Abstract
Ethical dilemmas occur across disciplines and cultures. Many times they are so intense that people take to the courts for what they perceive as justice. However, ethics regarding many life issues are so sensitive that even court rulings still leave parties dissatisfied with the ethical outcomes. In the following pages of this document the writer will examine an ethical issue facing society for which controversial opinions have been offered based on cultural beliefs emerging from religious orientations, egotistical dispositions; greed and merely a desire to contend. Questions are always asked about the right to die and the right to live. Who decides that a fetus has the right to be born? Most often parents and in some cases society makes that decision. The fetus has no input in the matter. Similarly, if a patient is unconscious it makes relatives and society accountable for that life. Who really has the right in both cases? Perspectives regarding the right to die from a legal perspective; obligations of medical staff and family members in the process as well as opinions caring versus curing will be discussed in this research presentation.
Introduction
In introducing this very sensitive discussion concerning ethical dispensations regarding the right to die the, author wishes to bring to the reading audience’s attention a very popular incident that graced news headlines some years ago in America. It concerns a young woman by the name of Karen Quilain.
She lived between March 1954 and June 1985 being born to a single mother of American Irish ancestry. Later, she was fostered to Joseph and Julia Quinlan; a childless couple at the time. (Quinlan, 1978). At age 21 in 1975, however, after moving away from her adopted parents to live with friends; she encountered the unfortunate experience of becoming unconscious, remaining in a coma for almost ten years.
A legal battle ensued and they surprisingly won. The ventilator was withdrawn, but Karen continued breathing for nine long years unaided by any life support, eventually succumbing to pneumonia. (Quinlan, 1978). This story had been scrutinized by almost every social justice authority in the nation and perhaps, internationally to the extent that the Quinlans were pressured to tell their side of the story.
Questions relating to this issue resound around the notion, could it have been that had Karen Quilain remained on the ventilator it could have prevented her from dying of pneumonia because the lungs would have been adequately ventilated? Precisely, if this can be proven it is clear that Karen Quinlan was murdered by her parents with permission from the New Jersey Court.
Right to die -- Legal perspective
James Park (2011), an existential philosopher and advocate of the right to die offering explanations pertaining to the legal aspects of this issue submitted that there are two segments of the law. One part relates to granting permission and the second towards protecting people like Karen Quilain from premature death. With these laws now active in twenty first century judiciary, the Quilains could have been spending time in a New Jersey Jail for prematurely killing Karen (Park, 2011).
When the first law is examined, it gives permission for the use of life ending drugs. In 1990 Oregon Instituted the Death with dignity Act and has been the first and only state until, 2009, in United States of America, to have had such laws. Washington DC was the next to institute similar legislation (Park, 2011).
Included in this legislation are safeguards. It specifies that the person must be an adult; the drug must be prescribed by the attending physician; the adult must be capable of making such a decision; the attending physician must be a consultant in his discipline; the individual must receive counseling prior to the writing the prescription; family members must be informed; there must a signed consent and the medical diagnosis must be confirmed as life ending (Park, 2011).
The next segment related to banning premature death has not been yet legislated anywhere in the world. Speculations are that countries which still kill though hanging, electric chair; lethal injections and police shootings would be held responsible for murder. Precisely then, the only laws functional in America regarding the right to die are those in Oregon and Washington.
Obligations of Health Care professionals
Nurse practice acts have been designed to safeguard the life, health, property and public welfare of people from unauthorized, unqualified and improper application of services’ (General Provisions).
Categories of health care professionals often caught in the cross fire of supporting right to die decisions are physicians and nurses. Some nurses specialize in end of life care which creates more vulnerability in participating in the process by administering medications prescribed by doctors. Terminally ill patients are usually given doses of morphine which doctors believe will help the process of dying.
Again patients who have been placed on ventilators or other forms of life support and do no make any positive responses overtime forge decisions to have devices removed on the request of relatives once they cannot make the decision themselves. Subsequently, they are allowed to die.
In most situations health care professionals, depending on the category of execution are faced with a dilemma. The case study cited in the opening paragraph of this research document demonstrated obligations of health care professionals on a very sensitive issue. Doctors refused to remove the ventilator from Karen Quilain. Her parents took to the court to gain permission. But nurses continued their obligation to preserve life and continued feeding her for 9 years until she succumbed to pneumonia (Quilain, 1978)
Hence, with no laws to protect health care professionals internationally in executing right to die procedures; the obligation remains to maintain life by all means available. Assisted suicides and the purpose of health care contradict creating moral dilemmas from every paradigm which it is viewed ( Shafaer,2009).
The definition of health as espoused by World Health Organization (WHO) is that it not merely the absence of disease, but total, mental and social well being (WHO, 2011). Is assisted suicide under the right to die legislation in anyway promoting health? Clearly, it conflicts with the very philosophy of health.
There are statistics to show that since the enactment of right to die laws in Oregon 525 patients have subsequently died after taking drugs prescribed by physicians. Patients had to self administer the treatment which eliminated physicians form the process except only by way of prescription. (Public Health Division, 2010)
Rights and obligations of Family members
In the same way health care professionals have no right of administering medication to hasten death similar relatives cannot make such decision except it was documented in a living will before the patient became unconscious and cannot make a decision for him/herself.
Caring versus curing- Ethical perspectives
In an era when approaches towards nursing care is moving towards a holistic nature evidences are that curing is very much desired than merely caring. Caring denotes that people will enter nursing homes and live there either for the rest of their lives or a major portion of it. Alternatively, curing takes the nurse and health care professional outside their comfort zone towards devising strategies that will prevent patients from being admitted to hospitals and if they are reduce the length of stay to the minimal.
But, is this the goal of twenty-first century health care professionals? Do they prefer to cure than to care? Are right to die issues curative measures to reduce cost of keeping patients on ventilators and life support devices?
According to studies conducted by John Luce and Gordon Rubenfield from “Department of Medicine, University of California, San Francisco, San Francisco, California; and Department of Medicine, University of Washington, Seattle, Washington” (Luce, 2002) of the $900+ billion expended on health care in 1995, 300+ billion went to hospital care of which 20% consisted of critical care allotment.( Luce, 2002). Further, they concluded that patients who die are far more costly than those who survive. These are the many that live on life support and ventilators for years.
The hope is that with magnificent health care reform changes curative medicine becomes a priority and not a privilege for a minority of the population. Health care cost in many developed countries which are said to have the best health care technology, it is not accessible to 90 % of the population.
What use there is in advanced health care devices when health insurance coverage, Medicare and Medicaid limitations prevent the average person from embracing quality health care? United State of America has been recognized as having the most unreliable health care delivery service for developed nations. Besides the health expectancy rate of Americans have moved for 2 in 1970’s to 12 in 2011( ).
Importantly, without much speculation the desire is for curative measures offered from an ethical perspective as every citizen having the right to health quality health care services. How ethical it is for doctors to dismiss patients from clinics when their health insurance coverage is over and they are not better. Many people are left to die without medicine due to no coverage. Where are the health care professional ethics when nurses have to refuse care to patients who are in dire need due to the same reasons? What is society offering the public? It is not care nor even worse yet, no possibility of cure.
Conclusion
The foregoing pages of this research explored ethical dilemma from the perspective of right the die and legal implications for healthcare professionals as well as relatives. Besides, Oregon and Washington there are no laws in America giving health care professionals the right to administer any medication that will hasten death as is practiced in many health care institutions around the country and the world.
Precisely, the obligation of relatives; nurses and doctors is exclusively to preserve life rather than taking it either prematurely or in other form of assisted suicide. Ultimately, the desire is for an ethical approach towards accessibility of quality care health for everyone irrespective of their health insurance, Medicare or Medicaid coverage.
Consequently, the goal should be curative rather caring which definitely is costly. In situations when patients are diagnoses terminally ill a holistic approach can be adopted from the perspective of arriving at a cure.
Reference
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