Of course , the major concern here is whether that proscription against taking on a friend as a client is indeed universal , reasonable , and therefore inviolable . Kant ’ s axiom , Live your life as though your every act were to become a universal law , might be helpful here . 2 Do we wish to make our proscription on treating a friend such a universal law that it includes all possible cases and circumstances ? If we do , then the matter is settled . But we may at least consider some cases where it might be reasonable to do so : for example , in a small community where everyone is a friend or relative and there are no other healers , or during quarantine conditions , or during natural disasters or warfare . These are admittedly unusual conditions , but they make the point . The question before us now is whether treating a friend with a terminal illness is exceptional enough to also make the same point ; that it is not reasonable to make the prohibition universal .
Consequentialism , on the other hand , asks us to judge an act on its consequences , both intrinsic and extrinsic . If the balance of positive outcomes significantly , and demonstrably , outweighs the negatives , then the act is by definition ethical . 3 Clearly , we would need to know all the actions Samantha took , including whether or not she also sought referrals , kept good documentation , treated with adequate knowledge and so forth . Knowing this , it is now at least possible to say that Samantha , in treating Margaret , did not act unethically if there were no demonstrable negative outcomes . Hence , we would be justified in saying that pushing the boundaries allowed Samantha to treat a dying friend .
Again , our difficulty lies in knowing all the actions that Samantha took , and in judging whether they led to positive or negative outcomes . For example , did the cooking and cleaning Samantha did while in Margaret ’ s home have positive or negative results on the therapeutic relationship ; did it erode Margaret ’ s view of Samantha as a professional , or enhance it ? If Samantha did refer Margaret to a person with skills in palliative care , did this referral enhance or devalue that therapeutic relationship ? How emotionally and psychologically beneficial was it to Margaret to be treated by a friend in her dying days ?
Ethical Principles approach
Among the large number of relevant ethical principles available to us , I would like for purposes of brevity to consider only three well known and generally accepted ones ; beneficence and nonmaleficence considered together , and justice .
Beneficence is commonly taken to be the quality or state of doing or producing good . Nonmaleficence is the principle which holds that there is an obligation not to inflict harm on others . It is closely associated with the maxim primum non nocere ( first do no harm ). In her treatment of Margaret , Samantha should be attempting to do good while avoiding doing any harm , either accidentally or by omission . Keeping in mind that Margaret is in an end-of life-situation , what harm can Samantha do beyond making those last days more uncomfortable , less dignified , more painful or traumatic than necessary or inevitable ? We need to be careful here . Samantha has taken on a dual role , as both friend and therapist . Margaret sees her as both , and so both roles will possibly affect the answer to that question . Cooking and cleaning might make Margaret ’ s last days more stress-free and comfortable , but if they take time away from actual therapeutic care , they might actually make those final days more uncomfortable . Or , take the issue of correct documentation . If Samantha did not take the time to fully and accurately complete the required documentation , this may or may not matter to Margaret ’ s end-of-life care , unless Samantha decides to hand her care over to another . Even were it to become a question for the coroner , that will not have affected Margaret .
Justice : For the purposes of this paper , I will confine our use of the term justice to that aspect which concerns the distinction between equality and equity . Equality means each individual or group of people is given the same resources or opportunities . Equity recognises that each person has different circumstances and allocates the exact resources and opportunities needed to reach an equal outcome . We are asking if justice is being served here if Samantha is pursing the notion of equity , recognising that Margaret ’ s terminal illness is a special circumstance that demands the allocation of special resources ( such as working outside her office ) and opportunities ( to work with a close friend in her time of greatest need ) to ensure that Margaret gets care equal to those not in her circumstances .
In short , we can argue against the deontological position by denying that the prohibition against treating a friend is a reasoned imperative . Consequentialism can be shown to lead to the conclusion that treating a friend is ethical if the positive consequences outweigh the negative . Beneficence , non-maleficence , and equity allow us to say that Samantha has acted according to valued ethical principles .
You can see that I am building up a series of arguments that would allow me to suggest that Samantha is acting ethically despite pushing the boundaries of her given code of conduct . Under the prescription that depiction does not imply agreement , it is a position that can be established logically but not defended legally or practically , given the lack of detailed information in the case study . This is an important point here . We have had to make several assumptions all the way through the discussion of the case study . If we make one set of assumptions , we feel that we can justify Samantha ’ s actions ; another set licenses us to condemn her as unethical , if not also in violation of the law .
Intentions
What if we inquired into Samantha ’ s intentions to see if they would help us make a decision ? Again , we are
202 | vol28 | no4 | JATMS