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Reassessing the 'Burden of Life': the Moral Judgment of Terminally Ill Patients Regarding the Value of Their Lives and What the Rest of Us Can Do About It

In a highly influential piece supporting a patient's right to choose euthanasia, Dan Brock uses an incomplete notion of autonomy in one of the key premises to his argument. He defines autonomy as the individual's ability to pass judgment on the value of his/her own life, using his/her established set of values, and then to act accordingly. The respect that others should have for the patient's autonomy is then seen as primarily the negative 'letting alone' of the patient. Brock identifies autonomy, in this sense, to be a necessary element in a person's 'dignity.' In other words, suffering, terminally ill patients who do not have the freedom to determine the amount of suffering they experience before death, or to decide the timing and manner of their death, are seen to be 'undignified.' What this view leaves out is the necessary analysis of how patients go through the process of their life assessments, the intrinsic relational nature of this process, and how respect for autonomy and dignity understood in a broader sense can be seen to entail obligations to foster positive opportunities and beneficial circumstances for terminally ill persons, rather than acquiescence to their demands. One of the most biting criticisms of this account of autonomy comes from a type of feminist bioethical thinking called 'the ethics of care.' The ethics of care aims to replace the false moral ideal of the masculine, atomistic, emotionless individual who seeks control with a feminine, interdependent, emotional individual who seeks positive relationships. However, the ethics of care goes too far in its opposition to the importance of autonomy in the moral life of the individual. There is a better concept of autonomy that simultaneously defends the individuality of the person deciding (free from coercion) and the interdependence of that person on others in that person's: 1) formation of values, 2) deliberation or assessment of how to decide based on those values, and 3) following through with the action decided upon. This 'redefined' autonomy requires, not only the negative allowing of decision and action on the part of others emphasized by Brock, but also and primarily the positive support of others and their input into those three steps of autonomous decision-making, as Grace Clement speaks of. It is this concept of autonomy as intrinsically relational that allows us to focus, not on obeying or allowing a patient's wishes at all costs (such as euthanasia), but in fact commits us to respond to and to attempt to influence the process by which the patient arrives at his/her judgments. We see that the circumstances and opportunities open to a person are a significant part of the persons' life assessment, and that these circumstances and opportunities depend to a large extent on the social structures surrounding the patient and the messages coming from society, and most directly from one's caregivers. The best thing for caregivers to do is to focus on the intrinsic dignity of each patient and to help identify an array of opportunities available to each patient to exercise his/her autonomy and to grow in virtue. The feeling or sense that patients have over their own dignity relates more to how they perceive their losses and circumstances than to what those losses are. The patient's self-worth is not completely invulnerable to the loss of health. Both external goods, such as health and wealth, and relational goods influence the value judgment of a person and can, in fact, influence the very character of the person- positively or negatively. The ancient philosopher, Aristotle, says that 'eudemonia' or happiness is vulnerable to the great loss of external goods, such as in the case of a patient who has lost health to the point of being terminally ill. Yet, he also says that even in great loss, the "fineness shines through" in the person who is noble and magnanimous. Within the hierarchy of goods, Aristotle places the goods of the soul as higher than the goods of the body. Relational goods play an especially important role, and are also higher than the goods of the body. From this perspective, a terminally ill patient and his/her caregivers may be encouraged to place greater weight on relationships and virtue than on physiological limitations. In fact, the loss of health and function can be re-evaluated as precisely the needed opportunity to grow in certain context-dependent relational virtues. Within the appropriate circumstances, the patient will be more easily able to live more of 'the good life', and become, not less human through external loss, but rather more human through relational virtues. The new moral ideal becomes, not the atomistic-autonomous individual, but the interdependent-autonomous individual. Politically, socially, and personally, we would do better to promote this latter moral ideal by creating circumstances and opportunities for caregivers to respect the patients' autonomy and dignity in the positive sense.

Identiferoai:union.ndltd.org:PITT/oai:PITTETD:etd-11202002-140557
Date10 April 2003
CreatorsFortunato, Angela Therese
ContributorsDavid Barnard, Mark Wicclair, David Kelly, Alex London
PublisherUniversity of Pittsburgh
Source SetsUniversity of Pittsburgh
LanguageEnglish
Detected LanguageEnglish
Typetext
Formatapplication/pdf
Sourcehttp://etd.library.pitt.edu:80/ETD/available/etd-11202002-140557/
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