Euthanasia - an analysis of the theories and principles which guide healthcare practice and decision making.

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This essay is going to look at euthanasia. This will include an analysis of the theories and principles which guide healthcare practice and decision making, a discussion of the relevant codes of professional practice and the legislation that may guide practice and decision making. This essay will also include an evaluation of the effects of the ethical issue for the individual concerned, their family, health care workers and for wider society.

Ethics are the principles on individual uses, in order to make decisions in life and when applying the values of a given profession. The value base informs the decision making process for the individual, but ethical principles also have to be used. There are different schools of thought regarding the function of professional ethics. Each school of thought will tackle situations in different ways.

Utilitarianism, or consequentialism, was developed by Jeremy Bentham (1748-1832) and John Stuart Mill (1806-1873). A utilitarian will believe that a morally right act has to bring about the greatest happiness for the greatest number of people. Utilitarians equate happiness with good, so a morally right act is one which creates the greatest good for the greatest number of people. Utilitarian philosophy holds that all knowledge comes from experience. It can be seen that utilitarian philosophy, like most ethics, involves making personal judgements, rather than following strict rules in a given situation.

Ethical systems of thought always encounter problems. It is difficult sometimes to define what is good. How can you guarantee that all possible consequences have been considered prior to action being taken? The concept of the greatest good for the greatest number of people is not straightforward. The idea of creating the greatest happiness for the greatest number of people has to be used as a principle to guide the construction of codes of professional conduct, or for designing laws and systems of social regulation. Utilitarianism does not work very well when it is applied to day-to-day decisions, or day-to-day actions. The first reason for this is that very few people can predict the future and manage to work out what will create future happiness.

The second reason that utilitarian principles do not work very well when applied to acts of behaviour is that most people are very biased in their judgement of happiness. So the idea of greatest happiness may be a helpful principle of social justice, but not a useful way to make moment-by-moment decisions in care work.

A deontological view (Immanuel Kant, 1742-1804) argues that the same rules should apply to all people and that knowledge comes from a process of reasoning. Whether an action is right or wrong will therefore depend on the motives for the action. Kant's theory is universal, this means that everyone has to follow the same moral rules whatever the situation. Kant believed that it is deemed an essential duty always to tell the truth because he believed that in this way respect for the individual is demonstrated. He also believed that all life should be preserved.

Kantians argue that it is impossible to have a meaningful relationship unless it is based on truth, for example, a patient has free will and, if he asks for a diagnosis, the truth must be told. In this way the doctor has done the right thing by telling the truth to the patient and has therefore demonstrated respect for that individual.

Critics of Kantianism state that the definition of duty can be interpreted in different ways by different people. The essential rule always to tell the truth may place an individual in an impossible situation, for example, being told something in confidence by one person then instructed to tell the truth about the confidence by another.

Pure logic and absolute trust seem a good idea at first, but when used as a basis for day-to-day decision making the idea does not lead to acceptable practice on its own. It is not enough simply to be logical or truthful. Communication has to show respect for individual beliefs and identity. The care value base does not suggest that it might be acceptable to lie or mislead clients, but it does suggest that truth and logic are not the sole issues in care work.

Decision making in health and social care cannot depend on simple principles like utilitarianism or logic but nor can decision making be left to the beliefs what individuals have been brought up with, or socialised into. Professional value bases or codes of practice are needed to help worked make decisions. The problem is that decision making is still a difficult task, even when staff understand value basses and codes of practice. Many situations require professional levels of judgement.

David Seedhouse (1988) combines the theories of utilitarianism and Kant's notion of consistency into one theory. Seedhouse argues that when an ethical decision needs to be taken, care workers should weigh up the facts of the situation, for example, workers collecting all relevant details about client need, legal rights and so on, the extent to which a decision may create a good outcome for everyone, this principle is the same as the idea of utilitarianism, fairness and consistency in any decision that is taken. People have a right to an equal quality of service or treatment. People must not be discriminated against. This principle is similar in some ways to Kant's ideas about consistency, and finally, the degree to which the decision empowers vulnerable clients and increases their control over their own life (autonomy). Decisions should not result in 'control' of others unless this is definitely in the greater interests of the majority people.
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The word 'euthanasia' originated in Greece and means a good or easy death. Nowadays the word is more often used to describe the deliberate ending of life. There are six different types of euthanasia which are usually recognised. These are voluntary euthanasia: a competent person makes an informed and free decision to end his/her life, non-voluntary euthanasia: a decision is taken to end a person's life because s/he is hopelessly or terminally ill; it is non-voluntary because the person cannot be consulted about the decision - s/he may be unconscious, involuntary euthanasia: ending someone's life either without regard ...

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