What is the right thing to do?
When we think about ethical dilemmas in medical ethics, we often end up with more questions than answers. We all have a strong preference for strictly black-or-white answers. However, most questions in life, including ethical dilemmas, always have more than one side of the story. The reality is complex and can be viewed from different perspectives. However, we are bound to make a decision. What should medical professionals do?
Euthanasia — what is the right thing to do?
When encountering ethical dilemmas, the first question I have in mind is what the medical professionals are expected to do. The first element to this answer is probably the legal framework set up by laws and precedents (e.g., elements of an informed consent), regulating things that we should and should not do. But not everything is clearly written into law. For the gray area without unambiguous laws and legal precedents, the Code of Professional Conduct for doctors in Hong Kong stipulates that “the profession is obliged to abide by a strict code of conduct which (1) embodies high ethical values, (2) protects patients’ interests, and (3) upholds professional integrity.” For the second element of this guideline in the Code, “protecting patients’ interests”, I take it to represent the respect for patient’s autonomy, their right to confidentiality, and doctor’s acting in best interests of patients. For the third element in this guideline, “upholding professional integrity,” I take it to represent honesty in our practice and when communicating with patients. But for the first element, “embodying high ethical values”, this warrants further discussion in the rest of the article. But for now, in summary, when there is no clear laws or legal precedents to guide our decisions, the only regulations we have are: protecting patients’ interests, upholding professional integrity, and embodying high ethical values.
We now proceed to the second question: what is the ethical thing to do? Ethics is the discipline concerned with what is morally good and bad and morally right and wrong. There are numerous schools of thought of ethics. The most common framework for ethical reasoning is ‘principlism’, which includes four guiding principles: respect for autonomy, beneficence, non-maleficence, and justice. But there are also additional frameworks, including but not limited to the utilitarian view, the deontological view, the ethics of caring, virtue ethics, and the doctrine of double effect. Considering the multiple ethical frameworks helps us understand the reality of the problem. Given the diverse interpretations of what the right thing to do is, disagreements among medical professionals and disagreements between medical professionals and patients/caregivers are unavoidable. Then, the question remains: what is the right thing to do?
“Doctors are equipped with medical knowledge, but it doesn’t make us the guardians of value judgements”.
Perhaps disagreements show up because different people afford different weighting to different factors. Regardless of the ethical perspective we lean towards supporting, our view is colored by our existing values, which is in turn shaped by our upbringing and our experience. Therefore, every person has a unique lens through which we see the world. However, when it comes to decisions to questions about life and death that are irreversible, we are especially inclined to uphold our view and might even question the validity of others’ perspectives. Since we know the mind of others, just like our own, is malleable, we may have a tendency to “correct” others’ opinion to align with our own. I am still a novice in the field of medical ethics but I think we all have the experience of talking to someone with a thoroughly considered idea, but the other person disagreed, forced their opinion on us, trying to change our mind. They usually don’t succeed. The incidence might even hurt our relationship. As medical professionals, perhaps we could help others to explore the rationale of their decision and to examine whether there are unrealistic expectations. Doctors are equipped with medical knowledge, but it doesn’t make us the guardians of value judgements. People stand on equal grounds, just as we are entitled to our opinion, others are too. We should agree to disagree and find ways to compromise if the disagreement is among the medical team, or fully respect the decision if the disagreement is between the medical team and the patients/caregivers.
Ethical questions — “what we should do when there are good reasons for following different courses of action — when no single decision is clearly right” ~ Dr Michael Dunn
In conclusion, when there is no clear laws or legal precedents to help inform our decisions, we are expected to: protect patients’ interests, uphold professional integrity, and embody high ethical values. Perhaps there really is not an absolutely “right” answer to the ethical dilemmas. Dr Michael Dunn, a scholar in medical ethics, defined ethical questions as “what we should do when there are good reasons for following different courses of action — when no single decision is clearly ‘right’”. Therefore, as “no single decision is clearly right”, different people arrive at different conclusions, even if we all considered the same principles. People afford different weightings to different factors, reaching different conclusions. As long as we have the foundation of respecting the law, protecting patients’ interests, and upholding professional integrity, perhaps what we should do in addition to them is to compromise and to balance different ethical perspectives.
Steven Chu (HKU MBBS1. 2019/20)