Nursing and the Ethical Quandaries of Euthanasia
Nursing is one of the most delicate professions since it deals with the preservation of human life, hence it is fraught with ethical and moral quandaries. Nursing trends, the development of new treatment methods, and the advent of new diseases, such as terminal illnesses, have resulted in the legalization of euthanasia, an act about which people on both sides have differing opinions and worries. Depending on which side of the debate one takes on physician-assisted suicide, valid arguments appear to emerge, leaving the concept of euthanasia as a healthcare quandary. Nurses are currently offering patient-centered care, which means they are providing interventions based on the client's health needs. Some patients in a hospital setting have terminal illnesses, and nothing can be done to improve their health or evade death that is to come. Such conditions include heart failure, chronic lung problem, kidney disease, strokes, and AIDs (Murphy, 2015). In most cases, when these diseases become severe, patients experience extreme pain making them request for termination of their suffering and the only solution for this is a peaceful death. In such a situation nurses have few choices and depending on the policy of the healthcare facility, the professional requirements and legal dictation concerning euthanasia the nurse and the doctor will have to act. Before the execution of the act, all the relevant forms and consolations from the relative and surrogate decision maker of the patient have to be made. If the patient requirement cannot be executed, valid reasons have to be given to the patient, and interventions are done to reduce the amount of pain experienced.
The Ethical and Moral Issues Surrounding Euthanasia
The actual ethical issue surrounding mercy killing or physician-assisted death is that people view it as murder since no has the right to take the life of another. The relatives and friends of the client who underwent euthanasia are the ones who have this issue especially if their say did not count before the execution of the procedure. Most people would wish to see their close ones die a natural death to avoid the memory murder. Another actual thing is that to some nurses it is not morally and ethically right for them to exercise euthanasia. The potential ethical issue is that nurses and doctors who conduct euthanasia might be going against cultural and religious beliefs, casing the people who follow the beliefs to despise them (Murphy, 2015). Therefore, some individuals might fail to seek healthcare services from the hospitals where their relative or friend's life was terminated. Also, some of these individuals might decide to take legal steps towards the doctors and the nurses who were involved in the procedure of evoking euthanasia. These can have negative effects on healthcare providers since they will be spending times in courts answering cases instead of serving patients in the hospital. As a result, some of the health workers might fear or be discourage to conduct physician-assisted death.
Legalization and Practices of Euthanasia in Different Countries
Steck, et al. (2013) addressed Legal in some European countries and US states, physician-assisted suicide, and voluntary active euthanasia remain under debate in these and other countries. A total of 1043 publications were identified; 25 articles and reports were retained, including series of reported cases, physician surveys, and reviews of death certificates. The percentage of physician-assisted deaths among all deaths ranged from 0.1%-0.2% in the US states and Luxembourg to 1.8%-2.9% in the Netherlands. Percentages of cases reported to the authorities increased in most countries over time. The typical person who died with assistance was a well-educated male cancer patient, aged 60-85 years. Despite some common characteristics between countries, we found wide variation in the extent and specific characteristics of those who died an assisted death.
The Future of Assisted Death in New Zealand
Based on current trends internationally, it is entirely possible that AD will be legalized in New Zealand in the foreseeable future, and it is vital that the health professions be prepared for that situation. While no survey can claim to be entirely representative of the population surveyed, the results show that there is a substantial cohort of doctors and nurses in New Zealand who support legalizing AD, potentially sufficient for reasonable seeker access to AD services once legalized (Oliver, et al., 2013).
Current Legality of Euthanasia and Physician-Assisted Suicide
Currently, euthanasia or physician-assisted suicide can be legally practiced in the Netherlands, Belgium, Luxembourg, Colombia, and Canada. Physician-assisted suicide, excluding euthanasia, is legal in 5 US states (Oregon, Washington, Montana, Vermont, and California) and Switzerland. Public support for euthanasia and physician-assisted suicide in the United States has plateaued since the 1990s (range, 47%-69%). In Western Europe, an increasing and strong public support for euthanasia and physician-assisted suicide has been reported; in Central and Eastern Europe, support is decreasing (Emanuel, et al., 2016).
Euthanasia and Physician-Assisted Suicide: A Perspective from Psychiatry
Euthanasia and physician assisted-suicide are terms used to describe the process in which a doctor of a sick or disabled individual engages in an activity which directly or indirectly leads to their death. This behavior is engaged by the healthcare provider based on their humanistic desire to end suffering and pain. The psychiatrist's involvement may be requested in several distinct situations including evaluation of patient capacity when an appeal for euthanasia is requested on the grounds of terminal somatic illness or when the patient is seeking euthanasia due to mental suffering. We compare attitudes of 49 psychiatrists towards euthanasia and assisted suicide with a group of 54 other physicians using a questionnaire describing different patients, who either requested physician-assisted suicide or in whom euthanasia as a treatment option was considered, followed by a set of questions relating to euthanasia implementation (Levy, et al., 2013).
Palliative Care, Euthanasia, and Physician-Assisted Suicide
Main topics of the white paper are concepts and definitions of palliative care, its values and philosophy, euthanasia and physician-assisted suicide, key issues on the patient and the organizational level. The consensus process confirmed the 2003 European Association for Palliative Care white paper and its position on the relationship between palliative care and euthanasia and physician-assisted suicide. The European Association for Palliative Care feels that it is important to contribute to informed public debates on these issues. The complete consensus seems to be unachievable due to incompatible normative frameworks that clash (Radbruch, et al., 2013).
Theories and Principles of Euthanasia in Relation to Nursing
Utilitarian Theory
This theory advocates for an action that yields results that would lead to the happiness of the greatest number of people involved. Therefore, the approach of utilitarian would only allow mercy killing if the greatest number of the friends and the relatives of the patients allow the action to be conducted to the patient. Thus, if the client wish to die and a small number of the family members object the decision, the physician will have to conduct euthanasia (Vaughn, 2015). This theory does not rely on the patient's decision or views from the healthcare providers. It focuses on those who will be directly affected by the decision.
Kantian Theory
This theory suggests that everything that is done should be taken as universal law. Therefore, it discourages euthanasia because when executed is like encouraging murder or accepting it as a new behavior of manslaughter. Thus, people who follow this law cannot allow the action to be conducted on their patient. Additionally, even a government institution that uses the Kantian approach can make it illegal for physicians to perform a mercy killing. On the other hand, this approach does allow murder but only limited to some situation. For example, when someone is killed for killing another person is acceptable to individuals who acknowledge this theory. In other words, it approves retributivism. The argument under this approach is that mercy killing breaks the code seal of killing and hence killing would be acceptable in all forms (Vaughn, 2015).
Principles involved in euthanasia
The principle of autonomy states that a competent patient has the right to decide on medical interventions to be carried out on his or her behalf. Therefore, if the patient is in the right state of mind, and have decided to undergo through the processes of euthanasia as a result of having a terminal illness, then he or she should be granted the wish. On the other hand, the decision should be evaluated before it is executed since some patients might be acting out of malice. The doctor or the nurse should educate the nurse about the benefits and the consequences of the decision they have taken and if the patient is certain the right procedure is followed. It is required that the health care providers inform the relatives and friends t the patient about the issue (Johnson, 2015). They should be given a chance to talk to the patient and say goodbyes or write a will. The procedure should be conducted as directed by the patient after the advice from the nurse.
The other principle of euthanasia is beneficence. This principle is supposed to guide the nurses and other healthcare providers to act only on the benefits of the patients and avoid causing harm. Therefore, when a patient has requested for life termination, the physicians should not consider the act of relieving the pain of the patient as well as minimizing the hospital stay period which is normally expensive. It is unethical for a healthcare worker to think of letting the patient live for a long period with pain and despair so that upon death a high amount of money can be charged. Additionally, the nurse advising the nurse should provide information that would benefit the patient and the family, and hence he or she should not misguide the client (Johnson, 2015).
The principle of non-maleficence states that one should refrain from the action that could cause harm to another. This means that in a hospital setup, the nurse should not ignore the request of the patient who is in agony and desperately asking for help. Therefore, the actions of all healthcare providers should be to help the patient and relative to be at peace. It is painful for the friends and relatives to a patient witness their loved one suffer in pain, and nothing can be done to help (Johnson, 2015). Alternatively, the patient's surrogate decision maker and relatives should not be selfish and deny the patient the chance to die peacefully by directing the nurses and doctors not to conduct euthanasia. They should encourage the efforts to relieve patient's pain.
The Application of Ethical Theories and Principles in Nursing
Relation of the theories and principles to nursing
The theory of utilitarian allows the nurses to conduct euthanasia if at all the action will be beneficial to the greater number of those related to the client. Therefore, the nurses here should concentrate on finding whether it is right for the higher number of patient's relatives. The Kantian approach discourages mercy killing, and hence according to this theory, the nurses should refrain from euthanasia since it is murder. All the three principles, beneficence, autonomy and non-maleficence protects the interests of the patient and directs the nurses to help the patient be at peace. Also, the nurses should avoid all the actions that might cause harm to the patient or those related to patients and hence he or she should be considerate of all possible outcomes and make the best decision.
The Role of Nurses in Making Ethical Decisions Regarding Euthanasia
Resolution
Nurses should apply different ethical theories and principals involved in nursing to guide them in making an informed decision concerning euthanasia. Also, before the nurses conduct mercy killing, they should consult the people associated with the patient and consider their views about this action. Also, there should counsel the patient to ensure that he or she has made a wise decision. All the decision made should be to benefit the patient and the relatives.
In Conclusion
Euthanasia has posed a dilemma that has not been solved entirely and hence proper actions should be taken to ensure that a proper decision as to whether to uphold or to drop the exercise is made. Different people in different areas have various insights and reasons that should be analyzed and evaluated such that a conclusion is drawn. In the meantime, nurses should follow all the professional ethics and requirement while making a decision on euthanasia as well as the legal requirements of the state.
References
Steck, N., Egger, M., Maessen, M., Reisch, T., & Zwahlen, M. (2013). Euthanasia and assisted suicide in selected European countries and US states: systematic literature review. Medical care, 51(10), 938-944.
Oliver, P., Wilson, M., & Malpas, P. (2017). New Zealand doctors' and nurses' views on legalising assisted dying in New Zealand. The New Zealand medical journal, 130(1456), 10.
Emanuel, E. J., Onwuteaka-Philipsen, B. D., Urwin, J. W., & Cohen, J. (2016). Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe. Jama, 316(1), 79-90.
Levy, T. B., Azar, S., Huberfeld, R., Siegel, A. M., & Strous, R. D. (2013). Attitudes towards euthanasia and assisted suicide: a comparison between psychiatrists and other physicians. Bioethics, 27(7), 402-408.
Radbruch, L., Leget, C., Bahr, P., Müller-Busch, C., Ellershaw, J., de Conno, F., & Vanden Berghe, P. (2016). Euthanasia and physician-assisted suicide: a white paper from the European Association for Palliative Care. Palliative medicine, 30(2), 104-116.
Vaughn, L. (2015). Doing ethics: Moral reasoning and contemporary issues. WW Norton & Company.
Johnson, T. (2015). Frances M. Kamm, Bioethical Prescriptions: To Create, End, Choose, and Improve Lives. Reviewed by. Philosophy in Review, 35(1), 23-25.
Murphy, S. T. (2015). A Bureaucracy of Medical Deception? Falsifying Death Certificates in Euthanasia/Assisted Suicide Cases: Quebec's New Euthanasia Law Raises Questions.
