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Related Ethical IssuesTrilogy of a Dying Patient’s Rights To respect a person consists in recognizing the dignity and inherent worth of that individual as being uncompromisable. Respect for persons is in some religiously oriented traditions defined as reverence for persons. An example of respect is to treat patients in the order in which they arrive, on the principle of “first come, first served.†A patients’ right to respect means that the patient is treated as an “end,†not as a means only, in Kant’s sense. In that sense, the patient’s right to respect includes the right to know the truth and to be told the truth insofar as it is known.The right to receive means that a patient has the right to be given the best available treatment. The right to treatment flows out of the right to respect and is a special health care right. It also means that the patient is not ignored or given custodial or palliative care if more aggressive measures are needed.The patient’s right to refuse and even to terminate all treatment is an especially important right of competent patients. Such a right assumes that hospital personnel are willing to take on the legal and moral responsibility associated with the death of patients who wish to discontinue treatment.Finally, the trilogy of a dying patient’s rights means a dying patient is treated with care and comfort and not left alone. For to show respect for a dying person is to provide maximum well-being for that person.Quality versus Length of LifeSome of these cases illustrate the moral issue between the principle of saving all life versus the principle of preserving only a life of quality. Those who say all of life is a gift aim to protect all life, regardless of its quality. Others defend the idea that control of one’s life and body are fundamental rights. These individuals are apt to evaluate the quality of life and would discontinue the respirator for the brain-dead in particular. On the other hand, deciding who shall live or die can present a serious moral dilemma. Those who invoke a quality-of-life argument are, in effect, playing God. A safeguard, then, to a quality-of-life argument is to obtain freely given first-person consents for health professionals’ interventions.Relief of Individual Suffering versus the Principle of Double EffectAnother issue that concerns a dying patient is whether to relieve suffering in the presence of competing goals, expressed through the doctrine of double effect. This doctrine recommends doing the least of several evils when evil cannot be avoided.Ordinary versus ExtraordinaryTreatment which at one time is extraordinary, scarce, and expensive later becomes ordinary. Antibiotics, dialysis, open-heart surgery, organ transplants, and cardiopulmonary resuscitation are examples of extraordinary treatments and procedures that have become ordinary.In any event, the words “ordinary†and “extraordinary†are fraught with vagueness and ambiguity. The President’s Commission identifies several often confused and conflicting meanings of terms, such as “usualness,†“complexity,†“invasiveness,†“artificially,†“expense,†or “availability.†The Commission prefers “useful†and “burdensome to an individual patient†as having an important advantage over other distinctions, such as “common/usual.†A difficulty with the useful/burdensome distinction is that despite the reference “to an individual patient,†this distinction overlooks other problems.In one standard sense of the “ordinary†and “extraordinary†distinction, the extraordinary is associated with doing for a patient something exceptional, extra, heroic, supererogatory, or special. On this view, “ordinary†means applying conventional procedures and treatments, which are routine. However, to associate “ordinary†medicine with “useful†medicine and “extraordinary†with “burdensome to an individual†may do a disservice to the advancement of health care. To give-up the extraordinary flies in the face of the human spirit of struggling to improve the human condition. Moreover, a word like “useful†offers no great gain in clarification over “ordinary.â€The ethically sensitive and intellectually critical nurse will in any event not be satisfied with any distinction that is not both effective and justifiable in considering what to do or refrain from doing for a given patient. One proposed usage is to drop the distinction altogether and do one’s best situation.Despite the difficulties, there are still advantages in using the ordinary/extraordinary distinction on occasion. Use of these terms sharpens one’s awareness that the principle of what to do is decided on the basis of doing good and not harm.
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