Introduction
Euthanasia is the act of providing assisted, voluntary or involuntary death to a patient, mostly terminally ill patients (ANA, 2013). Euthanasia can be administered by the physicians and nurses on request of either the patient, the relatives of a patient who is not in a position to make a request or by the physicians and the nurses depending on the condition of the patient. Euthanasia is an issue that has raised questions not only in the health care system but also in the legal system (ANA, 2013). It is surrounded by moral, social, cultural and religious challenges and finding a common ground to accommodate all the diversities has proven a difficult task for the legal and medical systems (Arries, 2005). Nurses, in their capacity, have the responsibility of providing care to the patients by providing empathetic to end of life care to their patients (ANA, 2013). However, this end of life care may sometimes be contradicted by the wishes of the patients, their families and relatives and the general health care system leaving the nurses and physicians in a moral dilemma regarding euthanasia. This paper will, therefore, discuss euthanasia and the moral dilemma facing nurses in regards to euthanasia.
Euthanasia and Moral Dilemmas
This is the act of offering assisted termination of life by a physician or a nurse at the request of the patient, the patient’s family or relatives or the medical center that the patient is in. euthanasia is allowed in some countries, where in others it is totally banned (Claessens, Menten, Schotsmans & Broeckaert, 2011). However, even in the countries where it is banned reports show that it is still carried out mostly at the discretion of the patients, the health care professionals and the relatives and families of the patients (ANA, 2013). There are different forms/types of euthanasia that can be performed on a patient. Euthanasia can either be voluntary or involuntary. If a patient voluntarily asks for assisted death, then it is voluntary euthanasia (Claessens, Menten, Schotsmans & Broeckaert, 2011). On the other hand, if the patient is not in a position to make their own decision as to life or death, but the choice to die is made by another person, it is called unvoluntary euthanasia (Suter & Hertwig, 2011). The patient may choose to live, but is killed anyway and this is referred to as involuntary euthanasia (DeKeyser & Berkovitz, 2012)
Euthanasia can also be either active or passive. If a nurse or physician deliberately causes the death of a patient, then it is considered active euthanasia. Although the care giver doesn’t directly kill the patient, he/she may take give an overdose to the patient and this fastens death (Suter & Hertwig, 2011). This contradicts with the ethical clause of providing care through end of life to a patient as stipulated in the code of ethics for nurses (Claessens, Menten, Schotsmans & Broeckaert, 2011). On the other hand, a caregiver can withdraw or withhold treatment for a patient who really needs it to survive. Different cultures, religions and societies hold different views as to which euthanasia is morally correct (Claessens, Menten, Schotsmans & Broeckaert, 2011).
While others argue that euthanasia is compassionate care because it offers relief from pain and suffering, the proponents of the same argue that it is morally wrong to perform euthanasia because it clashes with the ethical requirements of a nurse (Arries, 2005). Other terms used in reference to euthanasia include indirect euthanasia, assisted suicide and doctrine of double effect. Indirect euthanasia occurs when a patient is given medication that can bring death to them much faster (Claessens, Menten, Schotsmans & Broeckaert, 2011). Assisted suicide happens when the patient wishes to die but they are not in a position to make it happen on their own and therefore asks for the help of the physician or the nurse. The nurse acts as a facilitator to the death by providing the patient with medication or other resources that facilitate a quicker death. However, since the nurse is aware of the intentions of the patient and actually facilitates it, it is considered a breach of the Hippocratic Oath (ANA, 2013). Doctrine of double effect is used to refer to the use of one method to carry out two actions consecutively, for example, giving a patient pain reliving medications that hasten their death (Arries, 2005).
Proponents of euthanasia argue that the dignity of a patient should be maintained even through death. However, it presents a dilemma to the nurses since dignity of a person’s life cannot be preserved by taking a person’s life, whether directly or indirectly (McCormack, Clifford & Conroy, 2010). Neither can it be maintained by having a patient endure through great amounts of pain and suffering until they die. Proponents of the same also argue that euthanasia qualifies as compassionate care for the patients when a nurse aids the patient to die in a bid to reduce their suffering (McCormack, Clifford & Conroy, 2010). Nursing code of ethics stipulates in its first section (1.3) that a nurse should “alleviate suffering” and “meeting the comprehensive needs of the patient and their families across the continuum of care” (1.3). If a nurse alleviates the pain and suffering of a patient through euthanasia, is it morally right or wrong? This is a dilemma that nurses, especially working in palliative care have to deal with (ANA, 2013).
Proponents also argue euthanasia in terms of who stands to gain. Euthanasia may be carried out in respect with the patient’s wishes, or to alleviate prolonged pain and suffering for the patient (Arries, 2005). However, a medical insurance company may decide for the termination of a patient’s life in order to save on medical costs of treatment and management of an illness (DeKeyser & Berkovitz, 2012). On the other hand, the family and relatives of a critically ill patient may request euthanasia either to respect the wishes of the patient or to simply save on the piling medical costs (Arries, 2005).
On the other hand, opponents of euthanasia argue that life is precious and every person should be given the chance to die naturally. Palliative care purposes to give holistic care to patients up to the point of death while relieving pain and suffering for the patient (DeKeyser & Berkovitz, 2012).ANA, (2013), describes palliative care as the alternative for euthanasia and adds that legalization of euthanasia contradicts the purpose and code of ethics of nurses and might reduce availability of palliative care. They also argue that legalizing euthanasia is according the doctors too much power, appointing them to play God to decide when and how a person dies (Skar, 2010). The sanctity of life is lost and lives of the sick and disable are considered less than those of healthy people (DeKeyser & Berkovitz, 2012). Legalizing euthanasia not only affects the right of patients and their families, but also sets pace for improper and less quality of care for the terminally ill (DeKeyser & Berkovitz, 2012).
Resolving moral dilemmas for nurses requires the principles of justice, beneficence, autonomy and non- malificence (Claessens, Menten, Schotsmans & Broeckaert, 2011). While beneficence requires the best interests of the patients to be considered first, non-malificence calls for causing no harm to a patient through provision of inefficient care with malice (ANA, 2013). Euthanasia beats these principles when facilitated by health care professionals who are responsible for ensuring no harm to the patients under their care. The nurses are also required to observe the autonomy principle which states that the independence of the patient should be observed (Epstein & Delgado, 2010). A patient’s right to self determination is considered vital in palliative care. Therefore, a nurse encounters a moral dilemma when a patient asks for assistance to end his/her life (McCormack, Clifford & Conroy, 2010). At such a point, it is not outright clear as to which principle should take precedence, beneficence, non-malificence and autonomy.
Conclusion
In conclusion, euthanasia is a moral dilemma for nurses. Nurses have been given the mandate of ensuring the safety of patients, providing the best care for patients up until the patients’ death. Death is a natural occurrence and should not be hastened or withheld for any reason. On the centrally, nurses should help in reducing pain and suffering of their patients. This explains why they often face the moral dilemma of whether to administer euthanasia to save the patient from pain and suffering or to uphold the beneficence principle. It remains a confounding challenge for nurses to determine which principles should take precedence and under which conditions. Thus, The Hippocratic Oath and the Nursing Code of Ethics should act as guides for decision making involving moral dilemmas for nurses.
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