The Right to Die Cruzan by Cruzan Essay

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Nursing and Ethical Choices

What are the utilitarian and Kantian justifications for Advance Directives?

The health care proxy and the living will are two ways in which a patient can express advance directives relating to health care and/or end of life treatment should that person become incapacitated. The utilitarian justification for advance directives is that the end justifies the means, or in other words the greatest good for the greatest number of people. If an advanced directive is given, it covers all the people involved and lets the patient's wishes be known ahead of time in case there comes a moment when the patient can speak for him or herself. The doctors and care givers will be obliged to accept this as the greatest good, because it relieves them of any duty to give care (if the directive has in place that it should be refused) and vice-versa. The Kantian justification for advanced directives is that it respects the autonomous position, that is, the individual right to refuse treatment (should that be the case). The individual makes it known ahead of time in the living will, for example, and this is respected as Kantian philosophy upholds autonomy as a basic right.

2. Why do clinicians still struggle to practice full disclosure of medical error? Explain briefly the key elements of disclosure.

Disclosure involves stating everything that went wrong with a medical error to the patient, even if the patient does not understand.

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Indeed, this can often be problematic because it can be simpler just to correct the error and lie to the patient without the patient becoming any the wiser. From a utilitarian perspective this behavior would be justified, but not from a Kantian perspective. For the sake of integrity and ethical treatment, it is in the interest of the doctor to disclose fully any medical error, even if it is easily remedied, no harm will result and it requires length explanation to the patient. This will help avoid future litigation which can be much more costly in terms of time and moneyu (Gallagher, n.d.)

Thus, as Philipsen and Soeken (2011) note, it is the clincian's duty and ethical responsibility to inform the patient of any medical error in treatment, even if the error is "insignificant." The patient still has a right to know, as do all individuals who are impacted by the error (staff as well). This allows the medical community to remain transparent, which is a foundation of trust in the staff-patient relationship. Thus, the ethical implications of disclosure and non-disclosure are clear: to not disclose a medical error is to act unethically and without the transparency and loyalty that is owed the patient as well as the members of the staff. The legal implications of disclosure vs. non-disclosure are also clear. The severity of the error is what is most….....

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