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Euthanasia-Associated Ethical Challenges in Nursing

Abstract

This paper seeks to explore the complex and sometimes controversial ethical issues associated with euthanasia. Euthanasia entails the painless and intentional taking of the life of a patient, particularly the terminally ill one (Have & Welie, 2014). This study affirms that performing euthanasia has the advantage of stopping suffering and reducing the costs of treatment. In health institutions, clinical ethics committees have the task of assessing medical-ethical situations or practices such as euthanasia (Emanuel, Onwuteaka-Philipsen, Urwin, & Cohen, 2016). Though practicing euthanasia has its advantages, its drawbacks are considerable, and there is a need for extensive analysis prior to its approval or rejection by doctors (Have & Welie, 2014).

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The normative ethical theory is based on values that determine whether an activity is beneficial, right, and well-established (Trappe, 2017). Ethics committees and other stakeholders should reject euthanasia as it is tantamount to suicide or murder. Those who oppose euthanasia assert that it’s being permitted by law is similar to the legalization of homicide (Trappe, 2017). People trust that the code of ethics obliges physicians to ensure that patients live on irrespective of their conditions (Jill, 2015). This is because they believe that all health professionals have gone through medical education successfully (Danyliv & O’Neill, 2015). Nonetheless, bioethics is resulting in euthanasia being progressively accepted as a legal alternative for patients with terminal illnesses.

Introduction

In a situation when a patient is experiencing suffering that persists and is not curable, doctors may terminate the life of such an individual through the application of well-considered measures (Emanuel et al., 2016). One of such approaches is euthanasia, which signifies the painless and deliberate taking of the life of a patient, by act or oversight, for sympathetic motives (Udlis & Mancuso, 2015). Euthanasia takes different forms; for example, voluntary euthanasia is a process whose application is already in place in different countries and is embarked on when doctors try to treat a person to no avail, and ending suffering is unattainable (Udlis & Mancuso, 2015). At such times, clinical ethics committees may choose between the alternatives of decreasing pain via the use of sedatives and administering euthanasia with the patient’s consent.

The application of euthanasia has the benefit of ending torment and lessening the costs of treatment, which has no capacity to bring healing to the patient (Emanuel et al., 2016). Similar to voluntary euthanasia, involuntary euthanasia is contentious and is done without the consent of the patient. A spouse, guardian, or other family members make the choice of euthanasia since the patient is not capable of making the decision (Emanuel et al., 2016). The major task of clinical ethics committees in the assessment of medical-ethical situations or dilemmas such as euthanasia practice (Landry, Foreman, & Kekewich, 2015). When their advice is requested, the committees offer counsel regarding the ethically suitable approach (Emanuel et al., 2016). Although the application of euthanasia has its benefits, its drawbacks are weighty, and there is a need for comprehensive analysis before its use or rejection by doctors.

Historical Foundation

Though most people believe that it is against bioethics, it has been widely perceived that euthanasia began in Rome and ancient Greece in approximately the 5th century B.C (Guirimand, Dubois, Laporte, Richard, & Leboul, 2016). The practice was mainly in the form of abortions, but at times, there was the mercy killing of patients (Guirimand et al., 2016). Additionally, contrary to clinical ethics, although physicians understood the set regulation necessitating them to abide by the Hippocratic Oath, most of them deliberately chose not to and would give poison to terminally ill patients upon their request. In ancient times, euthanasia was not a topic worth discussing (Emanuel et al., 2016). Nonetheless, in the 17th and 18th centuries, there were increasing discussions concerning euthanasia (Guirimand et al., 2016). Despite the arguments, ethics committees and other people rejected the practice as they considered it tantamount to murder.

It was in 1828 that the first law to illegalize euthanasia/assisted suicide was enacted in the United States (Emanuel et al., 2016). Though the US prohibited the practice, several states such as California and Oregon were attempting to have the regulation enforced at the state level (Emanuel et al., 2016). It was not until 1906 that the states of Ohio and Iowa made the first attempt to authorize euthanasia in the US, but it failed terribly. After the attempts of 1906, the debate concerning euthanasia diminished greatly. Though it kept resurfacing occasionally, the discourse only became intense in the 1930s in the UK (Guirimand et al., 2016).

In the 1930s, the euthanasia debate started to regain momentum in the United States, and organizations supporting it began to emerge in other countries such as England (Thienpont et al., 2015). Practices during the Second World War affected the application of euthanasia (Have & Welie, 2014). For instance, Adolf Hitler and other Nazi supporters made a secret order that resulted in the Holocaust, in which over six million people were killed. This action stopped the euthanasia movement, and Americans, as well as other people internationally, became less fond of the practice. In 1950, a poll conducted in the United States found people’s approval of euthanasia to be about 10% lower when compared to its reception in the 1930s (Udlis & Mancuso, 2015). However, the late twentieth and twenty-first centuries marked an increase in the application of euthanasia. The Netherlands became the first nation in the world to decriminalize euthanasia prior to Belgium soon following suit (Thienpont et al., 2015). Additionally, in 1988, Oregon became the first American state to permit the application of euthanasia before Washington and Montana (Udlis & Mancuso, 2015). Around 1995, Australia also briefly legalized the practice. In contemporary times, health professionals in regions that are yet to legalize euthanasia practice it, and no legal action is taken upon them (Have & Welie, 2014). The supporters of euthanasia usually point to the nations that have legalized it to affirm that it should be practiced when required.

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Literature on Euthanasia

There are times when euthanasia becomes unavoidable, given the prevailing conditions that present themselves with the onset of terminal ailments (Bolt, Snijdewind, Willems, van der Heide, & Onwuteaka-Philipsen, 2015). At such a time, the patient undergoes torment and distress, has no desire to live, and gets a strong feeling of the readiness to die (Thienpont et al., 2015). Even in the present age of medical advancement, the drugs and treatment available might not alleviate the situation (Bolt et al., 2015). Furthermore, there have been endeavors by different stakeholders to make euthanasia a practice that will not amount to the violation of any law if performed (Thienpont et al., 2015). A few countries permit euthanasia, while others prohibit it (Thienpont et al., 2015). However, even in countries that prohibit euthanasia, doctors perform it behind closed doors because it is against the law and unacceptable (Bolt et al., 2015).

The argument concerning why euthanasia is practiced with fear of implications from the law is because of the fact that it deals with human beings (patients) and seeks to end their lives (Thienpont et al., 2015). Additionally, those who are not in favor of euthanasia claim that if the law allows it, the government will have legalized murder. However, when euthanasia is requested by a patient, there is a need to offer them a chance to face death with a sense of worth by allowing them to live the final phase of life with dignity and devoid of suffering (Dierickx, Deliens, Cohen, & Chambaere, 2016). This is their ultimate desire, which the law should accord lest the sick persons look for other ways of ending their lives, such as committing suicide. Euthanasia acts as the only appropriate avenue that guarantees an end to a patient’s anguish and intolerable distress caused by an incurable illness (Emanuel et al., 2016). No one can wish away the opportunity to live, but a terminally ill person can opt for physician-assisted suicide since the level of pain is increased by the compulsion to continue living while bearing in mind that death is imminent (Chism, 2017). There is a swelling of pressure for such patients to die, and they have no reason to live; this weighs down on the patient and the relatives (Tomlinson, Spector, Nurock, & Stott, 2015). Studies affirm that euthanasia eliminates the need to suffer pain before death.

In Oregon, relatives may consent to euthanasia when the sick individuals are not in a position to make their own choices, particularly at the time when they have unsuccessfully exhausted avenues that guarantee effective treatment (Udlis & Mancuso, 2015). Euthanasia might offer a solution in a situation where hospitals accommodate patients who can be treated and survive instead of the terminally ill ones who are willing to die (Chambaere, Vander Stichele, Mortier, Cohen, & Deliens, 2015). After mulling over the benefits and drawbacks of euthanasia, governments ought to device regulations that can seal off any loopholes and establish whether the practice is legal (Dierickx et al., 2016).

In all countries across the world, there has been a disagreement on the suitability of involuntary euthanasia and its practice among health professionals, sick people, and their family members (Bolt et al., 2015). Society believes that the duty of ensuring that patients survive regardless of the state of their health binds those in the healthcare profession (Bolt et al., 2015). This is attributable to the conviction that all physicians must undergo medical education successfully (Danyliv & O’Neill, 2015). People hold the opinion that if health professionals perform euthanasia, they act contrary to the code of conduct they have assigned themselves to- of ‘treating and not killing’ (Jill, 2015). Doctors fail to advocate this important concern of their profession, whether they practice voluntary, passive, or active euthanasia (Dierickx et al., 2016). Nonetheless, researchers, specifically those in support of euthanasia, have the views that if terminally ill patients desire to end their lives and caregivers decline to grant the request, they are also failing to respect the pledge of ‘not harming.’ Essentially, this denial is termed as ‘harming’ the patient for acting against what should be performed by a physician (Jill, 2015).

The Essence of the Topic

In every free society, people should make choices regarding their time of death if they have terminal illnesses (Landry et al., 2015). On the other hand, if the patient is in a coma for a long time, health professionals should practice involuntary euthanasia if family members feel that it is the best alternative left (Udlis & Mancuso, 2015). Illegalizing euthanasia is a means of prohibiting people from deciding their fate by forcing continued pain and suffering both on the patient and the members of their family (Landry et al., 2015). The law should regulate euthanasia by allowing its practice only when the situation demands since it offers a means of ending suffering in occurrences where the patient could have died in greater pain anyway (Landry et al., 2015). Under the law, patients have permission to refuse treatment of any kind, which could eventually result in the loss of life (Dierickx et al., 2016). In this aspect, it is also fair to practice euthanasia at the request of terminally ill patients and their family members in order to stop intolerable pain and suffering even if the outcome is still death (Udlis & Mancuso, 2015).

Research affirms that for enhanced healthcare improvement, rather than legalizing euthanasia, the government and other stakeholders in the health sector should push for the improvement of patient outcomes and nursing practices (Dierickx et al., 2016). This should entail the provision and administration of efficient healthcare services for quality care (Siegel, Sisti, & Caplan, 2014; Terkamo-Moisio et al., 2017). In the modern world, a significant part of the population does not access healthcare facilities thus far due to various challenges. Geographical alienation, illiteracy, religious convictions, poverty, and cultural beliefs are part of such challenges (Landry et al., 2015; Emanuel et al., 2016). Moreover, health professionals should give patients proper education about euthanasia; attributable to being ill-informed, many of them prefer it instead of treatment that might work effectively.

Core Bioethical Issue and Political Movement/Activity

Bioethics has been employed in the last couple of decades to denote the study and examination of the manner in which practices in the medical field influence the welfare and lives of people over and above the environment and society (Siegel et al., 2014). Bioethics is interested in questions regarding fundamental human values, for instance, the right to health and life, the unfairness or appropriateness of developments in the medical field and technology, and society’s accountability for the well-being of its members (Siegel et al., 2014). It entails concerns about the termination of human life through practices such as euthanasia (Browne, 2017). Physicians who see euthanasia as a sinister motive have rejected the progression by bioethicists to make it acceptable in the health sector. Clinical ethics creates the fear that the application of euthanasia will undermine the physician-patient relationship as it will distort the character of caregivers (Landry et al., 2015). In this regard, ethics committees across the world have taken a strong position against euthanasia, terming it unethical.

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There are concerns that, if not quickly addressed, economics and healthcare rationing will dictate to patients who will live and who will have to die (Moran, Burson, & Conrad, 2016). In line with clinical ethics, healthcare professionals go through medical education with the aim of saving lives and relieving pain, and not killing patients (Udlis & Mancuso, 2015). In some instances, healthcare professionals may be compelled to succumb to a patient’s plea for euthanasia even in cases where it is possible to lessen pain or treat depression (Moran et al., 2016). Additionally, bioethicists are convinced that anchoring ethical principles and legal rights entirely in human beings is whimsical, religion-founded, and illogical. It can go as far as to assert that giving special attention to people merely because they are human beings is an act of discrimination against animals, a concept that has been broadly termed as speciesism (Terkamo-Moisio et al., 2017). To prevent bias emanating from speciesism, bioethicists usually affirm that what matters is not being a human but being a person with reputation gained from the possession of identifiable psychological abilities (Moran et al., 2016). This may occur, for instance, through having self-awareness or the capability to take part in rational behavior such as accepting euthanasia when treatment acts as an unfavorable alternative compared to its performance (Terkamo-Moisio et al., 2017).

Unreasonably high costs or hasty administration of euthanasia mars medical care of the majority of people that bioethicists call “non-persons” (Peirce & Smith, 2013). In contemporary times, when the majority of hospitals are having skyrocketing budgets and seeking cost-reduction alternatives, bioethics is a threat not just to the terminally ill but also patients with mental and physical disabilities, chronic conditions, and the elderly receiving end-of-life care. Nevertheless, to avert unnecessary deaths, ethics committees should condemn euthanasia as doctors avoid it (Terkamo-Moisio et al., 2017). In cases where the assistance of doctors is by design and purposely geared toward enabling patients to terminate their lives, physicians act unethically, and the government should take severe legal measures against them (Peirce & Smith, 2013). Nonetheless, declining medical care is a fundamental right of a patient, and healthcare professionals adhere to clinical ethics by granting such a desire even if it leads to the death of patients (American Nurses Association, 2016).

Arguments against euthanasia affirm that this practice is inhumane (Emanuel et al., 2016). Euthanasia is a topic that critics have disputed largely from the moment medical expertise spectacularly improved (Terkamo-Moisio et al., 2017). Euthanasia acts as a tool for terminating the suffering of patients by making them die instead of treating them. Nevertheless, since medical expertise is advancing at a fast pace, euthanasia is not required in practice within healthcare in modern society (Emanuel et al., 2016). Furthermore, this practice is cruel over and above being vicious. Individuals with seemingly incurable illnesses or their family members rush for euthanasia when they feel that they do not want to bear the experience of pain anymore (Dierickx et al., 2016). One explanation as to why patients and their family members should avoid the choice of euthanasia is the fact that medical expertise is developing rapidly (Emanuel et al., 2016). In this regard, diseases that were untreatable about a decade ago are presently curable. With respect to the current technological advancements in the medical field, the cure for diseases that are incurable today will possibly be found in less than a year’s time (Peirce & Smith, 2013). Family members or patients mulling over euthanasia ought to obtain all facts regarding the underlying research on the illness first and think twice prior to arriving at the decision of requesting assisted suicide.

Euthanasia offers a brutal approach to dealing with an intricate problem. There have been arguments that it is cruel to let a person undergo endless pain and suffering (Cohen, Van Landeghem, Carpentier, & Deliens, 2014). Family members also have a more difficult time addressing pain and grieving because of the suffering of their loved one when compared to patients themselves, and they choose euthanasia as a way of easing their own pain in conjunction with that of the patient. However, it is not heartless to let the patient live for as long as it is humanly achievable while trying to address the problem (Peirce & Smith, 2013). It is inhuman to terminate the life of a patient only to find the cure for the disease about a month later (David, Luck, Cortizo, DeDonno, & Roshan, 2018). Human life is the most precious gift in the entire universe, and health professionals should give patients the opportunity to enjoy the beauty of life for as long as possible (Emanuel et al., 2016).

Euthanasia, mercy killing devalues human life (Cohen et al., 2014). Physicians normally undertake it when dealing with patients who have terminal illnesses (Cohen et al., 2014). Additionally, though doctors in many countries lawfully carry out euthanasia in some circumstances, it should be illegalized and ought not to be done as it is unethical, undervalues human life, and maybe easily abused. Doctors are supposed to treat and not to kill a patient (Kelly, 2017). The prohibition of euthanasia is paramount as its continued administration may gradually create a notion that death is more estimable than being ill (Udlis & Mancuso, 2015). On this note, progressively, more patients might prefer euthanasia over treatment attributable to the idea that death is the most preferred solution to illness (De Lima et al., 2017).

In support of euthanasia, De Lima et al. (2017) affirm that the practice is part of self-protection. In the same manner, in which a severely wounded fighter in the battle may die if not treated instantly, patients prefer euthanasia to stop their suffering, which might result in a more painful death (Udlis & Mancuso, 2015). Nonetheless, in cases of self-protection and treatment of a fighter, the aim is to save the life of a person, which is not the case with euthanasia, where there is the termination of life. Euthanasia makes life appear cheap as it creates the notion that taking a person’s life is easy and acceptable (Cohen et al., 2014).

Although health professionals may carry out euthanasia with the consent of a patient and their family members, studies establish that patients and families may prefer to have it done due to emotional problems they could be facing (Dierickx, Deliens, Cohen, & Chambaere, 2015). For instance, if a patient is in deep pain from an illness and the healthcare professional presents or recommends the option of euthanasia, the patient will not have another choice but to demand it. Such a person might have only chosen euthanasia owing to their suffering and erroneous thoughts that treatment will not be successful (Emanuel, 2017; Kelly, 2017).

Involuntary euthanasia, which occurs without the approval of the patient, is tantamount to murder. With the legalization of euthanasia, family members with ill motives could call for its application or advise the patient to demand it as an easy way of murdering the individual for their selfish gains (Emanuel, 2017). To prevent such forms of abuse, health professionals ought to focus on just saving the life of patients with no option of ending it with intent (Francke, Albers, Bilsen, de Veer, & Onwuteaka-Philipsen, 2016). Even where no cure is forthcoming, and euthanasia seems to be the best way out, doctors should strive to find the most successful treatment approach as a way of valuing life. Only God should have the authority to terminate life at will (Emanuel, 2017). Every person, whether ill or not, has the right to live, and death should not be encouraged as a solution to any problem (De Lima et al., 2017). There is still a chance of getting solutions to any health problem as long as the patient is alive.

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The application of euthanasia is highly influenced by political movements/activities. Political activities may either result in the ban or legalization of euthanasia (Francke et al., 2016). Although euthanasia is still a controversial topic around the world, political strides have intended to reform laws concerning assisted suicide (Kioko & Requena, 2018). The issue of euthanasia legalization or prohibition is strongly divisive, and political parties in different countries are approaching it from diverse perspectives. For instance, in New South Wales, political activities sought to finalize draft legislation in 2017, although the upper house voted down the Bill. Moreover, there has been political progress concerning euthanasia in Victoria, where the Labor government presented a Bill in parliament, and the Victorian Legislative Council made amendments (Kioko & Requena, 2018). If the Bill receives the formality of royal consent, it will become law, and doctors will have the authority to perform physician-assisted suicide (Kioko & Requena, 2018). With the option of regulation reforms around euthanasia, an increasing number of countries are legalizing it (Lerner & Caplan, 2015).

Potential Future Evolution

Countries across the globe are increasingly accepting euthanasia as a legitimate alternative for patients with terminal illnesses (Francke et al., 2016). This leaves minimal rational grounds for withholding any terminally ill patient from requesting euthanasia (Francke et al., 2016). In this respect, euthanasia will gradually become more accepted and widely applied. Society will change its attitude concerning euthanasia so fast that it will be shocking to find a terminally ill patient strive suffer through treatment and unwilling to request assisted suicide irrespective of pain (Kim, De Vries, & Peteet, 2016). A significant though the perplexing question is what will be the importance of ethical theories in such occurrences (Zielinska, 2015). Ethics committee members will live to tell of the gap that will emerge between classical ethical theories and clinical ethics (Emanuel et al., 2016).

Clinical ethics committee members who have no training in ethical theory might have an excellent understanding of the existing dilemma and could contribute to a meaningful and refined evaluation of the case of euthanasia (Emanuel et al., 2016). On the same note, having knowledge of ethical theory is not a guarantee that ethics committee members’ assessment will be top-notch (Magelssen, Pedersen, & Førde, 2016). The normative ethical theory is anchored in principles that determine whether the practice is of high-quality, right, and valuable (Zielinska, 2015). The tension that will arise in the future will be between the right for the application of euthanasia with manageable pain and the endeavors to fight to continue living more willingly than dying (Francke et al., 2016). This will result in the dilemma of the fight or flight reaction. Nonetheless, an increased emphasis on the benefits of euthanasia could skew the balance, thus resulting in a high proportion of the terminally ill people requesting it (Trappe, 2017; Van Raemdonck et al., 2016). Many physicians, especially the ones operating in the palliative care and oncology departments, will be compelled to reevaluate the significance of Hippocratic Oath with respect to their role in assisting patients to die (Kim et al., 2016). The growth of the right to die movement will lead to more interested parties requesting euthanasia for manageable chronic diseases and not just the terminal ones (Francke et al., 2016).

Conclusion

In cases when patients are in excruciating pain emanating from untreatable illnesses, physicians might terminate their lives through carefully considered practices, for instance, euthanasia (Browne, 2017). Attributable to the demerits of practicing euthanasia, in all circumstances, it should be the discretion of healthcare professionals to choose between continued treatment and termination of a patient’s life and not patients or their family members (Trappe, 2017). Healthcare professionals are in a continuous struggle with the fact that the choice to terminate life lies with the patient, while at the same time gearing towards practicing as per the requirements of their code of conduct (Chism, 2017). This leaves them to operate under the confines of what regulates their profession, while at the same time putting into consideration the power of discretion vested on patients as pertaining to the choice of how and when to face death (Bolt et al., 2015).

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