What is morally permissible, and what is morally obligatory? These questions form the core of a vast amount of philosophical reasoning. In his Fundamental Principles of the Metaphysics of Morals, Immanuel Kant developed a basis for the answers. In this landmark work, the German philosopher asks what sort of maxim might function as a guide to appropriate action under a given set of circumstances. By universalizing such a maxim, would morally permissible behavior not become clear? Suppose that everyone were to (...) behave in accordance with this maxim. If everyone followed the maxim in the same way without harm to civilized culture, then the behavior would be morally permissible. But what if no one followed the maxim? Would civilization thereby be at risk? In such a case, the behavior would be morally obligatory. Kant's test, known as the Categorical Imperative, is a logical proof of the Golden Rule and the centerpiece of this work. It constitutes his best-known contribution to ethical discussion, and a familiarity with his reasoning in this book is essential to students of philosophy, religion, and history. (shrink)

Approximately 400,000 people die outside US hospitals or chronic care facilities each year. While there has been some recent movement towards initiating procedures for prehospital Do Not Resuscitate (DNR) orders, the most common situation in the US is that emergency medical systems (EMS) personnel are not authorized to pronounce patients dead, but are required to attempt resuscitation with all of the modalities at their disposal in virtually all patients. It is unfair and probably unrealistic for EMS personnel to have to (...) make a determination of the validity of a non-standard prehospital DNR order (for example, a living will or a durable power of attorney for health care). Existing prehospital DNR protocols range from being very restrictive in the scope of patients allowed to participate and in their implementation, to those that are more liberal. Potential benefits of prehospital DNR orders include freeing up vital personnel and material for use by those who would more fully benefit, and alleviating the enormous emotional strain on patients, families, EMS personnel, and hospital medical staffs involved in unwanted resuscitations that only prolong the dying process. Given this, prehospital DNR orders present several legal and moral problems. These include proper patient identification, the nature of the document itself, precautions incorporated into a DNR system to prevent misuse, potential liability for EMS and hospital personnel, and potential errors in implementation. Functioning prehospital DNR systems need to include: 1) specific legislation detailing the circumstances in which such a document could be used, the wording of such a document, and protection from liability for those implementing the document's directives; 2) having the currently valid document immediately available to the EMS personnel or base station doctors; and 3) acceptable means of identifying the patient. Relatively few US jurisdictions as yet have a prehospital DNR order system, although it is an idea whose time is overdue. Society's imperative to use available technology has pushed us into a situation where a technique to save those with a potential to continue a meaningful and wanted existence is being used indiscriminately to prolong the agony of death. (shrink)