Autonomy can be defined as self-rule and it is a persons or patients basic right. This principle means that an adult who is an informed and competent patient has the right to accept or refuse any treatments, drugs or surgical procedures. These decisions must be taken in to consideration even if these choices are not in the best interest of the patient. It is a healthcare professional’s duty and responsibility to respect patient’s autonomy. Although sometimes this can be difficult as it may conflict with paternalistic attitudes of other healthcare professionals. A person’s autonomy could be overridden in cases such as, if an individual’s decision puts public health in danger or could potentially harm others, that person’s autonomy may be restricted.

Autonomy is often used in the ethical debate of euthanasia. Though it is a patient’s freedom to make decisions on their own treatment, the concept of autonomy is misunderstood in the case of ending an individual’s life. In this case, although a patient is capable of giving valid consent, a doctor does not have the authority to treat a patient unless he has signed a written consent.

2. In order to produce a non-maleficence conclusion without reducing the benefits for others the social worker could approach Bernie with the idea of informally admitting himself to hospital. If Bernie was to become unhappy at any time during his stay he would be able to discharge himself without the pressure of feeling isolated, but he would still be offered the help he needs.

This would take some of the pressure off his parent’s, his mother would then feel less threatened knowing that Bernie is being cared for properly and receiving the help he needs to address his problems. (Psychotic episode, grief counselling, family counselling). His mother and father could then start to concentrate on their own problems and try to correct their relationship.

If the whole family where to address their individual problems, it could be suggested this would then in turn create a better family life with effective communication.

3. For the justification for Bernie to be sectioned under the Mental Health Act would depend on Bernie’s state of mind. Bernie is unwilling to be voluntarily admitted to hospital, so if he was to be sectioned this would enable him to be treated with the correct medication such as anti-psychotic medication which would help treat psychosis. Although if Bernie is not actually psychotic and just grieving for his grandmother then being sectioned would not be justified as his problems could be treated with counselling in the community to help resolve his family issues.

If Bernie was to be sectioned this could change how people look at Bernie in the future for example job applications and generally within the community.

Bernie has often used threatening behaviour towards his parent’s, if this was to escalate the sectioning of Bernie could be the only option and then would be justified to protect his family and himself from violence.

Abortion

The ethical debate regarding abortion asks whether it is morally right to deliberately terminate a pregnancy before childbirth.

In the early part of the 20th century laws were brought in to reduce access to legal abortion. Many women resorted to seeking out backstreet abortionists, which either permanently damaged their health or even ended their life due to unwanted pregnancies.

In 1967 the Abortion Act became law, since then the act has been unsuccessfully challenged many times by pro-life groups who still try to limit the access to abortions.

Looking at abortion from a moral view there are many dimensions which are linked to abortion. This debate is very complex and every question leads to sub-questions and sub-parts.

There are pro-life enthusiasts who are against abortion and pro-choice groups who are partially or completely in favour of termination of pregnancy. Pro-life groups/people argue that that it is ethically/morally wrong to kill a foetus which has potential to live; they believe that every foetus is alive and has the capacity to develop into a human being like us. So killing a foetus is the same as killing a human being which is wrong.

Pro-choice groups regard abortion as acceptable in some circumstances such as there being a serious medical problem which could endanger the foetus or mother’s life, the foetus will suffer from mental or physical abnormalities or where the pregnancy was unintentional for example rape of failure of contraception.

Two philosophical theories that could be applied to this debate could be natural law and virtue ethics.

Natural law main focus is on actions, it asks if an action is good or bad and in accordance with nature.

One of the primary precepts is ‘protect and preserve the innocent’. From this we get a secondary precept ‘do not abort’. This is an absolute moral rule that you should not kill an innocent person. This is how the Catholic Church views abortion and therefore condemns abortion in all instances.

The Church of England tries to encourage the issues surrounding abortion, the church recognises that all individuals have different views regarding this sensitive matter.

The 1983 resolution of Synod stated:

‘That in situations where the continuance of a pregnancy threatens

the life of the mother a termination of pregnancy may be justified

and that there must be adequate and safe provision in our society

for such situations’

Church of England General Synod, 1983

There are a few Catholics that disagree with the Vatican regarding abortion. They argue against the total ban on abortion with arguments such as:

Theologians such as Aquinas and Augustine who believed that a foetus does not become a person until between 40 and 80 days after conception has occurred.

Every Catholic has the right and responsibility to follow their own conscience on moral matters.

Though pro-choice Catholics don’t see abortion as being morally good they to argue that there could be situations where it is the least bad moral choice that is available at the time.

Virtue ethics are concerned with what kind of people we should be. It helps to develop characteristics which help to make moral decisions easier, for example whether to consider and abortion or not. These ethics don’t say that abortion is right or wrong but that it is up to the individual’s personal character. A decision that a woman makes about an abortion must contribute towards her happiness.

A person, who is virtuous and has disciplined themselves in the virtues of temperance, would be in a better state of mind and condition to decide on the important matter of having an abortion.

In some countries such as India, aborting foetuses which are to be born girls are becoming a major problem. Some cultures prefer to have baby boys, so request are termination purely on the basis that the child is female.

Pro-choice activist and author Janet Hadley, sex selection abortions in India are extremely common:

“All over India, there are clinics performing amniocentesis and ultrasound scans, even in districts too poor to afford supplies of clean drinking water. Every day, an estimated 3000 female foetuses are aborted. And there are doctors making a mint.”

Janet Hadley “Abortion: between Freedom and Necessity” (Great Britain: Virago Press 1996) 88

Female foeticide is more common than male foeticide, countries, in particular India and China, are more likely to have serious consequences on the balance of the genders in the population. The reasons behind these are mostly cultural, rather than religious.

When it comes to this very sensitive debate, I feel I can honestly say that I am neither, for or against abortion. I do feel it is every woman’s right to decide. Until I am placed in a position where I am undecided on whether to continue with a pregnancy or not, I find it very difficult to have an opinion.

Working in an operating theatre, it is part of my role to be part of a surgical team which carries out termination of pregnancies. I think doing this job has influenced me to have an impartial view on this matter. I have seen patients use this procedure as a form of contraception, but have also had to be with patients who have made the decision to terminate their pregnancy due to foetal abnormalities and miscarriage.

Every woman’s circumstances are different and should be taken into consideration, and in a lot of these cases we have to consider the fathers feelings which a lot of people tend to forget.

Euthanasia

Euthanasia is the act of deliberately ending a person’s life in order to end their suffering. According to English law both euthanasia and assisted suicide are illegal.

This process is sometimes called ‘mercy killing’. Euthanasia can fall into categories such as: voluntary euthanasia – where a person makes the decision to die and asks for help enable to do this. Non-voluntary euthanasia is when a person is unable to make the decision or give consent to die, for reasons such as being in a coma or being brain damaged, another person will make the decision on their behalf. This could be because the patient expressed their wishes for their life to be ended in these circumstances. Involuntary euthanasia is where someone is killed regardless of their wishes.

There has always been lots of controversy surrounding the debate on euthanasia and whether this act should be legal or not. In most countries euthanasia is seen as a criminal homicide or murder. Although in countries such as Belgium, Netherlands and Luxemburg these practices are still considered legal. Killing is inexcusable yet is seen as excusable when used as a criminal punishment?

Arguments regarding this debate can often depend on which method is used to carry out the end of life for the patient.

There are many arguments on this debate, many of which fall into different categories such as ethical, practical and religious arguments and many more. Some ethical arguments for anti-euthanasia may include:

Euthanasia weakening the respect in society and the sanctity of life, and all human beings are valued regardless of age, religion, sex etc.

Voluntary euthanasia could be the start of a ‘slippery slope’ which may lead to involuntary euthanasia; where a person who wants to live is killed regardless of their wishes.

Euthanasia can affect other peoples hum rights, not just those of the patients, for example, family, relatives and even medical staff.

Practical arguments for anti-euthanasia in this debate could be:

If palliative care was to be carried out properly euthanasia would not needed to be necessary, it could help prevent a patient feeling this is the only option.

Doctors should not be allowed to decide when a patient should die; legalisation of this would put doctors in a position of power which would be unacceptable.

Religious people feel that euthanasia is against the will of god. Although god has given us all free will, they argue that it would be wrong for us to kill ourselves or ask another to do it for them.

The ‘slippery slope’ argument explains the fears of voluntary euthanasia becoming legal and where it may lead, such as involuntary euthanasia. If the law changes and voluntary euthanasia becomes legal, how would we be able to keep it under control? Without official regulations and control mechanisms proponents of euthanasia feel it would never be legalised

Where would this ‘slippery slope’ lead to? Could doctors start killing patients without their permission? Would doctors kill patients to save money and create more free beds?

“We conclude that is was virtually impossible to ensure that all acts of euthanasia were

truly voluntary and that any liberations of the law in the United Kingdom could not be abused.”

“We were also concerned that vulnerable people – the elderly, lonely, sick or distressed

would feel pressure, whether real or imagined, to request early death”.

Lord Walton, Chairman, House of Lords Select Committee on Medical Ethics looking into euthanasia, 1993.

Why do people want euthanasia?

Most people think that the main reason that people choose to seek euthanasia is because of them being in severe and unbearable pain. There are many psychological factors such as depression, feeling like a burden, the loss of their dignity and not wanting to be dependent which cause people to think of euthanasia.

People consider what quality of life they are going to have, for example; a terminally ill patient can be damaged by physical conditions e.g. incontinence, vomiting, paralysis and difficulty breathing.

Some people’s arguments may include:

People have the right to die when and how they would like; being independent gives them the right to carry out decisions about themselves.

A libertarian argument believes that if an action is in the best interest of everybody, then it does not violate anybody’s rights, so is morally acceptable.

Euthanasia happens, so is it not better to legalise it and make it regulated properly.

People are allowed to die with dignity and in their own way.

Relatives are spared from watching their loved ones suffer and die painfully.

Utilitarianism believes that moral rules should produce the greatest happiness of the greatest people. Looking at it from utilitarian point of view, people who are allowed to die a good death when they choose will allow them to be happier in their final days.

Utilitarianism looks at total human happiness and not just that of the patient involved. People who agree with this principle would see the negative effect it would have on those around the patient such as the family, friends and the healthcare professionals, these negative effects would outweigh those of the patient.

Kant’s ethical theory has a different perspective to utilitarianism. Kant’s theory on mortality derived from the Greek ‘deontology’, which means obligation. He didn’t agree with the making of moral choices out of compassion or kindness. He believed in what was the right thing to do, and choosing to fight the dying process is more important than just simply ending it all because of suffering and pain.

Kant felt that the intentions of and act was more important than the actual act itself.

I think that euthanasia is one of the most complicated debates to date. It’s very hard to say whether you are either for or against euthanasia until you are put in a position where you could choose to live or die.

The only way I could possibly have an opinion on this matter would be to imagine if it was a member of my family wanting to die. If I thought that they were going to have no quality of life and there was no hope of recovering then maybe I would consider euthanasia if it was what they wanted, the only way I would do this would be with their consent.

I do strongly feel it does depend on each situation and the mental state of the patient, as voluntary euthanasia could be made and easy option if someone was to have suicidal tendencies.