One very debatable ethical dilemma in today’s society is euthanasia. Euthanasia, like any other medical treatment should be seen as a choice. As a society, there are obligations to the sick that should be up held, but morally and legally may not be supportable. There are many aspects that go with this choice besides the obligation. There are also stakeholders to consider as well as social values, morals and religious implications. Euthanasia is Greek for good death which translates into English as easy death or mercy killing. It was accepted by the ancient Greeks and Romans. Three Asian religious traditions accept euthanasia: Buddhism, Shintoism, and Confucianism. It was rejected by the 3 main monotheistic religions: Christianity, Judaism and Islam. It has its supporters and opponents in all countries. Two types of patients are involved in euthanasia: (a) a patient in a persistent vegetative state who is awake but is not aware of self or the environment.
Such a patient has no higher brain functions and is kept alive on artificial life support (b) patient in terminal illness with a lot of pain, psychological suffering and loss of dignity. The patient may or may not be on life support. There are different types of euthanasia. Active euthanasia, an act of commission, is taking some action that leads to death like a fatal injection. Passive euthanasia, an act of omission, is letting a person die by taking no action to maintain life. Passive euthanasia can be withholding or withdrawing water, food, drugs, medical or surgical procedures, resuscitation like CPR, and life support such as the respirator. The patient is then left to die from the underlying disease. Sometimes a distinction is made between normal nutrition and hydration on one hand and medical nutritional support involving intravenous and naso-gastric feeding on the other hand. Euthanasia can be by the patient or by the health care giver. Euthanasia can be voluntary when the patient takes the decision, non-voluntary when the decision is made by another person for an unconscious patient and involuntary when the decision is made contrary to the patient’s wish.
There are ethical implications of European and American arguments for and against euthanasia. Two arguments are made for active euthanasia: (a) mercy killing because of pain, psychological and physical suffering (b) the utilitarian argument is that euthanasia is desirable because it relieves the misery of the terminally ill. Two arguments are made against active euthanasia: (a) killing is morally wrong and is forbidden by religion (b) unexpected cures or procedures may be discovered to reverse the terminal condition. Nurses are the gatekeepers of the healing facility, although they may have their own outlooks based on their own ethical, cultural, and religious views (LeBaron, 2010). There are always value conflicts when it comes to euthanasia, which can be demonstrated by examining utilitarianism and rights. The nursing practice should be to keep patients alive, do no harm, do everything possible to save the life, and do good to everyone by respecting the right or autonomy of the individual patient.
Although most of Americans presently think that physician-assisted suicide should be legal and no existing federal laws prohibiting the practice of euthanasia in United States, voluntary/assisted euthanasia is yet considered illegal and killing in all of the States but in Oregon, Washington, and soon Montana (Webster, 2009). First, Oregon and recently Washington passed a Death with Dignity Act and are actually the only places where euthanasia in terminally ill patients is legally and openly authorized (Blizzard, 2012). In 2009’s Baxter v. Montana case, the Montana Supreme Court declared that no law in state constitution stops patients from practicing voluntary/assisted euthanasia (O’Reilley, 2010). Any time the legislature can act to join Oregon and Washington in the public arena. According to both States’ laws, an adult competent patient must address three witnessed solicitations, two verbally and one in writing, to his/her attending physician for a fatal medication. Then the patient administers the dose on her/ his own.
Obviously, the Death with Dignity Act unambiguously bans assisted euthanasia that obliges another person than the patient to take part in administering the medication (Exit International Australia, 2012). As euthanasia is observed from a diversity of different perspective, the stake holders’ opinions are considered. In front comes the patient who wishes and requests to discontinue her/his life in respect to human right to select the time and manner of death when she/ he is terminal ill by stopping unwanted, burdensome and/or futile medical treatment. Other people entrusted with the euthanasia dilemma include physicians/healthcare professionals, the family, insurance companies, religious groups, and the government. The second stakeholder is families that have to admit and follow the desires of their loved one to die in nobility. The involvement in this kind of decision may be an unbearable load for some families who would be would be either not ready to let their darling one go, which could generate a catch-22 mainly if they are bending patient’s wishes, or emotionally scarred by the death.
Other stakeholders in this situation are physicians and other practitioners who might come across a real impasse because the euthanasia breaches the “do no harm” Hippocratic Oath. The insurance companies may drive the patient in opting for death to conserve the money on an individual who does not hope of staying alive. Some religious groups are against euthanasia and consider it a suicide. Lastly the government intervenes in the stake holder in this state of affairs in defensive position for citizen from illegal measures. Voluntary/assisted euthanasia is an ethical dilemma, and creates issues and disagreements amongst those involved (Gore, 2012). Netherland and Belgium are the two countries in the world to legalize euthanasia. In the US, Oregon and Washington also legalized euthanasia. The main barriers to legalize euthanasia are the government, religion, fear, education and the media. More religious people are against euthanasia.
Education also plays a major role in euthanasia. The more education a person has he/she believes all individuals have the right to autonomy and therefore the person has the right to decide to end their life. Euthanasia has pros and cons. Pros include relief from pain, relief from low quality or vegetative state of life, relief from financial strain on health care system and the resources can be used for other people. The cons include family members can kill another family member if they don’t like them or reduce financial burden, loss of respect of human life and according to religious view God can only choose when to end life. In Euthanasia legalized countries, such as palliative care nurses in Belgium have important roles and responsibilities in working with euthanasia requested by patients and their families. The nurse involvement starts when the patient requests to euthanasia and ends by supporting family and loved ones.
They are in key positions to provide valuable care to the patient and family. Nurses assist the health care team after the life threatening procedure. Pain management and comfort care are their main goals at that time. Nurses are open-minded and have unique relationships with the patient and family. “In the twentieth century, a number of social and technological changes made euthanasia a morally acceptable choice to growing numbers of people” (Wells, 2006). There are two types of ethical theories that are going to be focused on. The first is utilitarianism, which is an action that is morally correct if its consequence is good for the greatest numbers. It generally focuses on the greatest good for the greatest number, and neglects the individual rights. The other theory is called deontology, which takes into consideration the way something is to be done and not just on the consequences of that action. One may tell a lie to the doctor, just to save a friend but doesn’t think of the grave consequences they have to suffer later on.
A person making a voluntary euthanasia uses the utilitarianism theory when making such a judgment. One might choose to voluntarily do euthanasia if the person has reached an all-time low and the only other option is to the act. The person has to have thoroughly thought about the consequences and make sure his or her judgment is not biased or is not taken personal. There are certain conditions that apply for one to request voluntary euthanasia. Conditions are an unlikelihood of recovering from a cure, suffering from a terminal illness, and most importantly, they must have a voluntary wish to die. As can be seen by the multiple views of the authors, euthanasia is not an easy topic to side on. Due to many religious beliefs, one may feel euthanasia is wrong. But as a nurse that sees suffering every day, this same person would support euthanasia if not condemned by his/her religion. With the support of the ‘do no harm’ belief, it can also be construed that assisting in euthanasia is not doing harm, but preventing harm for those with chronic severe pain. There is no nationwide movement for the majority of the states to legislate for euthanasia, but thankfully there are two, soon to be three compassionate states that have in-acted this law.
Blizzard, R. (2002). Right to die or dead to rights? Retrieved from http://www.gallup.com/poll/6265/Right-Die-Dead-Rights.aspx?version=print Euthanasia: The nurses role (2011). Issues in nursing. Retrieved on 10/3/12 from Nursing students 417.wordpress.com
Exit International Australia (2012). Death with Dignity in Oregon (soon to be Montana. Retrieved from http://www.exitinternational.net/page/USA Gore, J. (2011) Stakeholders in Euthanasia. Retrieved from
http://jacktgore.edublogs.org/2011/08/03/stakeholders-in-euthanasia/ LeBaron Jr, G. (2010). The ethics of euthanasia. Retrieved October 3, 2012, from http://www.quantonics.com/The_Ethics_of_Euthanasia_By_Garn_LeBaron.html Purtilo, R., & Doherty, R. (2011). Ethical dimensions in the health professions (5th ed.). St. Louis, MO: Elsevier. Task Force on the Nurse’s Role in End-of-Life Decisions, 2011. (2011). Journal of Social Work Values and Ethics, 8(1). Webster, B. (2009). Assisted Suicide/Voluntary Euthanasia. International debate education association. UK. Retrieved from http://www.idebate.org/debatabase/topic_print.php?topicID=55 Wells, K. R., Frey, R. (2006). The gale encyclopedia of nursing and allied health ed. In J. L. LONGE (Ed.), (2 ed., Vol. 2, pp. 993-996). DETROIT, GALE
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