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Philosophy

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Dec 6, 2023

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Evaluating the Texas Advance Directives Act: A Bioethical Perspective Within the context of bioethics, the intersection of medical decision-making, legal system, and human rights are often controversial. The Texas Advanced Directives Act (hereafter TADA) grants hospitals’ ethics committee the authorization to support physicians’ medical decision and allows physicians to overrule patient or family requests for futile care. The starting point of TADA is to avoid unnecessary harm to patients, provision of unseemly case and encourage a good stewardship of medical resources (Kapottos and Youngner, 2015). However, does it deny or obstruct a patient’s constitutional right to life even if ‘medically futile’ decision was made after the hospital has made reasonable medical effort before transfer the patient to another facility? To answer above question, this paper adopted a range of ethical theories from Lewis Vaughn’s book: “Bioethics: Principles, Issues, and Cases” (2013). Utilitarianism. Utilitarianism can help resolve conflicts between ordinary obligations that universal moral thinking cannot resolve on its own (Sidgwick, 2019). Utilitarianism highlights the maximum benefits for the greatest number of people. This view considers the problem from a holistic perspective, rather than individual rights. In this case, abandoning patients who are medically futile and instead allocating these healthcare resources to patients with higher chances of recovery can effectively increase the utilization of resources and the number of people who can ultimately be cured. However, this consequentialist thinking puts a different price tag on lives, thereby ignoring the equality of life and the value of individuals. Kantian ethics. Kantian ethics highlights the duty and respect for individuals as ends in themselves which challenges TADA’s ethical underpinnings ( Vaughn, 2013) . This view is the opposite of the utilitarianism recounted above: i.e., behaviour is morally justified if it conforms to rational, universally applicable moral laws, not just because of its consequences. In the lens of Kantian ethics, TADA should be criticized as it ignores the rational will and moral agency of the patients. All patients are individuals with free will and inherent dignity (Secker, 1999), therefore, should be

treated with autonomy and respect instead of unilaterally announce the cessation of treatments that are considered medically futile. Natural Law Theory. Natural Law Theory emphasizes the sanctity and practical reasonableness of human life ( Vaughn, 2013) , which showcases both alignment and conflicts with TADA. This theory posits that ethics conforms to moral standards that were established upon human rationality and natural order. However, it is critical to highlight that the objective ethical standards under Natural Law Theory are not moral absolute, therefore needs to be carefully considered and adopted in practices (Steffen, 2016). When it comes to bioethics, considering the primacy of lives and the intrinsic value of individuals, patients should be treated no matter how serious their condition is. However, this is not absolute. For example, a physician may reasonably withdraw or refuse treatment in favour of palliative measures for a patient who, although medically amenable to treatment, suffers far more than there is hope for a cure. This can be considered as morally sound based on Justice War Theory, a sub-product of Natural Law Theory, as long as the new standards arise in such scenario have been fulfilled (Steffen, 2016). Rawls' Contract Theory. Rawls' Contract Theory stresses the principle of justice that is agreed upon in a fair setting. In the field of health care, the application of Rawls' theory requires consideration of how individuals would perceive and recognize TADA without knowing their own health status. This would likely help TADA to find a balance between medical decision-making, the law, and human rights. Mechanisms that allow patients and families to be heard and their views carefully considered should be included in the medical decision-making process, especially in cases where there is disagreement about the futility of continuing treatment. This ensures that decisions on futile treatment are made with respect for the patient's rational will and moral agency. In short, different theories of thought offer different interpretive perspectives for reading TADA’s ethical practice. Utilitarianism may tend to support it in terms of the greater good, while Kantian ethics and natural law theories may criticize it for undermining the individual rights of patients and

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