A guide To Moral Decision-Making

It outlines a step-by step process that considers the many aspects of ethical decision-
making:

1. Recognizing the moral dimension

- Is recognizing the decision as one that has moral importance.
- Important clues include conflicts between two or more values or ideals.
- Consider here the levels of ethical guidance of the code of Ethics for registered
nurses.

2. Who are the interested parties? What are their relationships?

- Carefully Identify who has a stake in the decision in this regard, be imaginative
and sympathetic.
- Often there are more parties whose interests should be taken into consideration
than is immediately obvious.
- Look at the relationships between the parties; look at their relationship with
yourself and with each other, and with relevant institutions.

3. What values are involved?

- Think through the shared values that are at stake in making this decision.
- Is there a question of trust? Is personal autonomy a consideration? Is there
a question of fairness? Is anyone harmed or helped?
- Consider your own and others personal values & ethical principles.

4. Weight the benefits and burdens

- Benefits might include such things as the production of goods (physical,
emotional, financial, and social, etc.) for various parties, the satisfaction of
preferences and acting in accordance with various relevant values (such as
fairness).
- Burdens might include causing physical or emotional pain to various parties
imposing financial costs and ignoring relevant values.

5. Look for analogous cases

- Can you think of similar decisions? What course of action was taken? Was it
a good one? How is the present case like that one? How is it different?

6. Discuss with relevant other

- The merit of discussion should not be underestimated. Time permitting discusses
your decision with as many people as have a take in it.
- Gather opinions and ask for the reasons behind those opinions.

7. Does this decision according with legal and organizational rules?

- Some decisions are appropriately based on legal considerations. If an option is
illegal, one should think very carefully before thanking that option.
- Discussion may also be affected by organizations of which we are members.
For example, the nursing profession has a code of ethics and professional
standards that are intended to guide individual decision-making.
- Institutions may also have policies that limit the options available.

8. Am I comfortable with this decision? Question to reflect up on include:

- If I Carry out this decision, would I be comfortable telling my family about it?
My mentors?
- Would I want my children to take my behavior as an example?
- Is this decision one that a wise, informed, virtuous person would make?
- Can I live with this decision?

Euthanasia

Euthanasia is derived from the Greek words “eu” meaning good or well and
“thanatus” meaning death; thus, euthanasia means good or merciful death.

It refers to the practice of terminating a life of a terminally ill patient to relieve him or
her from pain and suffering.

It is the intentional killing by act or omission of a dependent human being for his or
her alleged benefit. (The key word here is "intentional". If death is not intended, it is
not an act of euthanasia)

Forms of Euthanasia

Euthanasia comes in several different forms, each of which brings a different set of
rights and wrongs.

1- Active (Euthanasia by action) – death is brought by an ACT.

It entails the use of lethal substances or forces to kill. This is the most controversial
form of euthanasia.

2- Passive (Euthanasia by omission) – death is brought about by an OMISSION.

Intentionally causing death by not providing necessary and ordinary (usual and
customary) care or food and water. It entails the withholding of treatments such as
administration of antibiotics or any drugs or intervention necessary for the
continuance of life. Switching off the machine that keeps the person alive and
withholding the surgery that may extend the life of the person is under this form of
euthanasia.

Classification

Euthanasia is categorized in different ways, which include voluntary, non-voluntary,

or involuntary:
1- Voluntary euthanasia: When the person who is killed has requested to be killed,
this type of euthanasia is often termed as assisted suicide; As someone provides an
individual with the information, guidance, and means to take his or her own life with
the intention that they will be used for this purpose. When it is a doctor who helps
another person to kill themselves it is called "physician assisted suicide."

Voluntary euthanasia is made legal in countries such as Belgium, the Netherlands,

Switzerland, Luxemburg, and the US states of Oregon and Washington.

2- Non-voluntary: When the person who is killed made no request and gave no
consent, e.g. when a patient is unconscious or is still a child and unable to make
meaningful choices between living and dying, and an appropriate person takes the
decision on their behalf non-voluntary euthanasia is practiced.
non-voluntary euthanasia is illegal in all countries.
3- Involuntary euthanasia: When the person who is killed made an expressed wish to
the contrary (in cases where the dying patient chooses life but is killed anyway).

Involuntary euthanasia is usually considered murder.

Ethical Arguments on Euthanasia

Those who are against mercy killing have the following ethical arguments: ]ending
the life of a terminally ill patient in extreme suffering is consistent with the ethic of
beneficence in that it is a compassionate and merciful response that brings relief, and
is also consistent with the ethic of autonomy, which allows people who competently
request euthanasia to have their wish respected[.

Cons

1. Euthanasia might not be promoting the patient’s best interests.

2. Slippery slope argument: if voluntary euthanasia were to become legal
in countries nationwide, most probably involuntary euthanasia will be committed
at a higher rate. Doctors soon may start killing terminal patients involuntarily.
3. Accepting euthanasia means admitting that some people’s lives are more worth
than others.
4. It weakens the society’s respect for the holiness of life.

Pros

1. People have the right to die.

2. Euthanasia causes no harm to others and the state, thus, other people have no
right to interfere with it.
3. Euthanasia once made legal can be regulated, thus, preventing the incidence of
involuntary euthanasia.
4. Allowing a terminally ill patient to die would free the family from financial
problems.

Living Wills

- Prepared while patient has decisional capacity.

‫‪-‬‬ ‫‪Describes patient preferences in the event they become incapable of making‬‬
‫‪decisions or communicating decisions.‬‬
‫‪-‬‬ ‫‪Usually describes what type of life prolonging procedures the patient would or‬‬
‫‪would not want and circumstances under which they would want these procedures‬‬
‫‪carried out, withheld, or withdrawn.‬‬

‫‪Euthanasia is forbidden in Islam‬‬

‫َّللاَ َكانَ بِ ُك ْم‬ ‫فال يجوز للمسلم اإلقدام على قتل نفسه ألي سبب من األسباب لقوله تعالى‪َ :‬و ََل ت َ ْقتُلُوا أَ ْنفُ َ‬
‫س ُك ْم إِ َّن َّ‬
‫َر ِحي ًما (النساء‪ .)29:‬ولقوله صلى هللا عليه وسلم‪( :‬من قتل نفسه بحديدة فحديدته يتوجأ بها في بطنه في نار جهنم‬
‫خالدا ً مخلداً فيها أبداً‪ ،‬ومن شرب سما ً فقتل نفسه‪ ،‬فهو يتحساه في نار جهنم خالداً مخلداً فيها أبداً‪ ،‬ومن تردى من‬
‫جبل فقتل نفسه‪ ،‬فهو يتردى في نار جهنم خالدا ً مخلدا ً فيها أبدا ً) رواه البخاري ومسلم‪.‬‬

‫وَل يبرر ذلك فعله بدعوى الرحمة‪ ،‬وقد اتفق الفقهاء المعاصرون على الفتوى بذلك‪.‬‬

‫فقد جاء في فتاوى األزهر‪ :‬والمريض أيا كان مرضه وكيف كانت حالة مرضه َل يجوز قتله لليأس من شفائه‪.‬‬

‫وجاء في فتاوى قطاع اإلفتاء بالكويت‪ :‬إن التخلص من المريض بأية وسيلة محرم قطعاً‪ ،‬ومن يقوم بذلك يكون‬
‫قاتالً عمداً‪.‬‬