Euthanasia is a derived Greek word which means “good, or gentle, death.” It is commonly referred to as mercy killing and involves a deliberate act of terminating life in what is considered to be a humane action. This may be active or passive. The active version of euthanasia involves a deliberate effort and action aimed at hastening the death of a patient. On the other hand, the passive type of euthanasia involves cooperation with the patient’s dying process (Arend, 1998). For example, passive euthanasia may involve deliberate omission or discontinuation of tube feeding of a critical patient.
Whether passive or active, euthanasia remains a controversial topic in the health profession. Of significance are the ethical dilemmas that euthanasia raises. An ethical dilemma is a situation where there is a conflict between two or more relevant principles of ethics (Arend, 1998). The paper seeks to explain the ethical dilemma in nursing with regard to euthanasia and the patient’s right to die. Arend (1998) cited that in situations when an ethical dilemma presents, the nurse is faced with the challenge of choosing between two conflicting alternatives, none of which is easier to decide. Therefore, ethical dilemmas associated with euthanasia put nurses in situations requiring of the nurse to make an ethical decision considering the right of the patient to die (EdD, 2008).
Analysis of the Ethical Dilemma of Euthanasia and Nursing
Nurses, in almost all their areas of practice, encounter a wide variety of ethical issues in the course of delivering their services. Euthanasia is one of the issues that put nurses in situations of dilemma considering the ethical implications that this process evokes (Husted, Husted, STAT! Ref & Teton Data Systems, 2008).
Nursing as a health profession has the protection of patient’s rights and dignity as its prime objective. However, nurses often face the dilemma in situations where the ethical decision making is needful. EdD (2008) observes that in the context of euthanasia, ethical principles of nursing sometimes conflict, putting the nurses in dilemma on whether or not one principle overrides the other and to justify situations when euthanasia can be considered ethical or otherwise.
The case for euthanasia raises an ethical dilemma especially considering that the interest of the patients, that nurses serve, sometimes contradict the code of ethics in nursing as a profession (Husted et al, 2008). For example, a patient may consider and prefer the option for euthanasia and justify that he/she is using his/her right to die (Husted et al, 2008). In such cases, the effort of the nurse to prolong the life of the patient may be considered a violation of the best-interest and rights of the patient. On the other hand termination of the life of such a patient through euthanasia may be considered unethical with respect to the sanctity and dignity of human life and the role of the nurse in protecting the life of a patient.
The nurse is alienated in the decision making process involving euthanasia. EdD (2008) correctly observes that it is the doctor who determines whether or not a patient should be euthanized. The dilemma is that the decision of the doctor to perform euthanasia or not may be contradicting the personal ethics of the nurse who actually has no say in the cases involving euthanasia (EdD, 2008). The doctor may decide that the patient be put on life support while the nurse truly feels that the patient should be actually relieved from the severe pain, arising from a terminal illness, through euthanasia (Arend, 1998). This leaves the nurse in an ethical discord in his/her practice.
In most cases, it is the doctor’s decision that carries the day in the resuscitation orders. The doctor can therefore order the nurse to resuscitate a patient when actually the patient’s wish is to die. The dilemma is that in such circumstances, the doctor and the nurse are considered to be replacing God by deciding who requires quality life and consequently who lives and dies. This contravenes the principle of equal rights of patients to decide to live or to die and, in principle, autonomy of the patient (EdD, 2008).
The nurse is not relieved from moral conflict by deciding to allow a patient to die. The nursing code of ethics requires of the nurse to always act in the interest and well-being of the patient. No act or omission on the part of the nurse should thus be detrimental to the patient’s condition and safety (Husted et al, 2008). Euthanasia is an act in contravention of this ethical principle of nursing. On the other hand, by deferring the patient’s choice to die, the nurse will not be acting in the interest and well-being of the client especially in conditions when the patient is in extreme pain and in a condition that is terminal. This puts the nurse in great dilemma in making an ethical decision (EdD, 2008).
The ethical dilemma that euthanasia raises in nursing as a health profession relates to the conflicting principle of patient’s autonomy and defects and acting in the best interest of the patient (McCormack, 1998). For example, autonomy as a principle requires the nurse to always consider the preference and opinion of the patient. The patient as a client for the nurse has the right to die and can apply this right to demand for euthanasia. This puts the nurse in a dilemma of choosing between the professional ethics and the autonomy and right of the patient to die.
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McCormack (1998) contends that the ethical implications of euthanasia and nursing become more complicated in cases where the patient has defects that affect their reasoning abilities and denies them control over their deires and actions (Quaghebeur, Casterle & Gastmans, 2009). Balancing between the ethical principles and the decisions of the patient and the doctor with respect to euthanasia thus exposes the nurse to an ethical dilemma that is challenging to resolve.
The controversy surrounding euthanasia and nursing is to be found in the difficulty in making ethical nursing decision (Quaghebeur, Casterle & Gastmans, 2009). For example, a nurse has the moral obligation to act in a manner that will not harm the patient. However, the dilemma is whether or not it will be ethical to prolong the life of a suffering patient using a life-support machine, for example. Extension of the life of a suffering patient is equivalent to doing harm to the patient. On the other hand, euthanizing such a patient is also morally incongruent. The nurse is thus left in a dark situation with no light in either side (Quaghebeur, Casterle & Gastmans, 2009).
Legal issues involved in Nursing and Euthanasia
Deliberate action aimed at actual termination of life in nursing practice has been very controversial because of the legal issues that the process evokes. Arend (1998) cited that the “rights” issue that raises dilemma in this context is in the extent to which one can claim his/her rights right to life or to die (Arend, 1998). For example, the decision of the doctor to terminate a patient’s life, whether through active or passive euthanasia, requires the participation and support of the nurse. However, legally the patient has rights over his/her life. This right is guaranteed by the law and should thus be respected by the health professionals.
Euthanasia raises serious legal issues with respect to the autonomy and patient’s self-determination rights (Arend, 1998). The legal impasse is in the determination of the extent to which an individual’s self-determination rights can be taken. For example, whereas self-determination and right to life and autonomy are applicable to all patients, determining the authenticity and authority of a patient to choose which medical treatment to receive or reject is a dilemma in nursing with regard to euthanasia (Arend, 1998). However, the patient’s decision must be considered by the doctor and particularly, the nurse in cases where the choice and the decision of the patient fall within the boundaries of the law regarding medication and healthcare.
Active euthanasia has been legalized in many states. This implies that the nurse and the physician are legally allowed to terminate the life of the patients who are in a distressing condition and whose health condition is diagnosed to be terminal (Masters, 2009). However, this raises the dilemma with the respect to the sanctity of life. For example, the legalization of active euthanasia may be an open door for the violation of patients’ right to life. The legal dilemma therefore remains to be how to strike a balance between patients’ right to life and death. The autonomy and the freedom of the patient which are two key principles in nursing ethics therefore come into play (Joel & Kelly, 2003).
Euthanasia is crowded with legal dilemma especially considering the fact that in some cases, the patient’s condition does not allow him/her to make autonomous and personal decision. Arend (1998) cited that with regard to the respect for the sanctity of human life, the legal frameworks and interpretations is put in a dilemma. The dilemma is between termination and extension of the life of a suffering patient in an unbearable pain who applies for euthanasia (Arend, 1998).
More detailed legal guidelines with regard to euthanasia exist. For example, Rotterdam court of Netherlands established legal guidelines with respect to euthanasia in 1981. According to these guidelines, euthanasia can only be considered as an option when the patient is consciously in an unbearable pain (EdD, 2008). Besides, the death request must also be voluntary. Euthanasia is thus considered legal only in circumstances when the patient has also been made consciously aware of the alternatives to euthanasia and allowed ample time to consider the available options (EdD, 2008). This ensures that the death decision is voluntary and based on detailed information and consensual decision of the patient.
The legal backing for euthanasia is guided by the concerns for the individual’s right to life and autonomy. According to this perspective, it is not illegal for one to take his/her life. Accordingly, the role of the nurse or the physician is to help the patient to terminate his/her life if he/she so chooses (EdD, 2008). The rationale behind this legal perspective is that everyone, including the patient, has the legal right to life or death based on one’s own value system and beliefs. In this respect, the nurse or any other physician has no right to terminate the life of a patient through euthanasia or to prolong the life of a suffering patient who is willing to die.
Social issues in Nursing and Euthanasia
Euthanasia raises social issues especially considering that compassion requires of the family members and friends of a patient to offer psychosocial support rather than termination of life (Denier, Gastmans, Bal, Casterle, 2010). The wish of friends and family members of a patient is to end the pain and suffering of the patient. Therefore, in certain situations, euthanasia may be considered. However, the sanctity of life holds family members and friends to shun being judgmental by terminating the patient’s life through euthanasia.
The social interpretation and perspectives revolving around euthanasia are responsible for the institutionalization of terminally ill patients for palliative carre. This calls for the input of the nurse to offer appropriate help and support to the terminally ill patient and assurance to the friends and family members. In such cases, euthanasia only becomes an option as a last resort. The irony is that the choice of the physician and approval of the nurse to euthanize the patient in some cases may be in violation of and contradiction to the social and moral wishes of the family members and friends of the patient (Laabs, 2009).
Roles and Responsibilities of the Nurse in Euthanasia
The nurse remains the patient’s advocate even in the situations where the physician’s decision to terminate the life of a patient or to resuscitate a terminally ill person carries the day (Scheur, Arend, Saad, Spreeuwenberg, Wijmen & Meulen, 2008). Although the ethical dilemmas with regard to euthanasia still persists, the nurse remains the sole healthcare professional who bridges the gap between holistic and compassionate treatment and care of the patient and, more often, aggressive treatment of patients with regard to euthanasia. The role of the nurse is therefore to be the advocate of the patient and to actively campaign for the inclusion and participation of the patient in all treatment decisions, including euthanasia (Scheur et al, 2008).
The critical care nurse may advocate for the wish of the patient for euthanasia to be considered by the ethics committee. This role is founded on the principle that, although the nurse should abide by the physician’s decision with regard to euthanasia, the nurse is in a better position to understand the wishes of the patient. Scheur et al (2008) cited that it is based on this principle that the voice of nurses should be heard loudest of all the voices of the healthcare professionals. Studies indicate that in some cases, the nurse may perform euthanasia without necessarily following the recommendations of the doctor. Further studies conducted by (Scheur et al, 2008) on the role of the nurse in euthanasia also established that there are circumstances when the nurses play a supportive role with regard to euthanasia.
The nurse plays a significant role in the decision making process of performing euthanasia. Denier et al (2010) cited that due to the close proximity that exists between the nurse and the patient, the nurse always represents the true wishes of the patient (Scheur et al, 2008). To illustrate this further, many studies conducted on the role of the nurse in euthanasia found that more patients were likely to discuss their wishes for euthanasia with a nurse before engaging a physician. The nurse may therefore perform euthanasia in some circumstances without consulting the physician. For example, due to the empathetic relationship with the patient, studies indicate that there are instances when nurses perform euthanasia through administration of a high dose of an opiate to patients who are terminally ill (Scheur et al, 2008).
Impact of the Euthanasia Dilemma on Nursing as a Profession
Euthanasia has had significant implications on nursing as a profession. The patient’s autonomy and the right to life sometimes contradict the principles of nursing ethics. For example, the request by a patient suffering from a terminal illness to be euthanized and relieved from the pain puts the nurse in a unique dilemma (Denier et al, 2010). In such circumstances, the nurse is left in a dilemma between empathetic care, prompting him/her to advocate for euthanasia, and the ethical principles requiring of a nurse not to act in a way that is likely harm the patient.
Euthanasia led to the integration of law into nursing as a profession. Presently, the eventual decision to euthanize a patient must be legally ascertained to be a voluntary decision from the patient based on informed consent (Denier et al, 2010). Therefore, the provisions for euthanasia for the terminally-ill patients call for the establishment of significant legal and policy frameworks to guide the practice of nursing.
The role of the nurse in patient care cannot be overestimated. The nurse remains to be the closest healthcare professional to the patient. However, the role and participation of nurses in decision making process regarding euthanasia has not been considered in the transformation of nursing as a profession and a practice. For the ethical principles to be effectively implemented there is need to review the existing practice provisions and to realign them to the relationship between the nurse and the patient with respect to euthanasia (Masters, 2009).
The performance of euthanasia should be voluntary and in the best interest of the patient. The nurse, being the closest professional to the patient should thus be allowed more liberty and space in participating and contributing in the decision making process of euthanatics (Laabs, 2009). This calls for a review of the nursing policy provisions to allow the nurse to be a member of the ethics committee in any healthcare institution. This transformation is already evident in most healthcare facilities. Euthanasia has thus greatly affected nursing as a profession and in practice.
Euthanasia remains a controversial issue in nursing due to the ethical implications that it elicits. The nurse remains struggling with the need to make ethical decisions with regard to euthanasia as a result of the dilemma of balancing between ethical principles of nursing, the rights of the patient to life and the moral obligation of the nurse to protect and respect the sanctity of life. The dilemma is therefore in balancing between personal ethics, professional code of ethics and the rights of the patient to life. Euthanasia has thus had significant impact on nursing as a profession.