Ezekiel Emanuel - The Ends of Human Life

In his book The Ends of Human Life Emanuel used the AIDS patient "Andrew" as an example of moral medical dilemmas. Andrew talked to a local support group and signed a living will asking that life sustaining procedures be withdrawn if there is no reasonable expectation of recovery. The will was not given to anyone but kept in his wallet, and no one was given power of attorney. There were questions about his competence since he had AIDS dementia when he signed the will. Still, Andrew's lover said that he had talked about such situations, and asked that Andrew be allowed to die. Andrew's family strongly disagreed that Andrew wanted to die. Dr. Wolf previously saved Andrew's life, but promised to help him avoid a "miserable death". The ICU wanted guidance from Dr. Wolf as to how aggressively they should try to keep Andrew alive, as his chances of surviving a cardiac arrest were about zero. Two other critical patients were recently refused admission because of a bed shortage. There was a question as to whether Andrew's lover was representing Andrew's wishes or his own. There was also a question as to whether Andrew’s parents knew Andrew better than others, or whether they were motivated by guilt from rejecting Andrew's identification as a gay male. The cost of aggressive treatment was $2,000.00 per day.

This dilemma illustrates the ethical challenges faced by even the most conscientious physicians, in addition to patient confidentiality, the meaning of informed consent, and the ethics of experimental treatments, transplanting genes or brain tissue. Also, while many agree that every citizen should be given adequate health care, few agree on how to define what adequate health care is. Many of these issues have become almost impossible to solve moral dilemmas. Babies that would be born with serious birth defects pose a serious moral dilemma, and medical technology makes it sometimes difficult to define what death is in the case of permanently brain damaged patients on respirators. There are also ethical questions on how to allocate scarce resources. However, the Hippocratic Oath is proof that medical technology is not the cause of medical questions about ethics.

Emanuel said the Hippocratic Oath and the codes of modern medical societies require doctors to maintain client patient confidentiality, refrain from lying to a patient, and keep patients informed and obtain their consent, in order to protect the patient from manipulation and discrimination. Emanuel said that a doctor’s oath would never allow him to administer a lethal injection for capital punishment as a doctor, although the issue would be different if he were asked to serve on a firing squad not as a doctor but rather as a citizen. He said that in the case of mercy killing there are rare cases where the medical obligation to relieve suffering would be in tension with the obligation to save a life, and that a different argument (an argument that intentional killing "should not be used to achieve the legitimate ends of medicine") would be required instead.

Emanuel said there is often a need to balance different values: As Emanuel said,

To know whether it is ethical to turn off the respirator for a quadriplegic patient requires conceptions of personal identity, a worthy human life, murder and suicide; to know how much information a doctor must provide a cancer patient to obtain proper informed consent for an experimental therapy requires conceptions of autonomy, coercion and the public good and how to balance these values; to know whether to break the AIDS patient’s confidentiality and inform his wife requires a framework for weighing the relative importance of competing individual rights as well as the public good.

One reason such issues seem impossible to solve is because of the belief that public policy should be neutral, without trying to select one definition of the public good over another. Emanuel believes that "liberal communitarianism" could be the answer. Citizens, according to this view, should be given rights needed to participate in democratic deliberations based on a "common conception of the good life". For example, vouchers could be granted through thousands of Community Health Programs (CHPs), each of which would agree on its own definition of the public good. Each CHP would decide which services would be covered as basic, and which services would not be covered.