An apparent 19 year old male is brought to the emergency room by ambulance experiencing respiratory failure related to the patient’s AIDS virus. The patient is accompanied by his girlfriend who states that the patient has a do not resuscitate (DNR) order. As the emergency room physician tries to contact the patient’s primary care physician he finds that the patient is under the care of a pediatrician and becomes suspicious about the DNR order. The doctor then confronts the girlfriend about the age of the patient because he is unable to communicate due to his respiratory condition. The girlfriend gives in and admits that the actual age of the patient is 17. The doctor immediately intubates the patient in an effort to stabilize his respiratory condition. After the patient is stabilized he informs the doctor that he does not want to be intubated again or placed on a respirator. After the patient’s mother arrives the physician explains the preceding happenings including the DNR order given by the patient. The mother reluctantly goes along with her son’s wishes and signs the documentation implementing the DNR order.
The patient soon confronts the doctor and makes him promise to stick to the DNR order no matter what his condition, the physician agrees. Shortly afterwards the patient goes into respiratory arrest. All the parties involved in this situation are present when the respiratory arrest occurs. The physician stands by with all intentions of honoring the DNR but within thirty seconds of the arrest, the mother orders the physician to intubate. The physician looks over at the patient as he shakes his head indicating that he does not want to be resuscitated, the physician is also aware that the patient is within 2 weeks of being 18.
The major dilemma in this situation is who gets to make the life or death decision. It is clear what the patient wants for his course of treatment, but the mother is equally clear in the treatment her son should receive. Both, mother and son, have selfish reasons for wanting their decision to be upheld. The mother does not want to see her son die and will at all costs keep him alive. The patient, who has lived with the AIDS virus since age four, has seen many of his friends placed on ventilators only to later die. He does not want that quality of life in his final days, and the physician is supportive of this request but is constrained by many legal issues.
When faced with moral decisions, such as the preceding story, a person can use the philosophy known as Utilitarianism as a basis to make their decision. The basic premise of this philosophy is that the greatest good comes from creating happiness for the greatest number of people. It takes the view that an action is right if it is likely to produce the best consequences compared to all of the other possible actions. The best consequences are those which involve the maximization of what is good and the minimization of what is bad. Utilitarianism also takes the view that one should sacrifice their own good for the greater pleasure of others, if the situation calls for such action.
To decide a route to follow in a moral question, we all have the core feeling of sensitivity and compassion. These feelings make us look at any situation with these senses and may sometimes guide our decision. It has been shown that humans as a whole race desire happiness and things that will bring us happiness. As a pure utilitarian one may justify his or her actions by feeling that no other act that could have been performed would have produced more pleasure for the whole society. The decision is not based on any of society’s rules, but solely on the pleasure principle, which states that whatever action will produce the greatest amount of happiness for the greatest amount of people will be the correct action.
If something is intrinsically good, it is good in itself no matter what its consequences are. If something is instrumentally good, it is good because of its consequences. A utilitarian would say that pleasure and only pleasure is intrinsically good. This philosophy clearly takes pleasure to be desirable as it recommends producing greatest pleasure and minimal pain.
In the case of the 19 year old patient with AIDS, it seems highly possible that the greatest amount of pain would come from the death of the young patient. This probability suffices for a quantitative utilitarian, but it does not account for the consequences, which create an entirely different problem. After considering the possible actions, a utilitarian must also consider the consequences of an action.
As we look at this situation, if the patient is allowed to discontinue treatment his mother and girlfriend, as well as any other family members or friends, would have to stand by and watch the young patient die and would therefore suffer great pain. The action of not terminating the patient’s treatment means that the patient would have to live the rest of his short life on a ventilator and in great pain. This is where the first problem with the application of utilitarianism exists. How can you measure happiness and decide which action would result in the greatest happiness for everyone involved. Then there is the question of scope. How far does someone look in deciding who is involved and who would be affected by the action?
In Utilitarianism, there is no agreement about what is the “good” that is to be maximized for all concerned in different situations. Who decides what is good for whom? And whose interests are primary in these decisions? Furthermore does someone have authority over anyone else in making these decisions?
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