Free choice/will is an important principle of philosophy involving the dilemmas of bioethical. Personal liberty, free choice, self-determination and freedom are interchangeable terms, though on the ground of pure philosophy there are some differences amongst them. The antagonistic approaches of philosophy are fatalism and determinism. The closest and the most related antagonistic philosophical terms are paternalism versus autonomy. Free will is mainly dependent on two things which include: the moral right to act upon the chosen will of self-rule, and the ability to choose in an autonomous manner.
The debate whether individual actions are predetermined or are the result of free will can be traced to the ancient times though it has not yet been resolved. This is an ethical dilemma in the view that controversy arises out of scientific or factual substance.
The absolute determinism philosophy is general views that all occurrences, human actions inclusive are predetermined by the preceding conditions which usually make those occurrences and actions unavoidable. The predetermined influence is psychological drive, internal biological, metaphysical-divine or scientific-environmental rules. On the other hand, the notion of the freedom of the mind asserts that a human being has capability of reaching decisions independently of either metaphysical or natural controlling forces.
The alternate position of the relationship between determinism and free will about the real ability to make independent decisions recurred and developed throughout the history of philosophy and science. The most intense advocates of the fatalistic theory were the Islamic religious sect, Jews, Persians and the essences. Determinism has always been strongly developed by different philosophers among them being Spinoza, Stoicians, Schopenhauer and Kant. In psychiatry, both the behaviorism and psychoanalysis are deterministic doctrines. Philosophers have been asserting that psychic determinism is an important axiom of psychoanalysis.
There was a different development that took place regarding the human right to independence and free will. The autonomy principle has been promoted and advanced to one of the most essential and overriding the moral principles in the western culture. Self-fortitude indicates the value is ascertained on each individual to be a subject but not an object. Thus, when conflict of values emerges in a specific situation, this principle obtains precedence over the other moral values. The broad societal and philosophical emphasis on the right of human was established in the United States of America’s Declaration of Independence, and also in the Civil and Human Rights Declaration by the general assembly of France. There are no doubts that these efforts are praiseworthy and significant for self-determination in health care decision which appears undeniable. Thus, a zealous and non-conciliatory interpretation of rights in general and self-determination in specific may contribute to the vital education gap in failing to promote the requisites for the duty and the responsibility. These demands are usually obligatory for the personal refinement of one’s spiritual and moral life.
In addition, an extreme conception of independence advocating the denial of any command by others leads to the defense of anarchism making any government illicit and also offering values such as objectivity, loyalty and love inconsistent with being independent. This theory postulated that God decides the rulers and the dealings of the universe and supervises individual wants.
The ancient Jews segregated the basis of important theological disagreements into three sects:
These were the extreme proponents of the absolute fatalistic theory. The acceptance of this position precluded the basic need and right for seeking for Medicare. The Sadducee’s were of the idea of human free will and the providence of the divinity, and thus ascribing every opportunity to mere chance. The Pharisees were understood to have accepted the theory that combined divine providence and the human free will, which was a form of determinism. The theory observed that the determination of the universal actions, rule of actions and supervision of human need is done by God, though there is extensive and definite individual freedom of the mind. The theory is summarized by the sages, who are of the point of view that choice is given even though all is unforeseen. The majority of the Jewish legalists and philosophers expressed their profound belief in the man’s free will with this as an essential requirement for the moral conduct.
The Maimodes stated that any individual can choose whether to be evil or good without any divine pre-determinism. They argued that if it was not the case, the whole of Torah should be purposeless, without any justification of punishing the wicked and rewarding the righteous. The discussion between Maimodes and other Jewish philosophical scholars led to the realization of the inherent religious conflict that emerged between the God knowledge and human knowledge of the providence. The scholars proposed the methods of reconciling those ideas and also undertook several attempts of assessing the qualitative inputs of each and every one of them into a given action or the behavior.
According to the Jewish perspectives the free will should not be regarded as absolute libertadism, while the determinism should not be comprehended in an absolute fashion. This portrayed that human individual behaviors and actions are not either determined or free, but both are free and predetermined. Judaism acknowledged the ability of the freedom of the individual mind. This is what that led to the approval of the medicine in the normative law of the Jews. Talmud and his main interpreter were of the idea that medical practice engagement was permissible and disclaimed that by doing so one was abrogating the deeds of the Lord. In spite of that, the right of executing autonomous decisions had several limitations and restrictions.
The most significant difference between the current secular and the Jewish medical ethics involves the principle of autonomy. The current medical ethics has been shifting the decision making overwhelmingly from a physician to the patient and, hence, ascribing the autonomic independence to the patient in physician patient relationship. The principle of self-rule became absolute, taking the precedence over other life values and beneficence. Some of the critiques of this approach are Thomasma and Pellegrino, who were of the idea that the artistical question in clinical decisions was not whether or not individuals have the right to independent thinking, but about the proper autonomy exercise.
There was another scholar by the name of Engelhardt, who was of the opinion that self-rule and full freedom must be assured even though this seems downright offensive and devilish to others, for the maintenance of a peaceful society.
The self-rule’s rights in the libertarian perspective acquires the precedence over the good. This drawback to private morality may eventually lead to the moral atomism in which each person’s moral beliefs and deeds, unless they grow to be a bother to the peaceable community, are seen as unassailable. This led to moral debate becoming futile as each individual is his or her own arbiter of bad or good.
Thomasma and Pellegrino disapproved Engelhardt’s approach by asserting that autonomy/self-rule should not overrule all the other human values. In their perspective an ethic developed on beneficence embraces fully the nuances of the best interest of the patient.
Judaism attribute to a higher moral conduct order which obligates the society and also the individuals.
Application in the Medical Issues
The Jewish and secular thinking concerning the autonomous principle may be applied in real medical cases as shown below.
The adoption of the overriding autonomy power and hedonism has turned the practice of homosexuality into an alternative lifestyle which is legitimate. This promiscuous attitude change has come with enormous ill effect in this era of AIDS. On the other hand, Judaism was of the view that homosexuality was a serious crime which demanded eradication of the tendency. Due to this, the ongoing anti AIDS campaign methods of urging people to practice safe sex, which promotes sexual deviation, is in contrast to the advance by the Jews, which purported that there should be enormous need of enlightening campaigns against immoral life.
A moral conflict between the value of life and the principle of autonomy arises in a case of an individual committing suicide. It has been observed that suicide is regarded as a legitimate, noble and honorable act in some communities. Some secular philosophers were of the idea that principle of autonomy should be construed in a categorical intense form and, thus, override the merit of life. Others think of suicide as, prima facie, as unwise decision, and, thus, being in agreement with the principle of autonomy.
On the other hand, Judaism coaches us that the value of individual life is absolute and takes precedence over nearly all other deliberation, including personal- determination. Going by the Jewish philosophy and law, the life of a man was not at his own disposal at will. They were of the idea that the Almighty bestows the human body to an individual for them to keep it in a good state, thus, they are not their own masters to either harm or destroy their bodies. In both moral and theological considerations, the act of suicide is regarded as one of the gravest sins. Autonomy is completely waived on condition that it leads to the violation of the value of human life.
Individual Refusal to Take Treatment
The responsibility of saving the life of a dying out person is stipulated in the laws of the Jews. The approval of a life-saving therapeutic practice of proven efficacy is an ill-equipped religious and moral imperative. This is the duty of both the care giver and the patient himself. Therefore, rejection of a proficient life-saving treatment, even by a knowledgeable patient, is null, and such medical practice should be enforced. This advance is very different from the law of Anglo-Americans, which interprets the principle of self-determination in a manner that each man might, if he is of sound mind, vividly prohibit the routine of life-saving surgery.
A lethally-ill patient, especially when in pain and misery, is obliged to refuse futile treatments, intended to merely delay the time of death. This was based on the theological view that God approved the physician the consent to heal; withholding unsuccessful treatment is likened to the elimination of a factor that only put off the person from dying. However, fluid, food, and oxygen should never be withdrawn from the patient even though the autonomous wish is to do so. The removal of the above can lead to an individual being charged for murdering the patient.
The illustration above points the differences between an ethical theory and the rights ethic that requires compliance with high moral standards. A correct ethic is a minimalist ethic, based on only one general value, namely the protection of individuals liberties, denying any wish and manner, as long as does not disturb the peace of the community. This method disagrees with any other shared values of the society. The Jewish ethics ascribes to moral and religious practices and requirements, which are commonly shared and observed by all Jews, physicians and patients.