Saturday, January 15, 2011

Ethical /moral points of view:

I really enjoy teaching in Singapore the array of different cultures and ethical / moral points of view always make me reflect on life and consider another point of view: Ethics and morality are often interchanged…. Some people confuse ethics and think that it is ethical standards or a code of ethics even religion, which it is not…there is a subtle difference between ethics and morals….. Ethics is how society views social structure where as morals are a personal characteristic which often includes a religious flavor…. However generally people use the terms to mean one and the same…. Let’s face it morals are influenced by our religious, spiritual, cultural, scientific or learned experiences. Ethics goes one step further than morality in the sense that we have ethical theories (Utilitarian & Deontology)and principles, such as autonomy, beneficence, non-malefence, justice and veracity. Peter Singer states “Ethics has no necessary connection with any particular religion, nor with religion in general."

Interestingly I believe as we get older we generally change our point of view…. I think with maturity comes an understanding and wisdom and letting go of idealism. I think back to the days when I was a nursing student at 18… young and idealistic; I wanted to save the world from its self… I was given this knowledge as a student nurse and it was fantastic…. This particular day I was working in a rehabilitation ward looking after an elderly man recovering from major surgery, taking his blood pressure…and suddenly there was no blood pressure… I looked at the man and yes he was grey, pale, he had just passed away as I was talking to him….my first instinct was to resuscitate him… I did… when the team arrived someone read his chart and said….”he’s not for resus so maybe we shouldn't be doing this” I looked up and continued for a few more minutes then stopped. The man had died. The matron who was a nun asked me to see her in the office….. I had no idea what I had done wrong…. She asked me why did you resuscitate the patient. I am embarrassed now by my answer…. But I said… “God has given me the knowledge to resuscitate this man if he wants him to die he will die anyway”. The nun just looked and me and said nothing…..As I look back I can see I thought I knew best…. Ask me what I would do today…. I would respect the patients request not to be resuscitated…. I am not saying all young people are like this but I do think as we get older our morals, values and ethical views change due to our life experiences…. That is just part of life and getting older……

As a health practitioner I maintain that you have to have a good sense of “self” in order to care for your clients. That is understanding your own moral and ethical grounding, this sense of self awareness allows you to understand why you react in the way you do and allows you to step back and not be judgmental in the care you are providing to the client. I must say I did not become self aware until I was in my 30’s.

As we know there is no right or wrong when it comes to discussing ethics; however when you focus on the hard issues such as capital punishment, abortion, organ transplant, euthanasia, genetic testing, and allocation of health resources the students came up with some pretty black and white answers, they are rather pragmatic about the whole issue. Singapore’s Medical Council is currently reviewing its code of ethics to keep in line with the advancing technological age (biotechnology) and the demand for organ transplants and genetic issues. This is an attempt to hold the health profession more accountable for decisions made within these areas.

Recently President Obama called on Americans to “expand our moral imaginations, to listen to each other more carefully, to sharpen our instincts for empathy, and remind ourselves of all the ways our hopes and dreams are bound together”. This was an attempt to defuse the abortion debate in America which often reverts to violence due to such opposing views. But the reality is we all worlds apart in finding solutions – everyone has their own idea about polices and justice. Often our moral imaginations are so divergent that never the twain shall meet.

When I asked the students how valuable do they consider human life within today’s society? Everyone said it is valued, and yes it is wrong to kill another human being; except if they have killed another person…..(Singapore has the death penalty) I then asked what about drug traffickers? They haven’t directly killed anyone. Again most agreed that yes they deserved to die because they contribute to someone else’s death or changed circumstances; even though they are really only the carrier or victim because the real culprit is rich and to clever to be caught….this was food for thought. So in essence the wrong person is being killed: In order to question the rules of society I then asked what about the woman who is stoned for committing adultery….(not in Singapore). In this instance the person that is being killed is the woman; the man did not get the same punishment. This did generate some discussion and most agreed that this was wrong……however most agreed with the philosophy that if some takes a life theirs should be taken.

Abortion always creates a debate…. No one can agree on this topic, I wonder if the world will ever reach a consensus on this; Pro Choice v Pro Life; with a multi-cultural, multi-religious class it was an interesting discussion at least there was a discussion and an expression of opinions however the divide still remains; does life begin at conception? Or when the fetus moves @ 16 weeks or when the fetus can live independently from its mother? Is abortion under 12 weeks acceptable? What about late term abortion for abnormality or not? All these questions need to be explored by the people and policy makers in a peaceful and respectful way.

The ethical debate will continue on many subjects, should the alcoholic or drug addict have a liver transplant, the smoker have a triple bypass, what if a prisoner for murder needs a kidney transplant.....Should the pregnant woman who is a drug/alcoholic be in prision?(as they do in America), I hope this never happens in
Australia, the list is endless... what is the individuals responsibility towards health v poor.... if you can't help yourself in improving your health care.... should the government support your treatment....? we are spending billions of dollars on health care.... what is the solution? the debate about health care resources continues.

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