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Bioethical dimensions and issues


Sample Essay


Bioethical Essay

What is a Bioethics Essay?

An essay is a formal piece of writing focused on a particular topic – in this instance a bioethical issue relating to Covid-19. An essay aims to present evidence on a particular topic with the aim of informing and persuading the reader to a particular viewpoint. When you write an essay, you are making an argument for the validity of a particular point of view, analysis, interpretation, or set of facts or procedures. You are required to pose questions, consider alternative viewpoints, and reflect on how this challenge or reinforce your understanding, practice, ideas and assumptions moving forward.

Why do a Bioethics Essay?

Writing a bioethics essay will assist you to develop and clarify connections between what you already know and what you are learning, between theory and practice, and between what you are doing and what you will do and why. The purpose of this task is for you to engage in critical reflection on the bioethical dimensions and issues surrounding your news article. You are expected to demonstrate critical thinking around the evidence and theory informing the bioethical issues and make a recommendation based on your reading and thinking.

Assessment overview

Your Bioethical Essay should include the following:

  1. Question: What question are you answering?
  2. News article citation and summary: place the news article citation and summary from your Group Annotated Bibliography here. This will provide context for your consideration of the bioethical issues. Please note: this section will not be marked again and does not contribute to your total word count.
  3. Discussion of bioethical dimensions and issues: discuss the core ethical arguments for and against your question. You should draw on the academic literature to support your discussion (approximately 600 words).
  4. 4)      Recommendation: Provide a recommendation based on the ethical arguments you presented – it is appropriate to write in the first person for this section (approximately 400 words).
  5. References: list all resources used in the Bioethics Essay using UQ Harvard referencing style.

Upload your assessment via the submission link on the course BB site. Refer to the ECP for individual workshop submission times. Your Bioethics Essay should be 1000 +/- 10% words in total, including in-text citations. Your title, news article citation, summary and reference list do not count in your word total.

Assessment description and guide

With the end goal of forming a logical and evidence-based recommendation, there are a number of steps and multiple ways to approach a bioethical essay. The following guide will provide you both an explanation of appropriate steps in creating your essay, in addition to providing you excepts from a model essay submitted in 2018 for this subject. While this is guide is safe to follow and model your own work off, it does not apply every permutation of bioethical essay course. There are some extra resources provided at the end of the guide that will help you understand the fundamentals of ethical argumentation.

  1. News article citation and summary
NEWS ARTICLE CITATION ABC News, ‘David Goodall ends his life at 104 with a final powerful statement on euthanasia’, ABC News, 11 May 2018, viewed 2 August 2018, <http://www.abc.net.au/news/2018-05-10/david-goodall-ends-life-in-a- powerful-statement-on-euthanasia/9742528>
NEWS ARTICLE SUMMARY In May 2018, 104 year old Dr David Goodall, a science professor and Order of Australia recipient, travelled to Basel, Switzerland to access voluntary assisted suicide. His situation was unique as he was not suffering from a terminal illness; instead, his choice was based on his age. Dr Goodall said that he was no longer happy with his quality of life and believed that people his age should have the choice to decide when they can die. His family was also supportive, as they were able to receive some finality. There were inflamed debates from both sides, with euthanasia advocate Dr Philip Nitschke saying that Dr Goodall was exercising his basic right to make a choice of how and when to end his life. Doctors had confirmed that Goodall was of sound mind beforehand and confirmed that it was his intention to end his life. The other side of the debate, fronted by the Australian Medical Association, said situations such as these were dangerous and setting a precedent, as older people should be supported and taken care of. There is currently legislation in Victoria allowing assisted dying, whilst Western Australia is still examining the issue.
  • Discussing bioethical dimensions and issues (600 words)

Start with a short introduction. This introduction may provide some definitions and inform the reader of the scope and specifics of your discussion. This paragraph is a good opportunity to ensure the reader knows what aspect of this issue you will discuss – this is a short essay, so you will not always be able to cover all possible ethical dimensions. Therefore, if you are choosing a specific context this ethical issue applies to, you will want to specify that in this paragraph. Hopefully, by defining your terms and context early, you will avoid confusing the reader.

This discussion aims to answer this question by evaluating the opposing and supporting arguments in the assisted death (AD) debate. Here AD refers to assisting or actively killing another, upon their competent request but excludes withholding futile medical care or near-death sedation, (Lars et al., 2003). Patient assisted suicide (PAS) is a method of AD when a prescribed drug is self-administered. This debate is not new; opposing diatribes are specifying who should be eligible.

Present one side of the bioethical debate, linking to evidence that supports the argument. You may want to use a combination of scientific evidence as well as ethical arguments presented in reputable journals. Here, you are trying to provide the moral/ethical landscape of the issue that explains this side of the debate. Putting effort into this landscape’s description will allow the reader to see that you have thoroughly thought about and investigated (through literature) this issue and that your final recommendation is robust. You might also find it useful to flag post whether an argument is utilitarian, virtue based, rights or justice based in its perspective. This task is, of course, a process: you will need to read literature, brainstorm, dot point arguments then finally write your prose). Refer to the extra resources at the end of this guide to help you deconstruct the issue and identify arguments you want to discuss.

AD is still illegal in most states of Australia; one opposing argument is that a ‘slippery slope’ of morals will abandon the Hippocratic mandate to preserve life. The principle of valuing patient self-determination also breaks down when considering those unable to make competent AD requests, such as the mentally ill, severely disabled and minors, (Paul S. Appelbaum, 2017). A systematic review noted inconsistency, with psychiatric evaluation before PAS occurring below 5% in Oregon, yet 89% of psychiatric AD cases in the Netherlands involved psychiatric consultation, (Emanuel et al., 2016). AD guidelines may be inadequate for complex cases. The lack of transparent reporting from physicians is also a valid concern, with a study finding significant correlation between opposing PAS legislation and responding to surveys with incomplete details (Ganzini et al., 2000). Social theories aver that paternalistic AD could be oppressive, especially towards the severely disabled. Additionally, legal AD could result in undervalued and underdeveloped palliative care systems for economic reasons, (Lars et al., 2003). These arguments have had success, forcing bioethicists to specify when AD should be granted, such as denying AD for ‘treatment-resistant’ depression, (Miller, 2015).              

Dig deeper into the argument by providing an opposing view to what you have just described, along with relevant evidence. Again, this is somewhat of a landscape you need to describe. Be careful not to miss blind spots and try your best to think of/read about different contexts that issue applies to and try to look at both the pros and the cons of different views/decisions. You can see in this example that specifying the context and citing rebuttals is used to provide support to the opposing view.

AD advocates have specified who is eligible and how valuing competent self-determination is virtuous. Ultimately PAS is becoming the preferred AD option and detailed guidelines have been made, (Cohen- Almagor, 2015). Survey studies indicate that 1 in 6 PAS requests are fulfilled and 1 in 10 requests resulted in medicated death, (Ganzini et al., 2000). This suggests that physicians are effective gate keepers, similarly a systematic review found 87.2% of patients opting for PAS were in palliative care, (Emanuel et al., 2016). These statistics support the presumption that most AD cases involve foreseeable death and existing palliative care. AD advocates also admit that dementia cases are problematic, “patients with dementia who express the desire to commit suicide have already passed the point in time in which a self-determined decision is possible”, (Gather and Vollmann, 2013). AD supporters have generally rebutted critics, by specifying terminally ill patients’ self-determination is an absolute right and denying AD can increase suffering, (Singer, 2002).

Summarise the discussion of the arguments you have unpacked; by doing so you will aid the reader in crystallising this entire landscape within a/your perspective. You may want to give a different summary within each ethical framework discussed in lectures (e.g. utilitarians think X, virtue-based thinking might conclude in Y and justice/rights approaches would think Z). Aim to be direct in the language you use, so that the reader is clear on the conclusion you are leading up to in the following section.

Providing quality care encompasses the death process and the expanding legal approval is not resulting in abuse. There is risk of systematic underdevelopment of palliative care and mental health care, however this is not a guaranteed consequence. Physicians already make life and death choices, meaning AD is already within current medical scope. One must keep in mind that qualitative evidence cited only informs us of attitudes; we must pay close sceptical attention to quantitative evidence. There is approval for AD if a person will foreseeably die but if suffering is severe and uncontrollable; we should carefully consider requests from non-terminal patients. In Australia, 30% of male deaths over the age of 85 were caused by suicide in 2016, (Causes of Death, Australia, 2016). If AD reduces violent, unpleasant and dangerous methods of suicide, perhaps banning AD is not ambivalent, but malevolent.

Bioethical Recommendation (400 words)

The structure of this section is up to you. In this example the writer has directly stated their recommendation and then followed up with reasons why they have. Just remember to be clear in your logic and to be concise. You can see in the paragraph below that the student has specified which situations for which they are making a recommendation for allowing assisted death and for which they are not, followed by a justification for this decision. This allows the reader to see that they are taking time to be specific in their recommendation. The student also goes further, exploring broader utilitarian consequences that support their recommendation. Finally, the student also makes a more virtue and rights-based argument against universally supporting AD without caveats. This is an important step, as it shows the reader that you are thinking deeply and specifically about the issue.

Reflecting on the above discussion, I have concluded that we ought to provide AD options for a psychiatric evaluated person who is experiencing low quality of life, is under no third-party influence in their decision and is complying with reasonable safeguards. This excludes many experiencing purely psychological suffering, however chronic and incurable psychological illness should be considered with careful independent approval. AD has been legal for many decades with the number of legal jurisdictions growing, with little evidence of abuse. Yes, one consequence may be economic pressure to under-develop palliative care or cures for complex painful pathologies. However, one must remember that prolonging life needs to be desired by the patient; paternalistically extending all lives may mean resources are diverted away from other problems, such as preventing pathogenic diseases in the infants. Another consequence of restricting AD is the necessity to improve a patient’s (especially the elderly) quality of life past the point of diminishing returns. I also believe that self-determination is of high value and valuing it is essential characteristics of quality care, not a mutually exclusive value. As self-determination depends on a person being aware of their situation, I do not think that a rational case for or against AD itself can be made universally.

This example essay has now provided concluding specifications and future steps the medical community must consider, if they are to accept the writer’s recommendations. The writer has also considered what the consequences are if assisted death is not made available, this draws the attention of the reader to what is at stake for patients. Building on this, the student has also posed questions to the reader that point out fundamental philosophical issues that are probably out of the scope of the essay. But they are still important, so the student has included them. Finally, they close the essay by making their opinion/recommendation clear.

On-going observations need to be conducted; laws and regulations can be improved upon. There are not many advocates that do not admit that exclusions should apply for some illnesses, as self-determination is not possible. I also think that if someone is not given access to practical and humane methods of voluntary suicide, suffering patients may use more violent and dangerous methods anyway. New technologies will be developed that allow people to make their own methods of AD, outside of medical advice. This debate really draws my attention to the need to find better solutions in palliative care and the need to focus on quality of life, not just length of life. Is a life worth living if it is not pleasurable? What benefit is there of such an existence? If we paternalistically demand all should live to the longest possible age, are we acting ethically? I think that if we facilitate AD, enforce empathetic guidelines, and mandatory psychiatric evaluation there will be a positive outcome. There will be more humane, supportive pathways to death. There is no evidence of unfettered AD for the disabled or disadvantages demographics, such as the mentally ill. If anything, there is clear hesitation and withholding of AD from these groups.

Assessment format requirements

  • Assessment cover sheet: Please sign (typed is acceptable) and attach the assessment cover sheet to the front of your submissions.
  • Assessment template: Templates for the Bioethics Essay is available on the course BB site.
  • Writing style: Good academic English and draw on additional literature (where relevant). For the reflective section of your Essay you can use the first person singular.
  • Paper Size: Standard A4 (210 x 297mm)
  • Line spacing and Margins: 1.5 line spacing and all margins at least 2.0cm
  • Font: At least 11 point and Times New Roman, Calibri or Arial only
  • Citations and references: UQ Harvard referencing style


  

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