China
Africa
Explore chapters and articles related to this topic
Committees, courts and compromise at the limits of life
Published in Richard Huxtable, Law, Ethics and Compromise at the Limits of Life, 2012
Of course, not every purported ‘compromise between the various interests at stake’ to which Moratti refers will be all that it appears.111 The so-called ‘slow code’, which Lantos and Meadow believe should be ‘resuscitated’, may be a case in point.112 These authors argue that, where CPR is likely to be ineffective but a patient’s family cannot bring themselves to consent or even assent to a DNAR order against attempting resuscitation, then doctors should have ‘a carefully ambiguous discussion about end-of-life options’ and provide ‘resuscitation efforts that are less vigorous or prolonged than usual’.113 This initially looks like a compromise. However, on reflection, we should doubt whether it is sufficiently principled. The authors claim to denounce deception but this seems to be intrinsic to their proposal, which is thus contrary to the reliability – and arguably even the respectful and reflective behaviour – required by principled compromise.
Lies, Damned Lies, and Bioethicists
Published in The American Journal of Bioethics, 2021
John J. Paris, Brian M. Cummings
Meyers importantly notes that “Deception…undercuts the ‘trust’ at the core of professional-client relationships.” His essay cites Crigger and Wynia’s position that “[Honesty] remains the best policy” (Crigger and Wynia 2012). Meyers concludes “The best policy without doubt, but not an absolute one.” “Deception,” he maintains, “is sometimes the better ethical choice from within a set of bad options.” Meyers uses the ‘slow code’ material from an article of Lantos and Meadow in which those authors wrote, “The reviled ‘slow code’ may be appropriate and ethically defensible in certain clinical situations” (Lantos and Meadow 2011). Meyers recognized, “Professional life entails ongoing negotiations among ethical values and best practices.” That led to the more challenging question of, “How these negotiations extend to the clinical ethicist”? Meyers states, “Lying is ‘admittedly discomforting’ not because it is prima facie wrong, but because the ‘typical ethicist’ stands as an ‘institutional role model’ who is expected to present herself as an honest and trustworthy colleague.” Meyers underlying premise is “Deception is pervasive in clinical practice in which ethicists are immersed.” Our experience confirms that premise.
When First We Practice to Deceive
Published in The American Journal of Bioethics, 2021
Erica K. Salter, Jason T. Eberl
Second, Meyers’s analysis relies heavily on an assessment of harm: deception is only justified in the present case because the alternative constitutes (an undefined level of) unacceptable patient harm. Harm, however, is a value-laden concept. What constitutes unacceptable harm to one individual may constitute tolerable harm to another. Further, and perhaps more importantly, the task of identifying and weighing relevant harms and benefits will also vary person to person, based on their values. The clinicians in the “slow code” case attend primarily to the physical harms and benefits of the patient: resuscitation is unlikely to achieve the benefit of continued meaningful life and is likely to cause pain and distress to the patient. However, the daughter may regard the small possibility of additional days of life in an ICU as a weighty benefit for her mother, one that is perhaps more valuable than the temporary burdens of pain associated with compressions. Further, the daughter may justifiably include harms and benefits to herself, if she believes they are considerations her mother would be similarly concerned with. For example, perhaps attempted resuscitation provides the daughter the benefit of feeling as though she “fought for her mother” or “is a good daughter.” A judgment by the clinical team that these harms and benefits, as assessed by the daughter on behalf of her mother, are the wrong harms and benefits to consider results in an inappropriate substitution of values, which, in Meyers’s case, results in the further harm of deception of an authorized decision-maker. Harm prevention is a helpful concept in justifying deception only when the potential harm is so demonstrably bad that the vast majority of individuals in a similar position would agree (e.g., unnecessary death or permanent disability).