Introduction to Clinical Ethics -4-

"Well being" and the End of Medicine



P2: Intend to promote the well-being of the person(s) you face through medical activities!

With regard to P2, the term "a person's well-being" needs to be clearly defined. When we ask if a person is well or not, the question can be interpreted in two ways: if his situation is fine or if he lives his life well. The first interpretation refers to his/her given situation or circumstance. The latter one, on the other hand, refers to the person's attitude towards a particular situation, i.e. what he does or intends to do, or how he lives or intends to live in the given situation.

According to both interpretations, we can derive a specialized rule under P1.

1. The Bodily Situation and QOL: General Assessment

First, let us examine what rule results from the first interpretation of "a person's well-being".

On the basis of the concept of QOL and bodily situation, a rule results from P2:

R2-1: Intend to make the integrated sum of the QOL of the person you face from the present moment until the time of death as much as possible!

Here by "QOL" I primarily mean the bodily QOL, but I would not restrict the term to include only the bodily aspect. Consider the example of a woman who cannot walk by herself, but can move by means of a wheelchair. In this case the weakness in her bodily QOL can be compensated by another aspect of her QOL i.e. her circumstance -- that she can use a wheelchair. Creating such a circumstance is included in medical activities. For instance, a man with advanced cancer in his terminal stage, and in need of treatment for his bodily QOL, has to be separated from his family during the course of treatment. In this case, we should estimate not only the predicted improvement in his bodily QOL but also the change for the worse in his family circumstance. Thus, we should estimate not only one's bodily QOL but also the other aspects of one's QOL that relate to one's bodily situation.

2. The Private Attitude Towards Life: Interest Individualized]

Besides R2-1, which has resulted from the second interpretation of the "person's well-being", we can arrive at another rule on the basis of its first interpretation, which explains well-being as one's attitude towards the given situation. Here P2, which directs the medical staff to "intend to promote the well-being of a person", cannot explicitly direct them to make the person live well by adopting a certain attitude towards his/her life, for this depends exclusively on the person's own ability to adopt a certain attitude. The principle, however, implicitly directs us to let the person live well, or not to prevent him/her from living well, and this is what "intend to promote one's well being" means in this respect. Thus the second specialised rule under P2 is as follows:

R2-2: Don't prevent the person you face from leading a full life!

Although P2 does not recommend that the medical staff directly help the patient lead a full life, it does recommend promoting the patient's well-being. The patient's well-being is of value insofar as it provides the patient with a chance to lead a full life, and this is what R1-1 explicitly directs the medical staff to do -- improve the person's condition and attend to his/her QOL or freedom from the public point of view.

On the other hand, R2-2 directs by using negative expressions. It does not direct the medical staff positively to help the patient lead a full life, as well as R2-1 doesn't, but negatively not to prevent the patient's activity. This means, they should respect the individual's own preferences and values, which besides the bodily situation and QOL, play an important role in medical decision-making. That is, the patient's overall life-plan and his/her preferences have a casting vote in many cases of decision-making. For instance, QOL consists of several components: physical abilities (i.e., performance status), physical feelings (pain etc.), psychological feelings (anxiety etc.), the capacity to maintain human relationships, and so on. Thus, there can be a case where the patient considers one aspect to be more important than others in order to lead a full life. In such a case, the medics' role is to create circumstances that are conducive to the patient leading a full life. This involves taking care not to prevent him/her from leading a full life.

update: 15/August/2003

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