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KMID : 1142820230070020079
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Bio, Ethics and Policy
2023 Volume.7 No. 2 p.79 ~ p.104
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Overlooked Ethical Issues Concerning Patients’ Right to Self-Determination in Decisions About Life-Sustaining Treatments
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Lee Kyung-Do
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Abstract
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Recently in South Korea, a bill proposing physician-assisted suicide has generated significant debate on the controversial procedure’s permissibility. One abiding argument opposing this proposal states that, in fact, patients will still be unable to exercise their right to self-determination in decisions about life-sustaining treatments because the bur- dens associated with caretaking and the fear of imposing such burdens on loved ones may unintentionally encourage or force patients to choose physician-assisted suicide. Without evaluating this argument’s validity, this article addresses four ethical issues relevant to patient self-determination that have received insufficient attention. First, it explores the scope and definition of life-sustaining treatments. Although future scholarly discussion must establish a robust definition of life-sustaining treatment, the conventional legal defi- nitions of such treatments need further clarification. Second, this article highlights the need to address whether, when, and to what extent patients should be held responsible for their voluntary decisions about life-sustaining treatments. This issue is highly relevant to ensuring patients’ actual right to self-determination, yet it has not been addressed fully in the literature. Third, this article illustrates cases in which it is ethically defensible to infringe upon patients’ right to self-determination in decisions about life-sustaining treatments, even when infringement seemingly goes against their self-interest and agency. Unfortunately, in past literature, such cases have not been alluded to. This article pres- ents primarily justice-related grounds that may justify infringing upon patients’ right to self-determination when such infringement does not directly promote their interests. Fourth, this article discusses what institutional resources should be provided to patients to help them realize their right to self-determination in decisions about life-sustaining treatments. Certain authors in previous literature have implicitly claimed that patients should be provided equal access to life-sustaining treatments to realize their right to self-determination. However, this article argues that it is neither feasible nor ethical to ensure equal access to all kinds of life-sustaining treatments. While an exhaustive treat- ment of these four issues is outside this discussion’s scope, this paper nonetheless hopes to mitigate potential misunderstandings around these four issues, and to propose potential methods for addressing these issues in the future.
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KEYWORD
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life-sustaining treatment, right to self-determination, medical ethics, bioethics
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