Patients and family of patients requesting assisted euthanasia need to be thoroughly informed about the issue and the potential impact of the act of euthanasia in their lives. Euthanasia is defined in the dictionary as mercy killing. This means that the patient is in so much pain or his/her dignity would be further degraded by his/her sickness that terminating his/her life would be more compassionate or merciful. From a medical perspective, euthanasia is referred to as the “act or practice of ending the life of an individual suffering from a terminal illness or an incurable condition” (American Heritage Medical Dictionary, 2007). Passive euthanasia means “ceasing or not starting medical treatment that keeps a person alive, such as attachment to a respirator or provision of food and water through a tube” while active euthanasia takes place when “someone causes the death of a sick person without that person’s participation” (p. 2). The only person legally allowed to do that, such as take off the ventilator or remove a feeding tube should be a physician.
Cases about Euthanasia
The issues on euthanasia are illustrated by two cases, the Dax Case and the Terri Schindler Schiavo case. Both Terri and Dax suffered from traumatic events when they were in their twenties. Terri collapsed from a heart attack while Dax was badly burned during a propane gas explosion. Both underwent extensive rehabilitation for years, however, while Dax recovered and regained a “normal” life, Terri remained in the hospice. Dax explicitly “demanded” that he be “terminated” but this request was not granted while in the case of Terri, her husband requested that her feeding tube be removed and this was granted by the court.
Obligations to the nursing profession
Nurses are mandated by their profession to provide health services of the highest standard. According to the ICN Code of Ethics, nurses who are providing care “promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected” (ICN, 2012, p.2). They are also expected to realize the ethical principles of care, competence, and beneficence. As they go about their tasks they are realizing the theory of duty and respect. This means that in the case of caring for patients like Dax and Terri, nurses have the “responsibility to provide competent care in accordance with the nursing practice act” (Hoeman, p.32) and they should do so “regardless of the extent of disability” (p.33) of the patient.
Laws and policies regarding euthanasia
Unlike the countries of Netherlands, Luxemburg, and Belgium, the act of euthanasia is still considered illegal in the US, although there are at least two states where patient assisted suicide is permitted (Periera, 2012). The laws that directly address the issue of euthanasia in the US are the American Disability Act (ADA), Patient Self Determination Act (PSDA), Washington Death with Dignity Act, and Oregon Death with Dignity Act. Disability is defined in the ADA of 1990 as a “physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or being regarded as having an impairment” (Hoeman, 2008, p.40). The PSDA was authored by Senator John Danforth of Missouri and this policy was aimed at providing “uniformity and order to advance directives in the US” (McDougall & Gorman,2008, p.10). It also clarified and delineated the responsibilities of the different stakeholders such as the patients, their families, physicians, and the health care entities. An example of an advance directive is the power of attorney or health care proxy. This is a legal document which “designate[s] another person to make health care decisions on the patient’s behalf” (Olick, 2001, p.xiv as cited in McDougall & Gorman). Specific rulings of the court also provide legal explanations which become reference for future cases. In Missouri, in the year 1990, the decision of the court on the case of Cruzan, stated that the US Constitution in its clause on liberty “guarantees” the “right to refuse treatment even artificial nutrition and hydration” (p.9). In the case of the Terri Schindler Schiavo case, the removal of her feeding tube was also ordered by the court.
Stakeholders in this issue
The stakeholders of the issue of euthanasia are the patients, their families (spouse, siblings, and parents), health care professionals (doctors and nurses), health care institutions (hospices, nursing homes, hospitals), courts (judges, attorneys), media professionals, advocates, sectoral groups particularly persons with disability. The patients, after their accidents and during treatment may lose their capacity to express themselves, thus family members decide on their behalf. However, decisions of family are still subject to court rulings especially when there are varying perspectives, such as in the case of Terri Schindler Schavio. The husband says Terri would want to have the feeding tube removed while her blood relatives (parents and siblings) say she would not want that option.
Impact of euthanasia
Euthanasia has an emotional, moral, legal impact on society. When cases become publicized and various media present the differing opinions, individuals also start to think about what their decisions would be when faced with the situation of seeing a loved one devoid of his/her capacity to function “normally” in the modern world. Professionals including nurses and lawyers are challenged by their own moral values especially when their own beliefs contradict a court order, such as removal of a feeding tube. In an occasion where a nurse believes that a disabled person, such as Terri should be given the opportunity to continue living because of the value of the sanctity on life, but the court ordered that the feeding tube has to be removed, then the nurse is faced with an ethical dilemma. It is her duty to follow the standards and policies of health care institutions but she also holds the value of sanctity of life important. Thus, it is in issues like euthanasia that a nurse faces the challenge of ethical dilemmas especially since the American Nurses Association Code of Ethics (2001) “ clearly comes down on the side of the patients and against assisted suicide” (Hoeman, 2008, p. 39).
Ethical theory applied to euthanasia
The ethical theory of Duty and Respect can be applied to decisions on the issue of euthanasia. Doctors and nurses have the duty to provide the services of their profession. According to Hinman (2002 as cited in Hoeman, 2008) the theory of ethics and duty “specified that there are definable principles of natural right associated with jurisprudence” thus in the case of caring for their patients, nurses have the obligation to “provide competent care in accordance with the nursing practice act” and it is “right for nurses to administer medications and treatments in synchronization with physician orders” (p.32). When nurses do not act according to physicians’ instructions they violate their duty and their obligation of providing nursing care. In the decision of allowing a patient to undergo euthanasia, such as the request of Dax, or removal of his wife’ s feeding tube as requested by the husband of Terri, the ethical principles of quality of life, sanctity of life, and beneficence can be applied. Terri’s husband believes that his wife’s condition will not anymore improve and prolonging her life would degrade her dignity, thus removing the feeding tube is for her benefit (principle of beneficence). However, her parents and siblings invoke on the principle of sanctity of life in their appeal to the courts not to remove the feeding tube. Nurses too have the “obligation to care for all patients, regardless of the extent of disability or potential for recovery, because all life is of value” (Hoeman, 2008, p.33).
Response to requests for euthanasia
In conclusion, the response to requests for euthanasia entails providing the patients and their families with a comprehensive look about the issue. This means enabling them to see the different perspectives pertaining to the issue and facilitating discussion of potential impacts on the patient and their loved ones. Going through previous cases as well as laws and policies are also necessary.
References
Hoeman, S. P. (2008). Rehabilitation Nursing: Prevention, Intervention, and Outcomes. St. Louis, MO: Elsevier Health Science.
International Council of Nurses (ICN) (2012).The ICN Code of Ethics for Nurses. Retrieved from http://www.icn.ch/images/stories/documents/about/icncode_english.pdf.
McDougall, J.F. & Gorman, M. (2008). Euthanasia, 2nd edition. Sta Barabara, CA: AB-CLIO Inc.
Pereira, J. (2012). Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls. Current Oncology, 19 (3). http://dx.doi.org/10.3747/co.19.1142
