Two main ideas in modern bioethics: respect for autonomy and the principle of beneficence
Two main ideas lie at the center of modern bioethics: respect for autonomy and the principle of beneficence. As such, the former concept draws its basis from the aspect of the liberal and political idea which reiterates the importance of a person's freedom of choice and self-direction. If looked at through the lens of moral philosophy, autonomy fits the description of self-governance. The statement implies that a person rules themselves with full understanding and is not subject to the limitations imposed by the influence of others or personal encumbrances.
Respect for autonomy and the recognition of capacity and opinions
As such, the idea of respecting the free nature of an individual takes into account the fact that one recognizes the capacity and opinions of the person. Such an action also comprises the matter of appreciating the right of a person to hold a particular perspective and to take steps in line with their direction of life and beliefs. In essence, the respect for the autonomy of a person is a moral demand, and the independent action is not subject to the interference of others.
Moral challenge in honoring Margo's directive
Referring to Margo's condition, it presents a dilemma as to the action her doctors are to take. The principle of autonomy demands that they honor her directive that she penned down when she had a fully functioning and competent mind. The present situation presents a moral challenge. The doctors have a responsibility of respecting Margo's right to autonomy, but the fact that her directive precludes them from treating her means they have no option but to honor her wishes.
The principle of beneficence and the responsibility of health care professionals
On the other hand, the principle of beneficence revolves around the idea that health care professionals bear the responsibility of being of benefit to patients while also taking beneficial steps aimed at preventing harm or danger from a patient. In essence, these responsibilities have the characteristics of being rational and self-explanatory which makes them acceptable objectives in medicine. Under this principle, it makes the postulation that for a patient suffering from a particular disease, they can form a relationship with a person licensed and considered as competent to provide medical care while acknowledging the fact that the primary goal of the doctor is to offer help. Looking at the situation of Margo, applying this principle demands that the doctors do everything in their medical and legal power to help her avert death by giving the best treatment. As such, it creates a conflict with her autonomous right, but the moral ethics of the context in question overrides this same privilege.
Conflict between past wishes and present interests
With regards to the aspect of past wishes versus present interests, it presents a situation where a person made an advanced directive when they were in a fit state of mind that in the case they had a debilitating mental condition that they should not receive life-sustaining treatment. As such, the trick aspect here is that even though her last wishes were to avoid life-sustaining therapy for already mentioned reasons, the issue of life-sustaining treatment comes into conflict with her present interests which demands a person to receive treatment that could determine their lives. In the same line, a body of opinion also holds the view that the present interest of a person should inform the doctors of the steps to take in the case it comes to a matter of life and death decision.
Conflict between respect for autonomy and beneficence in Margo's case
In the case of Margo, the aspect of past wishes versus present interests becomes a matter of conflict between the respect for autonomy and beneficence. As such, we have the situation where Margo already had signed an advance directive saying that in the case she had an incapacitating ailment, and there comes a scenario where she might need to get life-sustaining treatment, then doctors should not provide it. In such a situation, the doctors must respect her autonomy as a person and carry on with her directive and wishes she had in the past. On the other hand, it is the responsibility of the doctor to protect and preserve Margo's life in the present state which makes him act on beneficence. As such, her present interests also align with her current belief system despite her mental incapacitation due to her illness. With that in mind, the past wishes versus the present benefits is a case of conflict between the respect for autonomy and beneficence. The overarching point is that the advance directive in the past mandates her doctors to give no treatment to her in case of a life-threatening condition once incapacitated while the present interests demand treatment which contradicts her past wishes in the advance directive.
Justification for upholding Margo's advance directive
One main reason that may justify one not upholding Margo's present wishes to receive treatment for her medical condition comes down to the aspect of this philosophy only applying to persons considered to have a sound mind. As such, persons diagnosed with Alzheimer's cannot make independent decisions since they do not have a comprehensive understanding of the past and future and are also incapable of reflecting on their past actions and forming a life-long objective for the future. As such, Margo cannot look at her life retrospectively and competently assert as to where it had any meaning.
Margo's loss of autonomy and competence
With that in mind, this means that Margo cannot fulfill any of the previous critical interests that would allow her to view life with introspective meaning. As such, any action she takes will not reflect the integrity of her life and will not become an accurate representation of her character. In essence, since Margo cannot adequately recognize her critical interests in her current state, she no longer possesses a continuous sense of self and cannot act autonomously. Moreover, the aspect of competence, in this case, refers to the ability to reflect on the action of the past and use them to formulate future decisions in line with a person's belief system and values. As such, this situation will justify upholding Margo's advance directive since her Alzheimer's has rendered her incompetent and should not override her past wishes.
Opinion on upholding Margo's advance directive
I hold the view that Margo's advance directive should still be a matter upheld by her doctors and she should not receive treatment. One reason for this opinion is the fact that Margo's mental incapacitation has made her not have a continuous sense of self and can no longer take on values that will dictate how she lives her life or helps her determine if those same actions support her value and belief system. In essence, Margo's sense of autonomy has been compromised, and her advance directive should hold. In this case, Margo's past wishes should take priority over her present interests since she made them in line with a belief and value system she had lived by all her life before contracting Alzheimer's disease. As such, her advance directive should take precedence by her sound minded decisions her mental condition renders her incapable of making autonomous decisions thus the doctor should honor it without question.
