Smebye, K. L., Kirkevold, M., & Engedal, K. (2016). Ethical Dilemmas Concerning Autonomy When Persons With Dementia Wish To Live At Home: A Qualitative, Hermeneutic Study. BMC Health Services Research, 16, 21. doi:10.1186/s12913-015-1217-1

Introduction

Generally, in every decision-making situation that involves human life and welfare, there is usually an ethical issue or dilemma that arise. In this regard, several scholars and researchers have written informative articles about ethical issues and most importantly ethical dilemmas. In this article above, the authors of the article’s point of reference were on the ethical dilemmas that impact the autonomy of individuals specifically when dealing with people suffering from dementia but wish to live in their homes.

In this qualitative hermeneutic study article, it is notable that Smebye et al. 2016 denotes that basically, providing services and taking care of people suffering from dementia is a challenge to the caregivers and that it becomes a more significant challenge when the same people are living or wish to live in their homes away from the health facilities. Fundamentally, Smebye et al. 2016 point out that the primary concern triggers ethical dilemmas when it comes to the notion of having to balance between the principles of autonomy and the safety or well-being of the patients. Ostensibly, the key terms in this article revolve around the ethical dilemmas, autonomy, dementia and the concept of both beneficence and non-maleficence.

Smebye et al. 2016 identify that patients autonomy have a conflict with the need of the caretakers to avoid misuse on patients which is the principle of non-maleficence, conflicts with the family carer’s autonomy and also conflicts with the beneficence of the professional caregivers. Summarily, the major ethical dilemma in this article is primarily about the autonomy and persons with dementia and wishes to live at the residence. The difficulty here was that the caretaker had to select between the best process of activity by either following a patient’s autonomy or being guided required principles; as much as dementia have their rights and autonomy to decide where to live, it is notable that it will be valuable if valuable care is provided with an implication that they depend on others.

Applying Kant’s Categorical Imperative

In considering the ethical dilemmas captured in the above-annotated article by Melbye et al. 2016, several issues are highlighted. Firstly, it is essential to identify what involves Kant’s Categorical Imperative. It is a concept that supposedly provides a method in which individuals may evaluate their moral actions in decision making or giving moral judgments otherwise referred to as the concept of assessing a morally relevant activity. According to Immanuel Kant, the concept of categorical imperative denotes the notion of deontological moral philosophy that encompasses the methods of evaluating what motivates actions for human beings(Robinson,2019). A form of the categorical imperative is what poses that absolute or an unconditional obligation that one has to obey in any situation and is equally justified.

According to Kant, this type of imperative as compared to hypothetical and moral imperatives fundamentally expresses that an action is needed when it is objective, for itself and no any other thing or purpose and is best described as “acting only according to that maxim by which one can or will that it should be made a universal law”. Under the concept of categorical imperative, it is notable that Kant had a number of formulations, for instance, he denotes that a person should “act in such a way that you treat humanity, whether in your person or in that of another, always at the same time as an end and never merely as a means “(Robinson, 2019). Looking at these formulations by Kant, one can note that categorical imperatives are all about sacrificial ethics.

Furthermore, in relating this ethical dilemma in the article above, Kant’s views were that generally, human beings are rational beings that are self-conscious with a myriad of choices and mindset to have a freedom of choice that is innate. The dilemma here equally touches on the concept of freedom of choice and autonomy. Kant posits that democracy is a will that has the capability of affecting causal power without being necessarily triggered but has to occur under the provided laws. In the same breath, Kant posits that freedom creates a concept of a person ascribing to the notion of moral responsibility which is the moral autonomy.

The dilemma highlighted here is that professional and family caregivers are conflicted whether to allow dementia patients to live at home or to be admitted in caregiver health facility and institutions. If Kant’s categorical were applied in this scenario, the caregivers would have the liberty and authority not to discharge the dementia patients to live at home despite their autonomy and freedoms. The rationale is that according to Kant on his views to ethics, anything imperative is that thing that a person has to compulsory do. Kant gives an example of a thirsty man; that if an individual wants to stop thirst, they have to drink water in what he refers to that it is imperative that the person has to drink water(Robinson, 2019). To avoid ethical dilemmas and help the patient with dementia, the caregivers are thus justified to retain the patients rather than allowing them the wish to live at home.

Additionally, in considering Kant’s formulations under categorical imperative, it is notable that there is the first formulation which creates a maxim idea which was an explanation by Kant to elaborate his idea of the categorical imperative. Under the maxim as mentioned above, a person has the liberty of saying what he wants to do and at the same time do it simultaneously. Ostensibly, this maxim is critical in decisions making and living an ethical life. Fundamentally, by refereeing to this maxim and the case scenario of a thirsty man drinking water, it is evident that this concept will solve the ethical dilemmas highlighted in the annotated article above (Kohl, 2015). The rationale here is that as a caregiver with the duty to make decisions or choices that may be formed on behalf of the patients; their choices are justified so long as it is for the best interest of the patients considering the circumstances of the sickness and the incapacity to make an informed decision.

In the same breath, Kant under the concept of categorical imperative indicates that decisions are based on morality. Further, the great philosopher also means honesty in a choice is founded on the reasons why a person makes a decision or a choice otherwise referred to as an intention, it is not grounded on what will happen, or the consequences after the decisions are made or action taken. This reasoning solves the ethical dilemma highlighted by Smebye et al. 2016 in their article in regards to patients with dementia. In the same lane, Kant also highlighted on the issue of making ethical decisions where he notes that moral decisions are not necessarily rules or binding laws, they can be adjusted to suit the situation or to derive more benefits especially for the patients(Kohl, 2015). However, the only rationale is that at any moment ethical decisions made ought to be logic, or reasonable and that in dealing with people, one should treat other individuals as people and not as tools.

Conclusion and Recommendation

In a nutshell, it is worth noting that categorical imperative is a derivative of what is referred to as the major foundation of morality. The rationale in this concept is that in a situation of making a decision, morality is usually invoked especially in choosing an action or process that is right and ignore an act or a merely pleasing process. The guiding principle or formulations in categorical imperative is that anything useful to a person should be good to the universe and vice versa(Kohl, 2015). Basically, in addressing the ethical dilemmas, the right decision should be pursued as long as it is good for both individual and universe even if it may not be pleasing at the moment.

As a recommendation, therefore, in any given situation that requires decision making, the right decision should be the guiding principle, it does not necessarily have to be a pleasing decision. In the problem highlighted in the annotated article, the best option would be to retain the dementia patients in facilities with the full attention of professional caregivers other than letting them have their wish to stay at home. Even if allowing their autonomy and wishes to be affected is pleasing, it is not the right decision.

References

Kohl, M. (2015). Kant on determinism and the categorical imperative. Ethics, 125(2), 331-35686.

Robinson, R. M. (2019). Kant’s Categorical Imperative and Moral Duties. In Imperfect Duties of Management (pp. 11-38). Palgrave Macmillan, Cham.