Ethical issues that concern the practice of euthanasia come from a variety of sources. Their intensity varies with the context of their debate and the societal acceptance of euthanasia. Two parties are involved in any euthanasia procedure, the patient and the physician. In some cases, families represent or advocate for the patient wishes while nurses assist physicians in making decisions and administering death drugs or pulling the plug off patient’s life support systems. This paper offers a review of relevant literature on euthanasia. It covers the view of the patient’s right to life, the role of physicians and nurses in ending patient’s life. The autonomy of nurses is reviewed and finally the principles governing the moral debate of euthanasia are highlighted on their role in the ethical arguments for and against euthanasia. This paper presents the following findings.
The ethics concerns of euthanasia come from a variety of stakeholders in the patient’s health as well as the patient in cases where they can communicate their desires. The stakeholders are nurses who wish to stay true to their professional calling of providing quality patient care and alleviate pain, physicians whose code of conduct uphold them as protectors of human life through medical treatment. There are religious proponents who view patients as compositions of the society whose life is valuable and therefore the practice of euthanasia is sinful, the patient’s family that wishes that their loved one feels no more pain. Finally, the health care system composed of hospitals, state departments and healthcare insurance firms that seek to provide the best care under minimal costs possible.
Euthanasia refers to the termination of a patient life to ease the patient’s pains in the case of an incurable illness. Debate rages in the ethical aspects of the practice in view of its acceptance to the society. The ethical debate lies on the two interpretations of the authority that comes first when euthanasia is concerned. That is, the patient’s autonomy that comes before the health care practitioner’s autonomy, or the contrary. In simple terms, debate rages on who is responsible for executing the order to end the life of a patient on the grounds of easing further suffering. Another argument has arisen in support for euthanasia that is not included in the right of life debate between patient and practitioner. It concerns the cost implications of keeping a patient under arterial life support when it is evident that without the machines the patient’s life would cease.
On the debate of the right of a physician to take the life of a patient with the reason of easing their pain, Donhoff and Reinhard (p.44) indicate that the physician must not be given the power to take lives of patients. The authors argue that it is against the societal view of the physician as the protector of life. The authors acknowledge that in many cases where families and patients request euthanasia, the health care teams fail to accept the request and continue to keep the dying patient alive to avoid a professional liability. According to the authors, euthanasia should be prohibited because it can lead to an abuse of basic laws governing human life that are supposed to be unconditionally protected.
For the discussion of euthanasia to be neutral, it should be free of any religious bias. Donhoff and Reinhard (p.44) confirm that we have already differed with the natural system by using a breathing support machine. The authors therefore persuade us to look at the issue of euthanasia from a different perspective that is still moral but does not depend on the religious view of the observer.
Euthanasia occurs in two ways, the active taking of a patient’s life or the moribund taking of life. In addition to the ethical question, overall concept of euthanasia, there is also a question of which of the two ways should be allowed to continue. Gastmans, Lemiengre and Dierckx de Casterle (p.58) discuss the roles of nurses in the ethical debate of euthanasia, acknowledging that previously the question of who was responsible for deciding on the termination of a patient’s life lay with physicians. They note that physicians are still relied upon to make the diagnosis of a patient’s chances of survival without the artificial assistance to normal body function such as breathing. In such a case, the physician usually deals with a terminally ill patient that is unable to express any thought or feeling such as those in comatose. Euthanasia in such a case falls under moribund way of taking life, as it does not actively involve patient choices. However, there are cases where the patient is able to express desires of ending their pain of illness by death. Such requests are given to nurses providing the healthcare. The authors therefore argue that the ethics of active euthanasia involve the nurses as much as physicians. They note that nurses are increasingly performing related tasks associated with doctors and this includes the admission of painkillers in large doses at a higher frequency to induce patient’s death.
According to Gastmans, Lemiengre and Dierckx de Casterle (p.59), the ethics concern in the case of nurse involvement in euthanasia is on whether the nurse’s or the patient’s autonomy comes first. Nurses have a right to decline participating in euthanasia and patients have a right to obtain the most appropriate care to alleviate their pain. The dilemma arises where a patient feels that death will be the ultimate treatment to ease their pain while nurses feel that they must ensure the patient leaves under all circumstances despite their pains. Donhoff and Reinhard (p.44) dispute the notion that subsequent exposure to dying patients makes physicians, nurses and other medical staff emotionally immune to euthanasia practices. They reaffirm that the exposure becomes more disturbing especially for nurses who see themselves as tools used by patients and their families to perform euthanasia in total disregard for the nurse’s feelings. Gastmans, Lemiengre and Dierckx de Casterle (p.59) observe that in the two countries, Netherlands and Belgium that were first to legalize euthanasia, as well as in other countries like Canada and Britain, nurses are given right to decline participating in a euthanasia procedure. Such an exemption is appropriate when the nurse feels that the act is akin to committing murder. To further make the reduce incidences of abuse of the practice by patient families and patients, active euthanasia is only accepted in cases where a deliberation on the case has been done by an appropriate medical team.
Quaghebeur, Dierckx de Dierckx de Casterlé and Gastmans discuss ethical arguments of euthanasia on moral principles. They show that the principles governing the debate on euthanasia are dynamic depending on the context of their application and therefore must be used as a means to reach an agreement and not a basis for an argument for or against euthanasia. This is because the principles can be manipulated to suit either side of the euthanasia argument. The authors bring out the ethical arguments as they are embedded in the clinical practice. They acknowledge that while morality forms the basis of all laws and regulations governing physicians and nurses on the policy of euthanasia. However, morality is also the number one reason for discontent in euthanasia policy as nurses become more conscious of their ethical importance of giving care such that nurses now feel they are unable to offer quality care, as they would wish because of an institutional lacking this awareness.
The ethical debate on euthanasia does not have a clear winning side in the context of the near future. However, key issues that emerge from the analysis in this paper are that ethical issues of euthanasia are different for each of the stakeholders involved in the patient’s life as well as the patient. Families wish ease the pain of their loved ones and so does the patient suffering a terminal illness. In this case, they see medical practitioners as a means to achieve their wishes. On the other hand, physicians and nurses see the request by families for euthanasia as manipulations that go contrary to their code of practice to provide quality care for saving and restoring patient’s lives. Principles governing the ethical argument based on morality come from a variety of sources such as religion and law. They should not be used as the basis of arguing for or against euthanasia but should form an understanding of the context in which the ethical debate is conducted.
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