Life and Death in Healthcare Ethics

A short introduction

Helen Watt

Introduction 1

Healthcare ethics is in the news, and seems likely to remain so. Hardly a week goes by without a new case coming up for discussion by the media. Frozen embryos, euthanasia of brain-damaged patients, the use of foetal tissue in research - a seemingly endless series of cases are reported in response to a growing public interest. Cloning, for example, is an issue in this area which - not surprisingly - has received enormous attention from the media and society at large.

Yet with all this interest in new cases, the moral issues raised will often remain obscure. Many people, including health professionals, will find themselves more or less perplexed when confronted with the latest problem case. Even if they feel strongly that a certain position is the right one to take with regard to the case in question, they may be unsure why they feel this way, or how their position might be rationally defended.

Role of emotion

The term 'yuk factor' has been used to describe a reaction of repugnance to some particular proposal. For example, many people reacted with horror to the proposal that eggs from female aborted foetuses be used in in vitro fertilization. Again, many people react with unease or distaste to the notion of keeping someone alive indefinitely in a 'persistent vegetative state'.

Such instinctive reactions are often criticized as 'emotive'. The role of emotion in our moral judgements is not, however, a simple matter. Moral judgements cannot be reduced to emotional reactions devoid of any content: by saying 'this is wrong', I do not simply mean to describe, or express, my emotions at this time. However, it is certainly true that our moral judgements are often accompanied by, and influenced by, emotional reactions of some kind. Spontaneous reactions and judgements may initiate a reasoned exploration of the problem, which will sometimes confirm the appropriateness of our original response. Alternatively, such an exploration may fail to confirm the appropriateness of the reaction first evoked.

How, then, should we regard our own spontaneous reactions to moral problems? If such problems do, in fact, have objective solutions,2 however hard these are to find, it may be the case that our spontaneous reactions point the way to these solutions. On the other hand, our reactions may mislead us - because, for example, they are biased by our wish to defend what we ourselves want to do, or have done in the past, in response to similar problems.

In many cases, if not in all cases, spontaneous reactions should neither be discounted nor simply accepted without investigation as morally appropriate. Rather, they should spur us on to find their rational basis, if any, in some aspect of the case at hand. If we are unable to find such a basis, this does not mean that there is none to be found. However, it does mean that we are less likely to be able to convince those whose judgements and reactions are different from our own.

Purpose of this book

What can be offered in the way of reasons for taking a particular position with regard to moral problems3 in healthcare? In this book, I will set forward, and defend against objections, the approach I myself find most helpful to a series of such problems. The approach I will defend links morality to human fulfilment: to the enjoyment of 'basic human goods' such as life, knowledge and friendship. It gives a central place to human intentions in evaluating means for promoting human well-being. It lays stress on the impact of choices on the agent him or herself: on the kind of people we make ourselves to be by choosing as we do. There is, I will argue, more to morality than the achievement of good results - to say nothing of 'the best' of all the results we could achieve. While the expected results of our actions are often decisive in judging them right or wrong, we should not attempt to judge our actions simply on the basis of the outcome they produce.

This book is intended as a brief introduction to the ethics of healthcare, in relation to life and death issues in particular. It has been written with both the general reader and students and professionals in medicine, nursing, law, philosophy and related areas in mind. The approach is one of 'natural' philosophy: there are no religious premises in the arguments put forward or discussed. In a book of this size, it is impossible to do more than sketch out arguments which could be expounded at far greater length. Moreover, I have chosen to focus on life-and-death issues - abortion, euthanasia, 'letting die' and so on - rather than on more mundane but also important concerns such as confidentiality and informed consent. Other concerns mentioned only in passing are those involving human reproduction: that is, the generation of human lives, as opposed to the treatment of existing human lives. Such concerns will perhaps be addressed in more detail in a future publication. In any case, my hope is that readers with an interest in healthcare ethics will be encouraged by this book to explore in depth those aspects of the subject which they find most interesting.

1 Reprinted by kind permission of Routledge back to text

2 For an introduction to arguments for and against the objectivity of ethics, see Benn 1998: 1-58. back to text

3 In this book, the terms 'moral' and 'ethical' will be used interchangeably. back to text

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