Analysis of an Ethical Dilemma: Euthanasia and Its Ethical Implications
Analysis of an Ethical Dilemma: Euthanasia and Its Ethical Implications
There has always been debates on euthanasia and the giving of assisted suicide to patients experiencing severe, hopeless cases in their state of health. Euthanasia is said to be applicable in cases wherein the patients experience excruciating, intractable pain and suffering. However, pain has not always been the only thing important when coming to a decision on whether or not the family should apply euthanasia towards a living patient. As it was seen in the case of Terri Schiavo, who was brain-injured and relied mainly on feeding tubes to keep her alive, deciding on the end of life and the right to live was always complex. In an ethical dilemma like in euthanasia, it is always important to understand the ethical implications related to it, which will be the centermost topic of this paper.
Euthanasia always carries with it some ethical implications in terms of decision making and the right to practice autonomy within the healthcare setting. Especially when it comes to deciding the end of life, physicians and nurses both experience complexity in cases wherein they have to confront the patient’s family regarding their choice. However, as reflected in the article of Robert Burt (1998), “Physicians knew what was best for patients, and the patient’s job was just to go along” (p.14). It is evident here that physicians and nurses are the ones who make important decisions regarding their patients, and to do so they should take into account the laws and ethical standards applicable to the given case.
Nurses would have to follow the law or they will face penalties, such as those working in Nebraska who work for patients living under terminal conditions and mandated by state constitutional amendment. It was stated in the law that
A nurse who practices in a hospice setting, whether in a hospital, nursing home, or in the home, would be mandated to continue administration of hydration and nutrition by artificial means even if not based on best practice. (Furlong, 2015, p.30)
It is the nurses’ obligation to care for the patient and provide hydration and nutrition continuously, as a result of this new Nebraska state law. With this, it is evident that it is not under the responsibility of the nurse to decide on whether or not to provide life to the patient, even those who experience intractable pain and suffering. Still, they would have to balance their decisions on what the evidence-based practices dictate to them, what the law mandates, or what the ethical dilemma calls them to do, before making an important decision.
In certain cases like that of Terri Schiavo, nurses and other stakeholders (e.g., family, physicians, healthcare providers) would also have the right to “advocate for what the patient may have wanted” (Furlong, 2015, p.31). To do this, however, they should have knowledge of the American Nurses Association’s Code of Ethics, especially in administering the patient’s right to life. Under the Nebraska Humane Care Amendment, Section 30, it is stated:
The fundamental human right to food and water should not be denied to any person, regardless of race, religion, ethnicity, nativity, disability, age, state of health, gender, or other characteristics. No entity with a legal duty of care for a person within its custody may refuse, deny, or fail to provide food and water sustenance and nourishment, however delivered, to any such person if death or grave physical harm could reasonably result from such withholding (Furlong, 2015, p.31)
With this, it is evident that in Nebraska, it is considered unlawful to practice euthanasia, whatever the reason may be for denying the right of any person to receive care and nutrition. More so, it states that nurses who decide on whether or not to apply euthanasia, should think critically about the effects of their decision, not just on the patient but also on the family and the surrounding community. The decisions should therefore rely not only on the patient but also the surrounding stakeholders like the family, who carries the financial burden.
As for the nurses, their professional obligation is “to act in the best interests of the patient” (McCormack, 1998, p.65). This is being reflected in the ethical theory of consequentialism, which states that “the answer to moral questions about which actions are right or wrong ultimately depend solely on the nature of the consequences of those actions or proposed actions” (McCormack, 1998, p.65). This is also known as utilitarianism, stating that an act is considered ethical and rightful if it produces “the greatest ratio of happiness over unhappiness for the community” (McCormack, 1998, p.65). With this comes the principle that all people have the right to control their body and decide what type of medical treatment they should receive. As Dax Cowart stated in his interview, “There is no legitimate law, there is no legitimate authority, there is no legitimate power that can take the right away from a mentally competent human being” (Burt, 1998, p.16). It is clear therefore, that patients should be mentally capable of deciding their choices; otherwise, other stakeholders should have the right and responsibility to make the right choice for the patient.
The Corresponding Stakeholders
The first stakeholder is the patient, who should make the choice on whether or not he/she wanted to end his/her life, or if he/she wanted to continue with his/her life. It is the patient who decides willingly whether they choose to end their lives or not, although in most cases they may be too ill to make their decisions. Otherwise, they should be allowed to do as they please. Others make their decision while they are still strong and healthy.
The second stakeholder is the physician, who carries and the expertise required to make the right decision. It is the physician who knows whether it is still beneficial to put the patient under hospital equipment, or if there is no use to putting them there. In other times, the patients had already made their decisions clear to the corresponding physician, which makes them a reliable source of whether or not they should apply euthanasia.
The third stakeholder is the family of the patient, who are the ones dearest to the patient and thus, should understand the true wishes of the patient. They are the ones who should know the desires of their loved ones on whether they would approve of practicing euthanasia. It is the family who should understand the beliefs, values, and norms of the patient, together with their true convictions regarding the use of euthanasia.
The fourth stakeholder is the hospital, which follows certain rules about implementing euthanasia. It is the hospital that grants the petitions on whether or not the patients and their families should be allowed to practice euthanasia. There are certain hospitals that do not allow it, depending on the location and the norms and beliefs of people from where the hospital is located. It is also the hospital that decides on the qualities of the physicians and doctors that they hire, which answers a lot regarding the implementation of euthanasia.
Last but not the least is the society, which indicates the customs, norms, and religion of those living within it. In practicing euthanasia, some societies may interpret it as a way of killing, while others see it as a practical way of letting nature take its path. It is usually the society that administers the doctrines, the laws and the rules being implemented, including those of the hospitals. It is them who give meaning on what it means to practice euthanasia.
Conclusion
Nurses have the power to decide on the common good of patients, even to those who experience severe pain and rely mainly on tubes for hydration and nutrition. Being a provider of care and health, they should care for their patients and act as good citizens of the world. As Crigger, Brannigan, & Baird (2006) stated, nursing professionals should “think reflectively about themselves and others, understand others’ point of view, and promote social justice” (p.23). This is centered on the fact that the actions and decisions of nurses would always have a strong impact on the social values, morals, and norms of the community, since their decisions would personally affect how life is seen in the community. Their decisions would reflect the entire culture on how people view life, or whether or not people have the right to end other peoples’ lives. Their decisions would also reflect on what level should personal autonomy be applied. The answer lies on their philosophies.
References:
Burt, R.A. (1998). Confronting death: who chooses? Who controls? A dialogue between Dax Cowart and Robert Burt. Hastings Center Report, January-February 1998 series, 14-24.
Crigger, N., Brannigan, M., & Baird, M. (2006). Compassionate nursing professional as good citizens of the world. Advances in Nursing Science, 29(1), 15-26.
Furlong, E. (2015). “Chapter 3: Right or wrong: Policy, legal and ethical issues, and decision-making.” In S.B. Lewenson’s (Ed.), Decision-making in nursing: Thoughtful approaches for leadership (pp.33-50). Burlington, MA: Jones & Bartlett Learning. Print.
McCormack, P. (1998). Quality of life and the right to die: an ethical dilemma. Journal of Advanced Nursing, 28(1), 63-69.
Others:
Butts, J.B. (2013). “Chapter 3: Ethics in professional nursing practice.” In J.B. Butts & K.L. Rich’s (Eds.), Nursing ethics: across the curriculum and into practice (pp.81-117). Burlington, MA: Jones & Bartlett Learning. Print.
Lynne, D. (2005, March 24). The whole Terri Schiavo story. WND. Retrieved July 28, 2016 from http://www.wnd.com/2005/03/29516/.
