Ethical studies involve the moral, psychological, and philosophical examination of an individual’s behavior, attitudes, emotions, and judgments. With the aim of making informed judgments and correct decisions, ethical studies apply varied methods to assess the situation of, for example, the hospitalized terminally ill and to examine the appropriateness of medical intervention to end their lives. The four-box method of ethical analysis can be used to determine whether the patient is psychologically or psychiatrically sound (Wilford 67). Depression, among other disorders, affects a patient’s judgment and decision-making, and therefore, ethical analysis is often applied to assess the patient’s preferences, medical indications, quality of life, contextual features, and counseling options before the patients’ preferences are taken into account.
Case analysis uses the four-box analytical method to analyze the condition of the female patient suffering from a terminal illness: acute myelogenous leukemia. She refuses medication although she acknowledges her refusal to take medication can lead to death from this type of cancer. The medical indications after diagnosis reveal that the patient suffers from acute myelogenous leukemia, a fast-spreading cancer of the blood and bone marrow. The condition poses a serious threat of invading the entire body within a few weeks or months as the affected blood flows throughout all the parts and organs. The treatment administered aims to help reduce pain and prolong life. The efficacy of the applied chemotherapeutics is unquestionable since they act in hours to alleviate pain if utilized consistently as prescribed.
The patient’s preferences include refusal of the medication and treatment for the condition although her refusal could lead to premature death. Examination by a psychiatrist shows that she is not suffering from depression although she is disturbed by her condition. The patient, an adult, requests medication to end her life to avoid a prolonged, painful death. The patient also knows that prolonged treatment using the various chemotherapeutics methods will deteriorate her life.
The patient’s quality of life will require continuous chemotherapy to relieve pain and sustain life as long as possible. Educated and articulate, the patient sees no future with her condition and feels that she cannot tolerate the painful death that awaits her. In terms of contextual features, close family members with the patient would accept the medication and hope the condition heals. Is this even a possibility in a terminal illness? In their opinion, they would prefer that the patient recovers from the illness rather than end her life prematurely, they persuade her to take the prescribed medication. On the other hand, they also respect the patient’s decision to refuse drug treatment. The attending doctor is not supportive of the patient’s request and, therefore, recommends ethical counseling.
Appeal to ethical principles
In the light of the analysis, the patient, a well-educated middle-aged woman, enunciated, with no depression or psychological malfunction indicated, an informed decision to have her life terminated. The attending physician offers alternatives to alleviate the pain and cares for the patient (Haselkorn 18), but the patient requests barbiturates to end her own life when she thinks fit. Close family members know the condition of the patient. These factors qualify the patient as competent and, therefore, her decision to terminate her life when the time comes needs to be respected for she thinks this would be best for her.
Response to objections
The application of the ethical principle of respect to ones’ own informed decisions to terminate one’s life depends not only on the psychological soundness of the patient but also on whether the disease is terminal or not. Therefore, the principle of respect for ones’ decision applies to those suffering from terminal diseases, provided the diagnosis and prognosis are certified by no fewer than two physicians. Terminal illness and informed decisions justify the honoring of a person’s autonomy. On the other hand, mental disabilities impair judgment and decision-making; above all, mentally disturbed people cannot consent voluntarily to assisted death since voluntary consent is an ethical requirement for assisted death even when the principle of compassion applies (Sjonding 34). Although compassion justifies assisted death, it still requires psychiatric soundness.
In my recommendations concerning this case, the attending physician should apply the ethical principle of respect and honor to the patient’s request for assisted death. The patient’s request for the required procedure should be granted because even the closest family members respect her decision concerning her own life and death. On the other hand, the patient has refused chemotherapy treatments, a potentially life-saving treatment, and has opted for death, implying that, even when the request for barbiturates fails, the patient accepts her death may be painful and prolonged. Therefore, the patient’s request to avoid a prolonged and painful death should be granted.
Ethical analysis of medical conditions and a critical examination of the patient’s preferences help in making judgments concerning not only the appropriate counseling method for the patient but also the attending physician’s recommendations for appropriate subsequent actions either to save life or to assist in death. In this case analysis, the analytical method leads to a recommendation in favor of the patient’s request, for she is mature and free from depression, factors that compel her family members to support her decision: termination of her life through a lethal dose of medication. However, the decision would not be the same if the patient was not terminally ill since a number of ethical implications would have to be considered.
Haselkorn, Jodie K. “Ethical issues at the end of life: Physician assistance with death.” Medical History and ethics 411 3.2 (2009), 31-4Standinging, Britta. Genetic counseling and ethics. Washington DC: Genetic Medicine Clinic Press, 2007.
Wilford, Benjamin. Exploring the ethical boundaries of enhancing our children. Washington DC. Washington University Press, 2008.