Medical Ethics or Murder, by David Barrows

Medical ethics 

Medical ethics is an applied branch of ethics which analyzes the practice of clinical medicine and related scientific research. Medical ethics is based on a set of values that professionals can refer to in the case of any confusion or conflict. These values include the respect for autonomy, non-maleficence, beneficence, and justice. These four values are not ranked in order of importance or relevance and that they all encompass values pertaining to medical ethics. However, a conflict may arise leading to the need for hierarchy in an ethical system, such that some moral elements overrule others with the purpose of applying the best moral judgement to a difficult medical situation. Medical ethics is particularly relevant in decisions regarding involuntary treatment and involuntary commitment.

Medical ethics encompasses beneficence, autonomy, and justice as they relate to conflicts such as euthanasia, patient confidentiality, informed consent, and conflicts of interest in healthcare. In addition, medical ethics and culture are interconnected as different cultures implement ethical values differently, sometimes placing more emphasis on family values and downplaying the importance of autonomy.

A common framework used when analyzing medical ethics is the "four principles" approach the four principles are:

  • Respect for autonomy – the patient has the right to refuse or choose their treatment.
  • Beneficence – a practitioner should act in the best interest of the patient.
  • Non-maleficence – to not be the cause of harm. Also, "Utility" – to promote better good than harm.
  • Justice – concerns the distribution of scarce health resources, and the decision of who gets what treatment.

Autonomy can come into conflict with beneficence when patients disagree with recommendations that healthcare professionals believe are in the patient's best interest. When the patient's interests’ conflict with the patient's welfare, different societies settle the conflict in a wide range of manners. In general, Western medicine defers to the wishes of a mentally competent patient to make their own decisions, even in cases where the medical team believes that they are not acting in their own best interests. However, many other societies prioritize beneficence over autonomy. People deemed to not be mentally competent or having a mental disorder may be treated involuntarily.

There is disagreement among American physicians as to whether the non-maleficence principle excludes the practice of euthanasia. Euthanasia is currently legal in the states of Washington, DC, California, Colorado, Oregon, Vermont, and Washington. Around the world, there are different organizations that campaign to change legislation about the issue of physician-assisted death, or PAD. Examples of such organizations are the Hemlock Society of the United States and the Dignity in Dying campaign in the United Kingdom. These groups believe that doctors should be given the right to end a patient's life only if the patient is conscious enough to decide for themselves, is knowledgeable about the possibility of alternative care, and has willingly asked to end their life or requested access to the means to do so.

In some hospitals, medical futility is referred to as treatment that is unable to benefit the patient. An important part of practicing good medical ethics is by attempting to avoid futility by practicing non-maleficence. What should be done if there is no chance that a patient will survive or benefit from a potential treatment, but the family members insist on advanced care? Articles have defined futility as the patient having less than a one percent chance of surviving.

Advance directives include living wills and durable powers of attorney for health care. In many cases, the "expressed wishes" of the patient are documented in these directives, and this provides a framework to guide family members and health care professionals in the decision-making process when the patient is incapacitated.

"Substituted judgment" is the concept that a family member can give consent for treatment if the patient is unable (or unwilling) to give consent themselves. The key question for the decision-making surrogate is not, "What would you like to do?", but instead, "What do you think the patient would want in this situation?".

Baby Doe Law establishes state protection for a disabled child's right to life, ensuring that this right is protected even over the wishes of parents or guardians in cases where they want to withhold treatment.

Case Study

I went to the Ottawa heart institute for my annual checkup on my pacemaker. It is a relatively simple and easy procedure. There is no waiting, I see a technician who wires me up and assesses the state of my pacemaker and then a doctor comes in and gives me the thumbs up. I go to the desk and get my appointment for next year.

While waiting to see the technician I observed a conversation in the room next door. There was an elderly gentleman in a wheelchair. He was obviously mentally challenged. He did not know why he was there or what was happening. His daughter was the caregiver.

The physician entered the room and asked the daughter who takes care of the father. She answered my mother and me. The physician said we are ready to replace the battery in his pacemaker if you want this procedure. The daughter thought about it for a moment and said no. The physician said OK I will disconnect his pacemaker and then he left the room. The daughter then proceeded to wheel her father out of the building.

I found this exchange very interesting. It took no longer than 5 minutes at the most. I am not a legal expert. My understanding of manslaughter is:

The unjustifiable, inexcusable, and intentional killing of a human being without deliberation, premeditation, and malice, May be involuntary, in the commission of a lawful act in the absence of due caution and circumspection.

In most jurisdictions, voluntary manslaughter consists of an intentional killing that is accompanied by additional circumstances that mitigate, but do not excuse, the act. The most common type of voluntary manslaughter occurs when a defendant is provoked to commit the homicide. It is sometimes described as a heat of passion.

Provocation must induce rage or anger in the defendant, although some cases have held that fright, terror, or desperation will suffice.

Involuntary manslaughter is the unlawful killing of another human being with no intent. The absence of intent is the essential difference. Involuntary manslaughter results from a heat of passion but from an improper use of reasonable care or skill while in the commission of a lawful act or while in the commission of an unlawful act not amounting to a felony. A driver who kills while high on drugs and alcohol did not mean to kill anyone. Simply an accident and bad timing.

Murder is different based upon the concept of premeditation: the unlawful premeditated killing of one human being by another.


From my standpoint this incident appears to be murder. There are mitigating circumstances. but mitigating circumstances could apply to a range of disabilities such as autism and dementia.

I support medically assisted death if the patient is cogent and understands the gravity of the decision. That was certainly not the case in this incident.

Source: The Doctoral students’ best friend, Wikipedia.