. 2015. <http://www.webmd.com/digestivedisorders/gastroenteritis>.

Lichtenberg, P., U. Heresco-Levy, and U. Nitzan. “The Ethics Of The Placebo In Clinical

Practice.” Journal of Medical Ethics 30.6: 551-54. JSTOR. Web. 13 Feb. 2015.

U.S National Library of Medicine. U.S. National Library of Medicine, 25 Aug. 2014.

Web. 14 Feb. 2015. <http://www.nlm.nih.gov/medlineplus/antibiotics.html>.

According to Beauchamp and Childress, “An individual acts conscientiously if he or she is motivated to do what is right because it is right, has tried with due diligence to determine what is right, intends to do what is right, and exerts appropriate effort to do so” (42). Prior to reading the second chapter of the aforementioned authors’ bioethics guide, I had known conscientious as only to mean one was aware of something. For instance, a nurse informs you that giving blood might make you lightheaded. You acknowledge this fact and still consent to donating; you conscientiously gave permission to have your blood drawn. However, in the case of ethics, I am learning commonplace words, such as rules or principles, can take on new meanings. Conscientious will now be added to my ever-growing mental list of words that do not mean what they should in ethics. All jokes aside, the above definition of conscientiousness has sparked questions about how moral conscientious refusal has a space in the field of healthcare.

In the introductory chapter of Beauchamp and Childress’s book, the notions of common and particular moralities are of focus. One such particular morality is that of a professional morality. The professional morality is non-universal and dictates moral codes and standards that are particular to a certain profession (Beauchamp 6). When you become a professional, you are ascribing to the moral codes that come with that profession. Ethically speaking, as a nurse or physician it is your duty to act in the best interest of your patient regardless of your own separate moral obligations.  So how can one claim a conscientious objection to a medical procedure that aligns with the patient’s morals but not their own? In the example Beauchamp and Childress give, a nurse can conscientiously object to having any part in an abortion procedure if that decision does not follow what she thinks is right (Beauchamp 43). This refusal is fine if there are other nurses around; the nurse is not interfering with the patient’s autonomy by not allowing the procedure to take place. There is also no malevolence because there is someone to aid the patient in the procedure. However, if there was only one nurse available and she conscientiously objected thus forcing the patient away would be immoral. The nurse is no longer doing what is right; yes it may be right in their mind but as a care provider it is not right. The patient’s autonomy has been taken away for an unjust reason. One cannot both be conscientious and refusing to provide care, which is not right and contradicts the nurse’s obligation to his or her patient.

The problem with conscientious objection in healthcare lies within the definition. Several times in the definition of conscientious, the idea of what one thinks is right is used. One’s personal morality does not have room in professional morality because one’s definition of right is subjective and falls outside the particular morality.  In accepting a job in healthcare you should be conscious of the fact that you may encounter patients that will have medical views that they are entitled to that do not align with your own.

Works Cited

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2009. Print.