Markkula Center of Applied Ethics

Life and Death with Dignity: An Editor's Note

As someone whose mother has undergone three heart attacks, two coronary bypass operations, one angioplasty, and several hospitalizations for congestive heart failure, I should feel like a pro in dealing with the ethical questions presented by serious illness. I don't; nor, I suspect, do the physicians, health-care workers, and bioethicists who regularly confront these issues.

Deciding what to do about impending death should not be easy. If we do not struggle with each case as it presents itself, we do not sufficiently honor the dignity of human life.

But certain ethical principles can guide us in that struggle. Usually, ethicists invoke two basic ideas when they address serious illness: autonomy and beneficence.

According to Markkula Center for Applied Ethics Director of Health Care Ethics Margaret McLean, "The moral bedrock of our decision making is the principle of autonomy, the ability to make decisions for ourselves and to implement those decisions. According to this principle, human dignity rests in the ability to make and to execute decisions based on one's own values and plans.

"In health care, autonomy requires that the patient be treated as a person with values, goals, plans, and commitments. Autonomy serves to protect individual decision making and to require that a patient's decisions be respected."

Beneficence simply means doing good. Ethics Center Scholar Peter Facione, dean of the College of Arts and Sciences at Santa Clara University, and Center Associate Noreen Facione, research associate in physiological nursing at the U.C.-San Francisco School of Nursing, apply the principle of beneficence to health care like this: "Beneficence demands serving the patient's interests as well as possible while doing no harm."

These principles undergird the discussion in the following articles, which tackle some of the most pressing issues confronting us in the death with dignity debate. SCU Associate Professor of Philosophy Michael J. Meyer explores the ethical questions raised by assisted suicide, recently argued before the U.S. Supreme Court.

McLean outlines the ethical questions we should ask ourselves as we prepare advance directives — documents that spell out how we want medical decisions to be handled if we become incapacitated. The legalities of executing these documents are explained by nurse and attorney Karen Markus.

Complicating the discussion of death with dignity is the concern that patients seeking to end their lives may be suffering from depression and that this mood disorder may affect their ability to make decisions. Physician Melinda Lee presents a case that should help readers work through this problem.

Issues in Ethics invites you to share how you have dealt with these issues. Please, share your thoughts with us.