Introduction
After suffering acute respiratory distress, Mr. Watkins was diagnosed with bilateral pneumonia, which led to his admission to the intensive care unit. Considering his health condition, he required supplemental oxygen on top of antibiotics; therefore, he was put on a mechanical respirator. After pneumonia had mostly cleared, Mr. Watkins, unfortunately, became respirator-dependent. Regardless of necessary interventions, the weaning process failed, and Mr. Watkins eventually became uncooperative with further weaning attempts. However, Mr. Watkins’ son and wife wanted the medical staff to “do something to save him.” Meanwhile, Mr. Watkin wanted the staff to disconnect the respirator and let him die. The case presents the physician with a moral dilemma; the conflict between patient autonomy and family wishes. She is torn between further necessary weaning interventions and letting the patient die. Based on relevant facts and consideration of available alternatives, this paper aids the physician in deciding to end Mr. Watkins’ life with a strong defense using Utilitarian and Kantian approaches before offering a critique of the decision.
Relevant Facts
The most relevant facts in Mr. Watkins’ case include the medical history, the treatment nature of his current condition, the causes of Mr. Watkins’ respirator dependency, the patient’s concerns over his social life, and his competence in making autonomous decisions. Notably, Mr. Watkin had chronic pulmonary disease for fifteen years; the condition had worsened for the past five years, resulting in his progressive debilitation. Before his admission, Mr. Watkin was confined in his home, considering his dependency on his wife for almost everything, including primary care such as feeding and dressing. The pulmonary disease significantly altered his more preferable independent life, whereby he enjoyed ordering people around and was used to total devotion from his wife and married son. Invariably, he could not tolerate the change from independence to dependence, far worse, on a mechanical respirator.
With the new condition, whereby Dr. Radburn estimated only a 20 percent chance of successful weaning, Mr. Watkins became less and less independent and lost the will to live. Regardless of the possible reasons for his respirator-dependent condition, a combination of the possibility of new lung damage, poor nutrition, fear of breathing on his own, and weakened respiratory muscles, weaning attempts were largely unsuccessful. This fact and his subjection to painful medical procedures such as suctioning, frequent needle punctures, and constant intravenous feeding discouraged the patient. Over time, Mr. Watkin grew less communicative but remained aware and alert, according to a medical staff’s opinion.
Available Alternatives
The available alternatives, in this case, included disconnecting the respirator, allowing the patient to die, keep trying to address Mr. Watkins’ condition, mainly focusing on the causes of his respirator dependency, and keeping the patient on the mechanical respirator but avoiding the painful medical procedures. The first alternative is based on Mr. Watkins’ preference considering his lost hope in the medical treatment procedures, which only cause him more pain with no improvements. The second alternative ignores Mr. Watkins’ decision in favor of his family’s wish since they have shown interest in continually supporting him. Finally, the last alternative reflects the mind of a physician torn between the other two decisions. It is based on the fact that weaning has failed regardless of medical interventions, but the physician is not ready to disconnect the patient from the respirator.
Decision and defense of the decision
In my view, the physician should allow the patient to die, considering his pain and suffering while undergoing the medical procedure for weaning, yet she only predicts a twenty percent chance that the interventions will work. Also, the physician determined that Mr. Watkin was fully competent, implying that he could make his own decisions regardless of his condition.
The decision to disconnect Mr. Watkin from the respirator is largely based on utilitarian hedonism and the principle of utility. According to the principle of utility, people should decide based on the usefulness of their actions. Individuals must always favor actions based on their resultant advantage, happiness, benefit, or good. In the case of assisted suicide, like Mr. Watkins’, the decision to end one’s life is permissible in cases where the positive outcome outweighs the negative one (Garcia 3). Hedonistic utilitarianism also supports the action producing the highest net happiness for concerned parties (Weijers 1). In this case study, the concerned parties, including Mr. Watkins, his son, his wife, the medical team and hospital, and other patients in need of attention will only receive immediate or gradual happiness, based on who they are, when the physician agrees to end Mr. Watkins’ life. Otherwise, the tension, suffering, and desperation will intensify as long as Mr. Watkin remains on the mechanical respirator.
Act utilitarianism also supports my decision. This moral theory states that the best actions produce the greatest welfare of happiness for most people, regardless of the laws or rules of action. It uses consequences rather than motives or intentions to judge actions. Therefore, act utilitarianism would determine that the immediate instance of happiness maximization lies in the action’s appeal to the patient in need of assisted suicide. The alternative would yield the opposite of happiness, whereby continued treatment would result in the patient continually undergoing painful medical procedures. Also, considering that the patient is fully competent to make his decision, the physician has a moral responsibility to grant Mr. Watkins his wish. The wife and son’s wishes should only be dismissed since they contradict the patient’s needs.
Furthermore, act utilitarianism in Mr. Watkins’ case reveals that others would benefit from his decision to end his life (Jordan 3). For instance, the physicians or hospital will benefit from avoiding unnecessary expenditure on Mr. Watkin, considering his low chances of successful weaning. Instead, the respirator could aid another patient with a better chance of quality life after use. Diversely, although the wife insists that the medical staff should do anything to save the patient, his death would benefit her, considering she will not have to watch him suffer anymore (Jordan 3). Mr. Watkins’ death will only result in more good than evil. The decision achieves happiness through the elimination of pain.
My decision is also rooted in patient autonomy, whereby he is entitled to control his life (Garcia 3), and rule utilitarianism, which states that an action is right only when it follows a rule or guideline that ends in the greatest good. Therefore, the moral theory believes in the moral correctness of individuals’ actions if they side with utilitarian-based codes or rules. Ultimately, based on rule utilitarianism, the physician will be morally correct to act in the patient’s best interest, considering he competently decided to die. The decision also results in the greatest good: Watkins’ family will not see him in pain, and the hospital and medical staff will not waste resources on Watkin, but instead channel them to other patients who can benefit from them.
On the contrary, Kant’s view of categorical imperative would argue against the assisted suicide decision and instead favor the family’s wish. Notably, categorical imperative or the law of nature determines that one should “act only in accordance with that maxim through which they can at the same time will that it become a universal law” (Effectiviology 1). According to Barlas (1), euthanasia, based on pain, only treats humanity as a simple means to escape pain. Based on the categorical imperative, euthanasia only applies when an individual’s condition affects their rationality, notably, a condition like Alzheimer’s disease (Barlas 1). People with impaired rationality are not considered human based on Kantian moral standards; hence their death is justified. However, Mr. Watkin is in a different state where his need is not propelled by fears of losing rationality but rather the pain and loss of his independence. Therefore, the physician’s only alternative is to “do anything to save the patient.”
Interestingly, Barlas’s (1) determination that euthanasia, based on pain, only treats humanity as a simple means to escape pain also goes against the formula of humanity. The formula reads, “So act that you use humanity, whether in your own person or in the person of any other, always at the same time as an end, never merely as a means” (Pallikkathayil 1). Considering that humanity means the rational nature of people, Kant would only agree with a decision to end life when the person involved has lost their rational ability; apart from that, not even a patient in pain and without hope, such as Mr. Watkin can decide to die to escape their troubles. Instead, they would rather look at the greater end, in Mr. Watkins’ case, the possibility for recovery, even if it means banking on the 20 percent chance of recovery.
Nonetheless, Kant’s categorical imperative procedure could end with an opposing thought. This procedure is based on the Identification, definition, and application of the maxim. A maxim, according to Kant, is a subjective principle of action. Based on this procedure, the physician should identify her maxim (Garrett 1), for instance, “I may assist a patient in pain and desperation, with minimal chances of getting better end their lives.” Subsequently, the generalized version of this maxim would be “Any physician can assist such a patient end their life.” If physicians do not aid the patients in pain and desperation, with minimal chances of survival end their lives, the patients would only continue suffering. Also, if they fail to help, patient autonomy, a universally accepted principle, only becomes meaningless. Therefore, the physician must fulfill the patient’s wish since it can be universalized for greater happiness.
Conclusion
Ultimately, insightful consideration of utilitarian hedonism, the principle of utility, and Kant’s categorical imperative procedure concerning the relevant facts orchestrate the physician’s decision to disconnect Mr. Watkins from the mechanical respirator. These aspects prioritize the ultimate good or happiness and universally accepted principles to guide the decision. On the contrary, only Kant’s views of categorical imperative would favor the family’s wish, considering that Mr. Watkin’s condition has nothing to do with losing rationality. Therefore, the first alternative, fulfilling Mr. Watkin’s wish, is the best for the physician to solve the ethical dilemma.
Works Cited
Barlas, Baran. “Does Kantian Ethics Permit Euthanasia?” TheCollector, 2022, www.thecollector.com/does-kantian-ethics-permit-euthanasia/.
Garcia, Grant. “Considerations Regarding the Ethical Viability of Voluntary Active Euthanasia.” Sound Ideas, 2017, soundideas.pugetsound.edu/cgi/viewcontent.cgi?article=1016&context=sounddecisions#: ~:text.
Garrett, Jan. “Kant’s Duty Ethics.” 2006, people.wku.edu/jan.garrett/ethics/kant.htm.
Jordan, Madeline. “The ethical considerations of physician-assisted suicide.” Dialogue & Nexus 4.1 2017: 12.
Weijers, Dan. “Hedonism.” Internet Encyclopedia of Philosophy | An Encyclopedia of Philosophy Articles Written by Professional Philosophers, iep.utm.edu/hedonism/.
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