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Bermudez, Armina Riezel R. Philo 133-A Principle of Utility vs.

Kantian Ethics (Reflection Paper) The Principle of Utility states that Actions are right in proportion as they tend to promote happiness, wrong as they tend to produce the reverse of happiness. In the health care practice, this principle pertains to anything that will provide goodness and least harm to the patient. Basically, it emits the importance of beneficence and nonmaleficence because of the same idea; the idea of providing maximum care to the patient and preventing the occurrence of anything that will deteriorate his health. On the other hand, the Categorical Imperative of Kant emphasizes the intention of good will. Moreover, it distinguishes the difference of the moral act that lies within the self and the act that is only according to duty. While I was reading the scenario, I was struck by these statements, A day in the ICU causes 4,000php, thats why at the second day of admission, the physician talked to the family and explained properly the real condition of the patient. According to the medical team theres nothing they can do, but to give the patient a peaceful death. Since there is a given emphasis on the digits which is 4,000php, it evidently shows that the patient came from a family with a low socio-economic status. I was deeply saddened by the idea of theres nothing they can do but to give the patient a peaceful death. As a health care provider, it is a responsibility to maximize the options of the patient and his family and not only be ruled out by one. Even if the patient is poor and critically ill, it doesnt mean that death should already be introduced. I, personally, had an experience similar to the situation but had different outcome. I was once assigned in the operating room on a morning shift. There was actually a minor case for debridement, but the patient was not immediately transported to the operating room due to some problems. I was sitting at the waiting area when I suddenly heard the institutional worker talking with the staff nurse. Maam, talya pa el pasyente. Nuay daw sen para na operasyon, said by the institutional worker. The staff nurse immediately replied, Ay liba ya kunakel aki. Maskin nuay kel sen, pasyente lang siempre kel. Obligasyon se diatun ase bibi pasyente. I was astonished. At that very moment I realized that there are still some people who do their jobs according to their principle and not according to what is ought to be. According to Kants categorical imperative, we must always treat people as ends and not as means only. As a health care provider, one is tasked to save lives according to the right perspective without taking into consideration the things that may hinder the promotion of wellness to a patient. Furthermore, the ethical dilemma in the given scenario is about the two nurses who refused to participate in terminating the life support systems that was supporting the patient. In this ethical dilemma, the principle of utility and the categorical imperative of Kant are both contradicting. The purpose of the medical team why they have to terminate the life of the patient is because they want to give the patient a peaceful death since the patient is already suffering a lot because of his health status. This is preferably related to the principle of utility because there is a said purpose in doing the act which has a good benefit for the patient. Yet at this point, beneficence end because there is already nothing that can be done to save the life of the patient since the patient and the family has been already decided to signed the Do Not Resuscitate Order. But because there are those two nurses who

refused to do the act, this is now where the categorical imperative of Kant enters. According to Kant, will is what directs our actions and guides our conduct. We act for the sake of duty when we act on maxims that satisfy the categorical imperative. In the case of the two nurses, though it is their obligation as nurses to follow the protocols of the hospital and to accept the fact that they already need to let go of the patient, they still prefer to refuse from doing the act because within them, they have this belief that terminating the patients life is an immoral thing to do. They probably do not want to do the act just because they have to do so or just because they have to. They decided according to what they feel and according to what they think is right. Even though they did not involve themselves in terminating the patients life support system, what they did is still in accordance of what is morally right. This is how the principle of utility and the categorical imperative differs. The first one emphasizes the production of happiness, while the latter emphasizes the difference of the act that is within the self and the act that is in accordance to duty.
Euthanasia is one of the most complicated issues in the Medical field due to the clash of ethically point of views. Nowadays, the lives of many patients can be saved with the latest discoveries in treatments and technology. But we still are unable to find cure to all illnesses, and patients hae to go through extremely painful treatments only to have time. These patients struggle with physical and psychological pain. Due to highly costs treatments, few capability to have total control of their lives and the only option to live a short amount of time with painful treatments: People should have the right, with certain restrictions, to end their lives in the best way possible to stop suffering of an endless pain. Society should have compassion and respect to the patient's decision whose life becomes unbearable. Euthanasia comes from the Greek words Eu: "good" and Thanasia:"death". It is the action of terminating intentionally the life of a human being to eliminate suffering for his/her benefit. When a person has a terminal disease, all the types of treatments have been practiced, nothing works and the endless pain of the patient still exists:Euthanasia could be an option, depending on the case. For example, a person is in coma due to brain stoppage, so his life is meaningless for that person. This human being will not be able to feel or rationalize what is going on. In such cases, Euthanasia could be an option for the patient and family members to relieve from agonizing processes. Euthanasia must be a decision made directly from the patient or, in extreme cases, from an immediate family member. Therefore in my perspective, the act of Euthanasia can be performed in two different types of consents: Voluntary and Non-Voluntary. The act of Voluntary Euthanasia is a decision made by a reasonable patient, who requests or gives an informed consent (Living Will) to the acceleration process or total stoppage of certain treatment to die. In this case, doctors must provide the patients with other options before they recommend Euthanasia as an alternative. If the patient make this choice, it should be respected and followed because nobody more than them, know the deplorable conditions in which their physical and emotional pain are driving their lives. In the Non-Voluntary Euthanasia cases, the decision is not made by the person who is going to die. The patient must be an infant, very old, mentally impaired, very ill physically and mentally, unconscious, or not competent to make such decision. If someone is so sick that is unable to make the delicate decision, Euthanasia can be performed only by consent of a close relative like spouse, parent or guardian or in extreme cases settle by a judge. For example, in the cases of coma or inability to communicate is impossible for the patient to make such decision, therefore the decision should be based in what is expected to be the

best for them. In some reports a third kind of consent is considered: Involuntary Euthanasia. It is described as the act of euthanasia performed without the person's consent even though they made an "expressed wish to the contrary" ( this type of act I object, as the act is performed contrary to the patient's wishes. If a person did not talk about what he/she would prefer when such situation would occur, then in some cases is understandable the decision could be made by the family members, according to their situation. Contrary to the fact that the patient expressed his disagreement to the act and then is performed. For me, is morally impermissible to allow such act, because we are violating human rights by not respecting their decisions. We are imposing our view of life into their lives. We can give opinions and views, but we should not impose death and Euthanasia should be based on the patient's decision as well as benefit. Furthermore to the type of consents, Euthanasia is classified in two categories: Passive and Active. In Passive Euthanasia, or euthanasia by omission, doctors will intentionally let the patient die by stopping any kind of treatment. For example, a patient was more than five years in a coma due to an unknown paralysis. The only part of his body working was half of his "brain stem", meaning half of his respiratory system. His family was devastated emotionally, economically and doctor's lost their hope to do more than they tried throughout the years. Psychologically the family was devastated because the possibilities to survived decreased as the days went by. In this case, the patient was disconnected to let nature take its course as the patient could not respond with machines.The family opt for euthanasia because according to medical studies there was no possibility to survive and the patient's wishes before his paralysis was Passive Euthanasia. According to Dyck, patients should not be subjected to medical treatment without their consent. In some cases Passive euthanasia could be performed if the patient has a terminal illness and the procedure affects more the person than trying any type of treatment. In such cases like an advance cancer chemotherapy affects physically and emotionally the patient in extreme ways. If the doctor find no possible cure or more time with the chemotherapy process and the patient decided not take it, then Passive Euthanasia should be respected. They should have an option for their death because in this case their death is foreseen in short time,whether they go under treatment or not. If the treatment will help in somehow, then it should be done; but if for the contrary it will increase suffering then the is the patients' decision what is best for them. On the other hand, in Active Euthanasia doctors will accelerate the process to terminate the life of the patient directly, with such procedures like the lethal injection method or drugs. For example, Annie had a car accident where she suffered deformations and third degree burns in almost 95% of her body. Her body couldn't take anymore pain as she went through all kind of treatments. She was in a constant pain with surgeries that affected her immune system, as anemia increased her weakness. Annie decided Active Euthanasia because she couldn't take the pain anymore, and few possiblities to survive from surgeries were given. According to Rachel's paper in "Active and Passive Euthanasia", once the initial decision not to prolong the patient's agony has been made, active is preferably rather than passive. His example focus on the case of a patient who is dying of an incurable cancer of throat and a terrible pain that cannot be alleviated at all. He is certain to die in few days, but he decided to not continue with the unbereable pain, therefore asked the doctor to withhold the treatment which will be a worse pain. The writer emphasizes that passive euthanasia leads to more suffering rather than less contrary to the purpose of euthanasia. The same situation is with Annie's case, if they stop the treatment the pain from the burns will be even worst and tragic before her death. Therefore, we are letting the patients to suffer even more, by

stopping the treatments instead to perform in the purpose of eliminitaing suffering. According to Rachel there is no moral difference between active and passive euthanasia because at the end the patient die, no matter in what way. He emphasizes that "killing" and "letting die" at the end is the same result: termination of life. Personally is not the same result as psychologically the process will affect patients and family members. We have to take into account how our surroundings, our beloved ones, will take our decision if we can make it. Letting die, or passive euthanasia, will give a rest to all the try-outs from medical procedure. Active Euthanasia instead, will end as quickly as possible the immense pain a patient has. Therefore is important to balance the pros and cons and decide which of the two is beneficial for the patient and family depending the situation.They should not take the easy way to end their lives, but is their decision to end it in those extreme cases. In my perspective Active and Passive euthanasia are permissible depending on the situation. People should be in an extremely painful situation where nothing in the doctor's knowledge is possible, and then decide which way is recommendable and painless. The lethal procedure can be implemented if the stoppage of the treatment is tremendously painful. In these cases, a measurement of utilitarianism should be applied. Look for the greatest amount of painless solution for the patient and also family members but the tranquility of the patient should be the main concern. Now, oppositions to Euthanasia misinterpret the concept of a "good death". Euthanasia should not be apply to escape from depression, chronic pain due to the lack of money, health insurance or lost of some senses. As the ultimate form of procedure Euthanasia can be mentioned. If a person suffers of an extreme depression, there are medicines and psychological treatments during the transition to a healthier life. Ethically doctors should do the best in their hands to save the life whenever is possible. Depression is a psychological stage that can be cure and even though physical injuries are involved, the life of a person should be respected and appreciated. If the person wishes the contrary, help should be seek as the person is loosing total control of their mind. If the lack of money or health insurance exists they should find all the ways to fulfill this need. As Rachel points in his essay, if the babies with Down Syndrome and congenital deformations have operation as an option, there is no reason to end their lives. Euthanasia might be the reason for only extreme inoperable or terminal disease. If we have the possibilities to cure, we should do in any mean to save it. Also if a patient have some sense lost, death should not be pursued. There are people who suffer from multiple dissabilities to live by themselves, and everyday they do something for our community. A disability is not an obstacle to find a meaning to live. According to religious organizations, some fear that the act will be the first step to a society who will kill elderly or disabled people against their will. They definitely took the definition to the extreme without taking into account the restrictions Euthanasia should possess. Euthanasia is not an act with the purpose to kill who the society think has not worth to live. The decision to accelerate the death of the patient has to be if and only if, is terminally ill with an endless pain. Oregon, which is the only lawful state to perform Euthanasia, has very strict regulations to accept the decision from the patient. A very clear argument for Euthanasia is that it will "never be used unless a terminal patient, who is sound of mind and not depressed" ( Doctor's ethically act to the benefit of the patient with the overview of all aspects. Disabled people and elderly are part of the community with all respect and should not be discriminated for health treatments. Furthermore, religious groups emphasize that God should be the only one allowed to end a

life. Personally I think this is true but with some exceptions to those terminally ill with a constant pain. As humans, we should have compassion for those who physically suffer constantly without long time to live. Doctors should try everything, but if is not possible we have to have mercy for the patients. For example we should reconsider the position, when we have cases of patients who developed Aids and the treatment is so severe that their lives become unbearable. Those patients should not be force to take treatments that will end their lives in the worst way. Death is foreseen sooner or later, it should be respected if they prefer death as the suffering is intolerable. Suffering without any mean to stop it, is the most cruel act humans can imposed to their world. God send us to learn and live the life he show us, but also he demonstrate compassion and forgiveness during these times.