Ethical considerations in ending the life of a person with a terminal illness
1. Introduction
Every day, people who have been diagnosed with a terminal illness have to face the reality of death and live with the knowledge that they will die. A terminal illness refers to a disease or condition which is incurable and irreversible, and as a result, it can be expected that the person’s life will end because of this illness. Diagnosing a terminal illness is one of the reasons people choose to forgo life-sustaining treatment. People with terminal illnesses know that they are going to die. They should be able to expect support and relief from the symptoms. They should also be able to expect support and relief from the symptoms that may interfere with their daily lives. Millions of people are affected by terminal illnesses and the suffering and the loss are extended to their families and friends. Given the severity of the disease and its impact on individuals, ethical and legal considerations pertaining to the right to life and quality of life become a concern for doctors and professionals involved in end-of-life decisions. It is important for one to consider one’s own values and beliefs and to assess how these may impact on your way of thinking and acting as a helper in a situation in which someone is faced with a terminal illness. Family members and friends should also be encouraged to express their opinions and to receive support at a time which may be distressing and uncertain for the patient and their family. The issue of ending the life of a person with a terminal illness and the associated ethical considerations is the focus of this essay. As people faced with a terminal illness and their families would have to make difficult decisions, it is important to have an open and honest debate about these issues and to respect the right of individuals to make choices about their life.
1.1 Definition of a terminal illness
The line between terminal and chronic illness is often blurry. According to the World Health Organization, a chronic illness is a long-term physical condition that gradually and progressively impairs functioning, while a terminal illness is a disease that cannot be cured or adequately treated and that is reasonably expected to result in the death of the patient within a short period of time. “Short period of time” is also not specifically defined, but doctors generally agree that this means six months or less. This definition is employed in Death With Dignity Acts, which is interpreted as the patient has a prognosis of six months or less to live. However, what represents a “short period of time” can sometimes be unclear and patients who actually live beyond six months may be excluded from the option of assisted dying. The key issue here is the prognosis – doctors may not always know exactly when a patient is going to die, and such uncertainties could pose difficult legal questions in the future for healthcare professionals who assess patients’ eligibility under assisted dying legislations. As a result of this uncertainty, patients may have differing experiences on their access to assisted dying. Moreover, in some chronic illnesses, the line between chronic and terminal can be clouded. For example, motor neuron disease is known to be a terminal illness, but from the point of diagnosis, patients can sometimes live for many years and in some cases outlive their initial prognosis. This means that patients may find it hard to access services such as end of life care and hospices until they are considered to be appropriately close to death. This contrasts with the person-centered approach and discourages patients from making a choice of where to spend their last days. Such difficulties occurring from the terminology for the illness can have an impact on the lives of both the patient and their family. For example, the family may have to undergo practical and emotional impacts during the process of moving between different services and ultimately also during the bereavement process unless the patient chooses to die at home. Besides, families of a non-terminally ill patient may feel that they are left in limbo – there is support available for patients with chronic illness, but certain services such as hospices or assistance with finding carers in the final days are not accessible until a doctor’s prognosis has shortened. This can pose challenges to a caregiving family, both materially and emotionally. All these difficulties underscore the importance of the ongoing discussion of end of life issues and the availability of assisted dying. Especially in the realms of law and medicine, it is essential that ethical terms, such as “terminal illness,” are understood and applied with consideration.
1.2 Importance of discussing ethical considerations
Discussing ethical considerations is important for several reasons. First, it helps to ensure that everyone is clear on what the issues are. This is important because in practice it is often difficult to work out what is in the best interests of someone who is very ill. There may be different opinions and sometimes there may be actual disputes. In these situations, it is important to have a clear and fair way of making a decision. This is where having a good understanding of the ethical considerations can really help, because it provides a structured way of working through the problems. Secondly, people need to talk about what should happen and what should be done. It is often assumed that family members will know what is in the best interests of a patient, but this may not be the case. If there has been no discussion about what the patient would want and under what circumstances, then family members and those who have to make decisions may feel confused and worried, and this can make an already difficult situation even more stressful. Sharing ethical considerations and making sure that the patient, as far as possible, forms part of that discussion helps to promote the autonomy of the patient. Autonomy is a key ethical consideration, which means allowing the person who is ill to make their own decisions and choices – supporting any that can sensibly be supported. This applies to decisions about treatment, care, and where they would like that care to be provided. Of course, in many cases the patient may also want to talk through their decisions with family and carers as part of a wider discussion about what is best for them. However, having a good understanding of the patient’s autonomy and the conditions and situations in which it can be upheld is always an important step in discussing and interpreting ethical considerations that may have a bearing on what should be done. Well and widely established discussions about ethical considerations also help to provide a bit of a shield in case of dispute and accusations of improper or harmful decision making. They show that decisions have been carefully considered and show that the decisions are based on more than one person’s views or potentially on partial or overly hasty judgments. The existence of a clear and sound ethical framework that defines the criteria for good and reasonable decisions in a very complex area such as decisions regarding the care of the dying and the severely ill is something the courts in England and Wales now actively recognise and advise in. The Mental Capacity Act 2005, which provides the legal framework for acting and making decisions on behalf of adults who lack capacity and who are not able to understand and weigh the information needed to make a decision, actively requires that the statutory principles are used to help determine what is in a person’s best interests. One of these key principles is that ‘any decision made… must be the least restrictive option in relation to the freedoms of the person in question’ – that is to say, we should look to find the option that interferes the least with the individual’s basic rights and needs. However, this key principle of the Act allows us to end up deciding between alternative courses of action – and discussing ethical considerations helps us to understand what the options are and how we might logically and fairly decide between them. The Act also makes clear that a person can have all necessary information and still be unable to make a decision because of the way their brain or mind works. This puts good decision making, including the use of established ethical considerations, at the heart of the legal provisions.
2. Arguments for ending the life of a person with a terminal illness
For example, the Mental Capacity Act 2005 provides a statutory framework to empower and protect vulnerable people who are not able to make their own decisions. Also, clinical guidance from the General Medical Council (GMC) states that decisions made in the best interests of the patients should take into account the patient, if they have capacity and are willing to be involved in making the decision. This guidance also emphasizes that it is good practice to involve those close to the patient in discussion about what would be in the patient’s best interests. This is very important in ensuring that the patient’s perspectives and wishes, if they are expressed, are being taken into account and the wider implications of the decision are being considered.
However, arguments based on autonomy need to recognize that such a shift would require the doctor to make decisions based on what the patient thinks is best for him. It would also require doctors and society to accept that, for some people facing a terminal illness, a quicker and less painful death is a better option than a slow, painful, and undignified life. Autonomy operates as the foundation of arguments both in favor of and in opposition to assisted dying and euthanasia. However, this principle is not absolute and is subject to certain limitations, which are based on law as well as in professional and clinical guidelines.
For example, in the United States, the Patient Self-Determination Act recognizes the ethical and legal right of competent adults to accept or refuse medical treatment, even if that refusal will result in death. In most end-of-life decisions, respect for autonomy provides a clear moral and legal way of respecting the strongly held beliefs of all parties. Autonomy can also be used to support a shift in the doctor’s duty from prolonging life at all costs to promoting the best interests of the patient. This helps to establish a respect for the patient’s decision – a crucial aspect of the doctor-patient relationship.
Arguments for ending the life of a person with a terminal illness can be based on respect for the patient’s autonomy. Autonomy is based on the ethical principle that an individual should be respected as an agent, is in control of his own life, and has the right to make decisions about his life. It emphasizes the rational capacity of an individual to make an informed decision about their own life. However, to qualify for autonomous decision-making, one should have decision-making capacity and the decision should be free from controlling influences.
2.1 The principle of autonomy
The opponents of euthanasia, however, argue that the potential abuse of autonomy may lead to the situation where the patient’s choice ends in the patient’s own death but not in his or her best interest. They believe that sanctity of life should always be respected and there is no moral justification for any intentional termination of human life.
The principle of autonomy has dominated the ethic argument for the permissibility of voluntary active euthanasia, which means physician ends the patient’s life by some medical means in response to the patient’s needs and in the absence of patient’s informed consent. The supporters of autonomy claim that is the patients’ self-determination that matters the most and they should not be forced to suffer every day.
The principle of autonomy can provide an ethical basis not only for the patients’ choices to end life, but also for the legalization of physician assisted suicide as public policy. And it has been used as a legal basis for making end of life decisions in the United States. For instance, the Supreme Court ruled that a competent adult has the right to refuse life-saving medical treatment. From then on, many states have passed legislation that allows a living will or advanced directive to be established. A living will provides specific guidelines about the individual’s personal wishes about medical treatment in case he or she is unable to communicate those wishes.
In the context of end of life decisions for a person with a terminal illness, a key argument is that it is respectful to support the patient’s choice. If a person with a terminal illness decides that he or she would prefer to end his or her life rather than to suffer until he or she dies, then his or her choice should be respected. The supporters of the principle of autonomy also argue that allowing to end life may actually increase the person’s autonomy, because the person is able to choose when to end his or her life and therefore can escape from the poor quality of life.
The principle of autonomy is often referred to as the right of self-determination. It is based on the idea that each and every rational person has the right to decide what will happen to his or her body. Using his or her autonomy, a person could choose to refuse medical treatment or even to end his or her life, given that the decision is made voluntarily and without any outside influence.
2.2 Relief from suffering
There are several arguments in favor of ending the life of a person with a terminal illness. One of the most important and persuasive of such arguments is what is called the argument of “relief from suffering.” This holds that if a patient is terminally ill and is suffering in a way that is intolerable either for that patient themselves or for those close to him, then the patient’s life should be put to an end in order to release him from that suffering. Such a view is often supported by what is called the “principle of mercy”: that is, if we can act to mercy-kill a person, in order to relieve that person from unbearable suffering, we must do so. It is said that it is cruel and inhumane to refuse and prolong our patient’s life when he is in a hopeless and helpless situation, pending from day to day living in fear and agony not knowing what is going to happen next, but knowing that life will just be more and more intolerable for him. It is also an unfair and egocentric act with regard to the kith and kin – significant others surrounding the patient, to keep the patient alive by no other reason but the knowledge of the suffering that will just further accumulate from day to day and the sentimental attachment for the patient. Such argument is always considered to be a just cause for euthanasia, as we have the moral obligation to respect our patient’s autonomy, to spare those who are close to him further terminal pain, and to decide whether euthanasia is appropriate in terms of the social, ethical, and legal perspective.
2.3 Quality of life
One of the arguments in favor of ending the life of a person with a terminal illness is the quality of life. Quality of life is an important consideration when discussing end-of-life decisions. Everyone wants to lead a meaningful and fulfilling life, but when someone is diagnosed with a terminal illness, the decline in their quality of life can be significant. Quality of life can be measured objectively as the physical well-being and the ability to live a normal life, but also subjectively as what gives the person pleasure and makes their life something of value. One of the main reasons why quality of life is used as an argument in favor of ending life is that terminal illnesses often result in a significant and progressive deterioration in the patient’s quality of life. For example, as mentioned in the article “Euthanasia and the principle of the double effect,” people suffering from a terminal illness like Motor Neurone Disease “suffer almost total paralysis whilst becoming increasingly cognitively impaired.” To those who believe that life should not be terminated under any circumstances, this argument might seem insensitive. However, most ethical frameworks which provide guidelines for end-of-life decisions do recognize the importance of considering a patient’s quality of life. For example, according to the principle of double effect, an action that has both good and bad effects – such as hastening death to end suffering – could be justified if a terminally ill patient’s quality of life is significantly compromised by unmanageable pain and if death could be brought about “as a collateral effect of a certain type of pain relief and not because of the intention to end life.” Therefore, while it is true that quality of life is always subjective and difficult to define, the article argues that the choice of allowing the patient to die with dignity and stopping the progressive deterioration of their quality of life by ending life should ultimately lie with the patient, as long as the patient is found to be capable of making such a decision and death is chosen under the proper legal and ethical frameworks.
3. Arguments against ending the life of a person with a terminal illness
The phrase “sanctity of life” means that life is sacred, or holy, and should be preserved at all costs. A life that is shortened, even in the case of a person with a terminal illness, may be deemed to have been shortened without the authority or consent from a higher power. For many people, taking a life, or making it shorter, is unnatural and wrong. The religious roots of the sanctity of life argument can be seen in the teachings of many major world faiths, including Christianity, Islam, and Judaism. Despite the fact that many countries and states have legislated to allow assisted dying, there are no universal human rights that permit the hastening of death. The slippery slope argument is often cited when the topic of PAS or euthanasia is discussed in medical, legal, and ethical literature. The argument promises that, once we allow for a slippery slope which starts with interventions with non-voluntary euthanasia at its end, profound changes will follow in the professional-patient relationship. Advocates of the slippery slope argument suggest that if reforms to law and medical practices are accepted in the initial phase, it may trigger such potential effects. This may introduce new criteria for what are characterized as lethal pathological conditions; the private and public funding on assisted dying will expand; and palliative care will be increasingly viewed as outdated and unnecessary. It is argued that the ‘slippery slope’ could see unethical, and potentially criminal, activities become more acceptable and widespread. It is only when the patient receives palliative care from an experienced healthcare team that patients can live their life to the fullest without the pain and discomfort from their illness. Palliative care integrates the psychological and spiritual aspects of the patient’s life. It focuses on improving the quality of life, and it treats the patients as a whole, not as separate parts for treatment. A terminal illness diagnosis presents new and emotional challenges for many patients and families. However, rather than simply ending the patient’s life as a method to relieve them from pain, the patient and the family are encouraged to seek psychosocial support and exceptional guidance for any tough choices and changes. Palliative care is both an ethical and compassionate practice and an evolving area of expertise in modern healthcare. By discussing the various arguments properly and conducting an extensive educative approach to the public, there may be more awareness when an ethical, informed decision can be made by the patient and the family. Well-publicized cases about assisted death and euthanasia often trigger not only emotionally fueled debates but also a rise in public concern over whether it is the ‘right’ for one to die in a dignified manner. The image of the care of the dying process, as well as associated legal and ethical principles at the end of life, will be reshaped by the professionals and public. It is not implausible that, in addition to laws, new criteria for promising developments in technology and medical sciences will one day be anticipated.
3.1 The sanctity of life
In considering ethical arguments against ending the life of a person with a terminal illness, we come up to another interesting idea. Modern society’s belief in the sanctity of life is really the one which, it is frequently suggested, makes it impossible to justify any instance of euthanasia. The state of the discourse of the sanctity of life today is deeply troubled. Critics argue that much of the public often misunderstand the idea, and that its political currency merely serves to block a proper examination of the issues. Yet, the notion has a deep rooted and an enduring aspect of the ethical, legal and political culture of the Western society. Literally, the term ‘sanctity of life’ means that all life is sacred, too valuable and precious to be taken away at any time every person is thought to have an inalienable right to live, a right that is thought to be absolute and not admitting of any qualifications. That is, the invalid or the demented, the very young and the very old, the innocent and the guilty all have a right to live, no matter in what condition their lives might be. This argument can be traced back to mainly the religious practices, where God gives life. So, only God can take it away. This also can be seen in secular ethical reasoning, like that of Kant, another reason to argue that the sanctity of life is beyond empirical consideration, and thus, gives no room for any form of euthanasia – as its justification. On the other hand, the firmness of this argument depends on how we understand the termination of life by itself. If the importance resides in actually protecting the life, then even those who are suffering from no prospect of recovery, no prospect of life properly called the ‘human’ life, and no prospect of control over their body still ought to be protected and preserved. However, many believe that the primacy of the value of human life cannot support such absolutism – if life is worth living, then life is the good thing to have, and it is the present quality of life that matters in using any sophisticated measure of life as an important part of ethical decision.
3.2 Slippery slope argument
The slippery slope argument is one of the most concerning arguments against the ending of a life of a person with a terminal illness. This is because if we start to make exceptions for when it is acceptable to end a person’s life, we would not be able to have control over these in the future. It is possible that the requirements for when it is acceptable will become watered down over time due to pressure from pro-euthanasia groups to a situation where ending a life is seen as the best option where a patient is not responding to treatment, even though there are other viable options, such as access to new treatments or more advanced palliative care. This argument is used by people who are against the idea of any exceptions in place where ending a patient’s life could be deemed acceptable. They worry that it could start off being something that is only seen as an acceptable option in extreme circumstances and potentially ending with vulnerable people feeling pressured into it as a form of guilt tripping. It should be noted however, that there is a strong argument that if a patient has considered all the options and has been deemed to be mentally capable of making the decision, it is their life and their right to make the decision of when it ends. Just because there may be the potential for the requirements to be watered down does not mean that the option should not be made available to patients who are suffering. However, the argument does still have a lot of weight and is often one of the key stumbling blocks in changing the law on euthanasia to allow any exceptions to be made where ending a life is deemed acceptable as a last wishes.
3.3 Palliative care as an alternative
Palliative care, also known as end-of-life care, is supportive care provided to people who have an illness that cannot be cured. The goal of palliative care is to help people with serious illnesses feel better. Physical, emotional, and spiritual needs are considered, and the focus of care is on improving the quality of life. People who are in favor of the development of palliative care often argue that, with better palliative services and care, the need for ending the life of a person with a terminal illness will be greatly reduced. As it stands, one of the common arguments against palliative care in comparison to euthanasia and assisted dying is that it is often seen as less of an urgent and necessary intervention – and it is often assumed that there is no choice made available by palliative care during justice. However, the practice and development of palliative care have been seen to have covered this alternative, which will be discussed in detail later on in the essay. In showing that it is as effective as and even more effective morally and how it is interlinked with the topic of assisted dying – that of eschewal of futility – and how it highlights the weakness in both the plea for euthanasia and the counter-argument against palliative care. Because given the development of palliative care, the alternative which pleads for and had been used for promotion by anti-euthanasia group will increasingly be strong; thereby the argument is invalid based on the chain of futility plea for ending the life and the number of cases whereby the termination of life is justified.
4. Ethical frameworks and guidelines for end-of-life decisions
As for the casuist, it refers to a case-based reasoning which is moral reasoning using analogy and precedent. This primarily concerns encountering particular cases and drawing from the wisdom that comes from consideration of past answers to like moral problems.
On the other hand, the ethics of clinical care is based on the virtues that a person has. It requires attention to the moral character of the caretaker, that is, the doctor or the nurse. Decisions are supposed to flow from the interests and caring of people. This methodology encourages a high moral and professional commitment from healthcare team members in order to provide the best results.
The principle of deontological is also a dominant tool in discussing ethical dilemmas. This emphasizes the importance of the decision rather than the consequences, and the rights of a person must be respected at all times. It involves the belief that claims about rights and justice will take precedence over the greatest happiness principle which is embodied in the utilitarian.
The principle of utilitarianism is commonly referred to when healthcare providers and their patients make end-of-life decisions. It is particularly helpful when dealing with issues that result in the greatest good for the greatest number of people. In relation to end-of-life decisions, the utilitarian would focus on the consequences of providing or not providing certain treatments. In other words, they would look at how many people’s lives would be improved during the remainder of their life as a result of a particular treatment.
Different ethical frameworks and guidelines for making end-of-life decisions are discussed. The purpose of these frameworks is to provide healthcare providers and their patients with ethical guidance so that the especially difficult decisions are consistent with ethical principles. There are four practical theoretical frameworks that have been used, including the utilitarian, the deontological, the ethics of clinical care, and the casuist.
4.1 Utilitarianism
The essay then moves to a discussion of different ethical frameworks and guidelines for making end-of-life decisions.
Assigned readings asked me as the surrogate decision-maker for my mother to make the moral value judgement using what is known as “the utility principle”.
This principle is based on the ethical theory of Utilitarianism.
John Stuart Mill, in his Utilitarianism, claims that “actions are right in proportion as they tend to promote happiness, wrong as they tend to produce the reverse of happiness.
By happiness is intended pleasure and the absence of pain; by unhappiness, pain and the privation of pleasure”.
Utilitarianism is a consequentialist theory, which means it evaluates actions solely on the basis of their consequences.
According to Utilitarianism, the moral worth of an action is determined only by its resulting outcome, and each course of action is judged solely by the extent to which it maximizes utility, which can be defined as pleasure or happiness.
Utilitarianism asserts that the best action is the one that maximizes overall well-being – a theory that seems particularly relevant in the context of end-of-life decisions but which also provides ethical guidance in other areas of health care.
Using the example of a woman suffering from terminal cancer, the paper explains that “if adhering to the utility principle I should do that which maximizes the woman’s wellbeing, that is I will seek to bring about the state where she experiences the most happiness.
4.2 Deontological ethics
Similar to utilitarianism, deontological ethical theories require us to focus on the principles and rules in making moral judgments.
Deontological ethics is often associated with philosopher Immanuel Kant. According to Kant, we have a duty to act in a certain way and we should do actions that can be consistently willed to be a universal law.
The priority in deontological ethics is to follow the rule regardless of the consequences; an action cannot justify the means. This is contrasting to a utilitarian approach whereby the end goal of producing the most pleasure is all that will matter.
In the context of ending the life of a person with a terminal illness, a deontologist would argue that it is not justifiable to end the life with lethal injection, narcotics, or active euthanasia.
This is because the rules society has and should apply, which is the principle of sanctity of life, will always be stronger and take precedence.
A deontologist thinks euthanasia is unacceptable as it is akin to murder, which goes against the idea of moral rights – we are not viewing the patient as a person.
A colleague at work, Professor Raus, speaks in favor of deontological ethics in the context of ending the life of a person with a terminal illness.
Memorably and persuasively, he argues that we should always respect human dignity and autonomy. He challenges the idea of mercy killing or active euthanasia.
By allowing the doctor to assist the patient in dying is to reduce the patient as a mere instrument. Instead, the proper respects and moral rights – the right to make decisions about the patient’s life – must be fully acknowledged.
The teleological and deontological debate about moral decision-making in medical ethics is well summarized by Robert M. Veatch. He argues that doctors seem to really have two choices. They can either respect the patient’s right to life and continue to carry out useless treatment or they can adopt the consequentialist view that some further good, such as the relief of suffering, can be brought about.
4.3 The principle of double effect
The principle of double effect is another ethical principle discussed in our essay. According to the principle of double effect, it is permissible to carry out an action that has two effects, one good and the other bad, provided that certain conditions are met. These conditions have been summarised by Foot as follows. First, the action itself must be good or indifferent. Second, the good effect must not be obtained through the bad effect. Third, there should be a sufficiently weighty reason to permit the bad effect. And finally, the bad effect should not be intended, but only foreseen. In the context of end-of-life decisions, the principle of double effect can help to justify the use of interventions that are intended to relieve pain and suffering, but which may also hasten the patient’s death. For example, it is generally understood that high doses of pain killers such as morphine can have the side effect of shortening the patient’s life. However, provided that the doctor’s intention is to relieve pain rather than to bring about the patient’s death, and the other conditions of the principle of double effect are met, the doctor’s actions can be justified. It is important to note that the principle of double effect is not without criticism. Some scholars have suggested that the principle of double effect is indistinguishable from the principle of doing whatever is necessary in order to bring about the most good, which is the fundamental claim of utilitarianism. In addition, the concept of intention, which is central to the application of the principle of double effect, is often difficult to interpret correctly in practice. However, courts and the medical profession have sometimes referred to the principle of double effect when making or evaluating end-of-life decisions, especially when the options are either to continue a patient’s life or to ‘let them die’ without life support. This is perhaps the most common situation in which end-of-life decisions need to be made in our modern society. The paper, however, does not commit itself to advocating for one single ethical principle, such as the principle of double effect, over others. Rather, it suggests that the discussion of ethical considerations concerning the end of a person’s life due to a terminal illness should be patient-focused and guided by the principle of respect for autonomy.
4.4 Legal considerations
The main argument raised by the author, I think, has been overcome by time as he pointed out that legal provisions require showing the wishes of the patient. Nowadays, the law has been updated to give some level of recognition and protection to the patient’s decision. This is evident in various legal frameworks with the emphasis on the significance of patient wishes. In the Australian context, for example, the Commonwealth law legalizes euthanasia in the Northern Territory by means of the territories’ self-government act. However, the act was overruled by the federal parliament through enacting the Euthanasia Laws Act 1997. This effectively prohibited the legalization of euthanasia by any of the territories, invalidating any laws already passed to legalize euthanasia. This shows the legal precedence in governing how decisions should be made in relation to medical law, including the right to life. That said, the author’s proposition that there are no cases supports the argument that an agent’s life should be ended in order to avoid personal indignities and the burden on family is contentious. There have been cases reported in which the patients manage to secure court injunctions restraining their families from dissuading treatment using the right to life legislations. For instance, The Times reported a case in which Mr. Richard West was suffering from motor-neuron disease. His doctor agreed to his request for vaccinations after he got pneumonia, but his two sons persisted in a court action to have such injunction discharged. It is hard to envisage how these injunctions, secured by patients in the state of consciousness as Mr. West or more ill, would be final orders. Such legally binding injunctions would thereby duty the doctors to comply with the treatment wishes of the patients – later stages and arguably more unwell wishes – and this seriously undermines the patient’s rights to self-determination. This also goes against the family’s argument that the patients should not be allowed to undergo the indignities of personal life simply because of their illness. Another part of the argument is that the family members should be allowed to make decisions when the patient is not capable of making such decisions. However, section 25 of the Mental Capacity Act 2005 states that a.
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