4 Considering ethics in death and dying
In the previous sections of this OpenLearn course, you have considered whether it is wrong or right to let someone die, and evaluated your own personal opinion about assisted dying. These are ethical questions because they evaluate to what extent an action, event, or opinion is appropriate, right, or good in a particular context. The issues of a ‘good death’ and assisted dying have ethical dimensions in that they are commenting on the appropriateness of a situation or event. Ethical issues around death and dying are often talked about in terms of decision-making and actions. In this section, you will be given an introduction in how to recognise and discuss ethical issues.
It is important to realise that ethics is not the same as the law or professional codes (i.e. ethical standards professionals are expected to work within), although ‘doing the right thing’ or ‘doing good’ is a common feature of all of these. Ethics is specifically about the moral reasoning applied to a situation. A useful way to begin to recognise ethical issues, is to look at examples where questions are raised about what should happen. One of the first steps in studying ethics is to understand your own ethical perspective, which this next activity enables you to do.
Activity 5 Considering ethical viewpoints
Consider the following statements in Table 3. State whether you agree or disagree and then write in the table why you chose this answer. If you are undecided, why are you undecided?
Table 3 Viewpoints
|Statement||Agree or disagree, and why?|
|Dying people should always be told the truth.|
|End-of-life care is a human right.|
|Health care professionals should determine when a person has died.|
|Everything possible should be done to keep people alive.|
|People who are bereaved should talk about their emotions.|
Choose two of the statements above. Write one argument supporting each statement and one argument disagreeing with each statement.
Here’s an example of what some students have written in response to their selection about the statement that end-of-life care is a human right:
One student who agreed wrote ‘Everyone has the right to care throughout their life, including at the end-of-life.’
Another student, who chose disagree wrote ‘end-of-life care focuses on particular cultural understandings of what health, death, and care are, which are not necessarily universally agreed upon by all people. Saying it should be a right privileges certain ways of dying over others, and this may not be appropriate for an individual or the society in which they live in.’
Another responder found it they often wrote ‘it depends’ but then struggled to say exactly what would make it clearer for them to answer. For example, they were not sure under what circumstances they thought a dying person should not be told the truth, but nevertheless did not agree with the statement that they should always be told. This shows us that there is more to ethical decision making than just saying ‘it depends on the situation’ – there are principles and frameworks people use to guide their decisions.
It is important to remember that ethics is inherently a ‘grey area’ – there is always an element of debate on what is right.
Peter Singer has written extensively about end-of-life ethics. He argues that ethics requires people to move beyond being self-interested and engage with a level of objectively, for example by using agreed ethical principles (Singer, 2011). In other words, he believes that ethical principles provide standards that guide actions that should be applicable to all similar situations. Whatever your perspective, you need to be able to justify your position by providing a logical, coherent, and consistent account.
In some ways, ethical decision-making in the context of death and dying is different from choices in other areas of health and social care, not least because time is limited. However, the context of ethical decision-making at the end-of-life has much in common with other care situations. For example, the question about whether someone should be told all information about their health condition is not only an issue that comes up at the end-of-life. Uncertainty is often a feature of health and social care situations, and it might not be clear why something has occurred or how long it will last. Not knowing what might happen in the near future can make decision difficult. Health and social care professionals are also obliged to follow their own professional ethical codes of conduct, and these might conflict with their personal views or the views of others. Furthermore, individuals and their family members might not agree about what constitutes the best course of action in a given circumstance. People may also change their minds as events unfold. It is not uncommon for families and professionals to disagree, for example, about how much a dying person should be told about their condition and likely remaining lifespan. These complications, which include competing ethical perspectives, uncertainty, and disagreement about the value of information or action, as well as the emotional pain that is often associated with death and dying, all complicate the task of making ethical decisions in this context. Consequently, what is considered ‘right’ can vary depending on the situation and is often debatable.
If this introduction to ethical decision making has sparked your interest, you may be interested in learning more through a video drama and accompanying quiz on the challenges of making ethical decisions on behalf of others. You will have the opportunity to watch a series of events unfold and be intermittently asked what decisions you would make in each situation. So what would you do? Access this interesting interactive quiz activity.
In this brief introduction to ethics, you should now be able to identify and recognise what constitutes an ethical dilemma in death and dying and how there might be different perspectives on what is right and wrong. In the next and final section, we will move on how people demonstrate grief both privately and publicly.