Ethics in Medicine: Dilemmas in Healthcare Part 2

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The four principles of ethics discussed in Part 1 of this series are not always binding, but rather, should be applied in all circumstances unless there is a more important factor that must be considered for the greater good. While ethical codes are established as principles that a consensus of medical professionals believe in, they often do not address situations that occur on an individual basis. Two main issues in bioethics today are euthanasia and religious liberty in health care.

There is an ethical dilemma in the choice of caring for individuals nearing the end of life for prolonged periods of time when there may be little benefit in doing so. Euthanasia is the process of a doctor ending someone’s life by painless means, which provokes debate about whether doctors should be able to deliberately end someone’s life with their consent. There are two main types of euthanasia: active euthanasia and passive euthanasia. Passive euthanasia is the less controversial type: it allows the patient or their family to withhold life-sustaining treatment such as opioid medications, a ventilator, or a feeding tube. Active euthanasia occurs when medical professionals or another person deliberately gives lethal drugs that end the patient’s life. In classical ethics, there is a moral difference between actively killing a patient and refraining from actions that would sustain the life of the patient. However, others argue that because both types of euthanasia are done with the intent of the patient’s death, there is no substantial difference between the two types if they are administered with proper consent. In 1990, the United States Supreme Court approved the use of passive euthanasia, and some states have adopted Death with Dignity Acts, allowing physicians to assist terminal patients in ending their life if they are expected to die within six months.

Religious Liberty in Healthcare
Addressing a patient or caregiver’s religious beliefs that may conflict with certain medical practices is also an ethical problem. This can involve a patient’s religious objection to procedures such as vaccination, or a doctor’s religious objection to treating someone whose lifestyle violates their religious beliefs. Many state laws include conscience clauses, which protects the rights of doctors and medical professionals to withhold treatment that violates their religious or moral values, such as abortion, sex reassignment, and euthanasia. In 2014, the Supreme Court ruled in Burwell vs Hobby Lobby that the government cannot force private companies to provide insurance that covers birth control methods if it violates the employer’s religious beliefs. Some activists and ethics professionals disagree with this Supreme Court decision and with the wide use of conscience clauses: they believe that the expansion of religious liberty for doctors could endanger some groups from receiving emergency care and decrease the availability of contraception for women.

To better address these ethical issues, many healthcare facilities establish an ethics committee that creates formal policies to better resolve issues. However, these ethical dilemmas will continue to be hotly contested at the personal, federal, and global levels.

Books About Ethical Dilemmas and the Practice of Ethics
For further exploration, here are four books widely acknowledged as innovative or informative in developing a more-complete understanding of medical ethics:

  • Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present by Harriet Washington
  • The Spirit Catches You and You Fall Down by Anne Fadiman
  • The Immortal Life of Henrietta Lacks by Rebecca Skloot
  • Bioethics: Principles, Issues, and Cases by Lewis Vaughn

Situations that create conflict between bioethical principles show how the study of bioethics is not always clear cut and has many contrasting opinions within the field. However, the improvements to health care that have resulted from the adherence to these principles show that bioethics is an integral part of creating a better and more equitable healthcare system. The study of bioethics may appear abstract and theoretical, but the forms, practices, and procedures you encounter at the doctor’s office or hospital are governed by the special standards of bioethics to ensure the best care and future for you and all patients.