In this ethical case study, I review the case of Miss S., an elderly patient recovering from severe physical injury and paralysis who advocates for physician-assisted suicide. In reviewing the case, the potential ethical issues and potential ways to address the issue at hand are provided, discussed through the lens of the ANA Code of Ethics. Assisted suicide is a complex issue, especially from a nursing perspective, and this case study provides one potential way to address it.
Facts
Miss S. is an elderly woman who has recently developed severe paralysis following a cervical spine stabilization surgery. Because of partial paralysis of the pharynx and vocal cords, she is no longer able to comfortably speak and eat, either. Despite being of sound mind and body, she experiences intense physical pain and her recovery will be slow and extremely expensive. This, combined with her own ethical and quality of life issues with being placed in a nursing facility and the depression and stress that comes from her difficult living situation in the neurosurgery step-down unit, has led her to consider physician-assisted suicide. She wishes to save money that would be spent on her health care to give to her family, as well as spare her own mental well-being and sense of comfort.
Ethical Issues
The primary ethical issue in this case is physician-assisted suicide, which is one of the most complex issues in health care practice. Assisted dying is a practice that is currently available in four European countries and three American states, and is the subject of controversy due to its unclear position between respecting the patient’s wishes and failing to provide adequate palliative care (Hendry et al., 2013). On the one hand, physicians are duty bound to do no harm, and her prognosis shows at least a slight possibility of recovering some quality of life. However, there is also the issue of bodily autonomy, and the right of an individual to choose the time and circumstances of their own death. Most instances of physician-assisted suicide come where patients’ lives are “severely impaired by loss of function leading to feelings of helplessness, loss of dignity, loss of meaning, loss of humanity or loss of ‘self’” (Hendry et al. 2013, p. 19). By all indicators, Miss S. was of sound mind and body, and clear in her wishes, when she made this request, which eliminates the possibility of ignoring the request as something said without fully considering the consequences.
Courses of Actions and Related Outcomes
Support Miss S.’s Request – Miss S.’s request was made of sound mind and body, and she was stated as being in full command of her faculties when she gave her thoroughly considered request to commit physician-assisted suicide. The related outcomes to this course of action would be the end of Miss S.’s physical and psychological suffering, savings in medical costs for her and her family, and the freeing of medical resources that could be used on other patients. However, it would also mean the loss of a life, particularly for her family, which is very emotionally tragic.
Refuse Her Request – Miss S.’ request could also be flatly refused by the nurse, and not considered again. The related outcomes for this course of action would be ignoring the distinct wishes of a patient, ignoring her autonomy and human rights, and costing her a fortune in medical costs. However, she would get to live, and the possibility exists that she would recover and spend many more years of her life in good health.
Further Discuss the Request – As a nurse, I would be able to discuss further with Miss S her request, and offer alternatives to her situation (such as changing living conditions, etc.). As an advocate for the client, my related outcomes would be possibly getting her to take back her request, or at least making sure she has considered every possibility before coming to that decision. In this course of action, Miss S.’s decision would be thoroughly considered and discussed with a medical professional before a major decision is made. I believe I would make this choice, as it still ultimately puts the decision in the patient’s hands, while also allowing my informed medical opinion to be considered in her decision-making.
Evaluation
The best way to evaluate if my course of action was successful would be if Miss S., regardless of what decision she made, did it with the full knowledge of the consequences and her potential options. This moral evaluation would occur at the end of my discussion with her, if I were able to determine that she was still of sound mind and body and she still made the decision.
Discussion
Conclusion
Physician-assisted suicide is one of the most difficult avenues of nursing care I would every have to consider. The decision between whether to allow someone to be euthanized at their request is a quality of life issue, and should ultimately be up to the patient; the nurse is only meant to facilitate the discussion and advocate for their rights as human beings. As emotionally conflicting as it would be, I must reconcile the fact that my patient’s welfare and dignity supersede my own discomfort with the issue itself. As such, this case study has made me consider the limits of my own ethical character as a nurse, and highlights the importance of the Code of Ethics as a framework for decision-making.
References
ANA Code of Ethics. (2015). American Nurses Association. Retrieved from
http://www.vcuhealth.org/?id=1220&sid=13.
Hendry, M., Pasterfield, D., Lewis, R., Carter, B., Hodgson, D., & Wilkinson, C. (2013). Why do
we want the right to die? A systematic review of the international literature on the views of patients, carers and the public on assisted dying. Palliative medicine, 27(1), 13-26.
Zerwekh, J. & Garneau, A.Z. (2015). Nursing today: Transition and trends. (8th ed.) St. Louis,
MO Elsevier Saunders.
