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Euthanasia in Nursing Practice

Introduction

Nursing is inevitably related to ethical dilemmas, and thus the behavior and decision-making of medical personnel vary drastically in each patient’s case. Euthanasia is “is a practice in which a person who is suffering from a painful and incurable disease or debilitating physical disorder, is put to death after the patient’s consent” (‘Euthanasia: Historical background,’ n. d., para. 1). No doubt, the existence of such procedures raises discussions on their legality and compliance with morality. Euthanasia as a phenomenon of a democratic society, being an aspect of nursing, has been under discussion for decades. However, people still have not concluded whether it is ethically appropriate and whether the legalization of euthanasia should spread wider.

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Some people whose profession is nursing believe that euthanasia should be supported by the government and be stated legal because its purpose is to ensure a person’s right to get the proper care. Although care is not a relevant word for explaining the purpose of euthanasia, it is a part of medical assistance procedures, according to some nurses. On the other hand, medical staff sometimes cannot bear the necessity to deal with euthanasia because they feel that it is immoral and triggers guilt in any case. Euthanasia in nursing is still a debatable phenomenon, but in the countries where it is legalized, nursing staff should be prepared and educated for it to provide high-quality care and avoid suffering themselves.

Types of Euthanasia

Although euthanasia as a phenomenon seems to be wholesome, some details can change its content drastically. For instance, there are two types of euthanasia – active and passive – which are determined by the action or inaction of the medical personnel. More specifically, according to Brassington (2020), active euthanasia is “the intentional ending of one person’s life by another… through the deliberate administration of a life-ending substance or procedure” (p. 3). Passive euthanasia is “the ending of one person’s life by another… through the deliberate withholding of a life-preserving substance or life-preserving procedure” (Brassington, 2020, p. 3).

In other words, active euthanasia is determined by the active involvement of a particular person who does something to the patient. In contrast, passive euthanasia implies that the patient does not get a specific medication or treatment. Therefore, the tremendous ethical difference is raised by the existence and implication of these two kinds of euthanasia, and the questions regarding the patterns of choice between them stay unanswered.

The distinction described above leads to a significant problem that affects the existence of euthanasia in general. This problem is the involvement of the nursing personnel in the process of euthanasia – because the active type implies them undertaking actions. In contrast, the passive type implies doing nothing special, and both scenarios may trigger guilt. The difference between these two variations can be referred to as the difference between killing a person and letting him die (Brassington, 2020). Morally, both of them may seem unsuitable for the medical staff to perform unless they are correctly described and supported by the facts on the severity of the patient’s condition. However, the law may regulate these inconsistencies by introducing strict definitions of both actions and implementing the rules of use for each of them.

Euthanasia Controversy

Although euthanasia exists in some countries and is widely used for helping people with incurable diseases or diseases accompanied by unbearable suffering, nothing is practically clear about it. To be more exact, there are still inconsistencies regarding the rules for the procedure, availability of it for different social groups, and controlling the number of cases. Due to the problematic moral aspect of the procedure, not every medical staff member would agree to participate. However, euthanasia implementation would meet introducing it as a simple part of medical treatment.

On the other hand, nursing personnel may decide for the patients if the euthanasia procedure is relatively simple and available. For instance, Miller et al. (2020) describe a few cases in the Netherlands for patients with dementia, when nursing staff decided to give patients sedative medicine before the procedure, although it was agreed. Miller et al. (2020) specifically focus on the case of a woman with Alzheimer’s disease who was placed in the nursing home to get assistance in euthanasia based on her will. The woman stated that she was scared of living with Alzheimer’s disease and wanted to have euthanasia if the disease progressed and if she still wanted it.

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When she started losing her memory on a profound level, her condition was evaluated by the medical staff, who were concerned that she was suffering for a significant part of each day (Miller et al., 2020). Therefore, the case concentrates on the question of whether a decision to perform euthanasia in those conditions was right, or the nursing staff could not decide this for the patient since she could not do it herself.

Such situations highlight the flaws of the existing medical assistance system in general and procedures connected with euthanasia in particular. More specifically, if they are legalized, such services have to be thoroughly described, specified, standardized, and regulated by law. Otherwise, various issues regarding different aspects of the phenomenon would occur, and the trust of the society for this procedure would not increase, as well as the spreading of it would be limited. Generally, this is a negative effect since people in different parts of the world suffer from various diseases which make them live in inhumane conditions, and euthanasia could be a solution.

Legalization of Euthanasia and its Consequences

Research on the topic of euthanasia and people’s attitude to it has been conducted for many years. Recent studies prove the point of view on medical assistance in dying (MAiD) mentioned above. The subject of the research by Monteverde (2017) was to ask people who work in the medical sphere and face the necessity for euthanasia, whether they are for or against it, and why. These people’s opinions were gathered to reflect the situation in the world – in other words, to reveal the global attitude towards MAiD. The result has shown that countries where euthanasia remains illegal, such as Australia, New Zealand, Ireland, and the United Kingdom, attempt to legalize it (Monteverde, 2017). This reflects a tendency to spread euthanasia wider globally, along with the rise in popularity of democratic ideas regarding the lifestyle, medical standards, and other aspects of public life.

However, the other part of the world considers a slightly different point of view on the issue – that this is not just good for incurable patients but that this risky step triggers more problems. More specifically, the representatives of countries where MAiD is legal, such as the United States, Canada, and Switzerland, claimed that it requires a thorough law inspection aimed at legislation concerning euthanasia improvement (Monteverde, 2017). Therefore, the experience that the countries where euthanasia has been legalized possess are essential for soothing its implementation in other countries and improving the system in general (Monteverde, 2017). Thus, legalizing this way of helping people with serious diseases does not guarantee its proper functioning and may negatively affect medical personnel if the law system has imperfections leading to nurses’ prosecution.

Factors Affecting the Nurses’ Perception of Euthanasia

The problems connected with euthanasia implementation in different countries are not the only issue concerning the controversy of this phenomenon. People who work in the medical sphere refer to euthanasia, and MAiD is even more substantial for the procedure’s quality and spreading. The study by Cayetano-Penman et al. (2020) proves that the nurses’ attitude to euthanasia depends on different factors. The nurses who supported euthanasia mentioned such factors as unbearable pain, the suffering of the patients, legalization of euthanasia, and the patient’s right to choose death rather than torturing life (Cayetano-Penman et al., 2020). Nurses claim that these factors predetermine the existence of euthanasia as a legal medical procedure because they describe the conditions of a person’s life with complicated diseases and portray their inhumanity.

On the other hand, the negative attitude to euthanasia was mainly caused by religious views, morality, ethics, and poor quality of palliative care (Cayetano-Penman et al., 2020). In other words, people who do not support euthanasia are concerned about their conscience, which cannot accept that the act of euthanasia can be referred to as a good deed (Cayetano-Penman et al., 2020). These respondents stated that they do not find it relevant to decide whether the person is adequate and can make such choices in a clear mind (Cayetano-Penman et al., 2020). Generally, nurses appeared to think positively of euthanasia because they value patients’ decisions and the role of medical personnel in providing care.

The Difference Between the Nurses’ and Students’ Attitude to Euthanasia

Another critical issue in solving euthanasia legalization and ensuring its proper functioning concerns the attitude of future nursing personnel – students – to it. The research on the difference between the euthanasia perception of nurses and medical students was held by Green et al. (2020). It has shown that nurses support euthanasia more frequently than students and reflect on euthanasia-related communication positively (Green et al., 2020). The reasons for such differences in points of view can be explained by students’ understanding of their inconsistency and lack of knowledge and experience on euthanasia and the related behavior (Green et al., 2020).

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Another research conducted by Hosseinzadeh and Rafiei (2017) revealed that most respondents were against active euthanasia, supported by the fact that most of these people had faced euthanasia before, portraying the negative image of the procedure. Therefore, students in medical universities should have an opportunity to get familiar with all the aspects of working in the nursing sphere, including euthanasia, not to be discouraged by the lack of experience.

Mental Health and Euthanasia

Moreover, there are issues related to the justification of euthanasia and its aspects. For example, the study by Demedts et al. (2018) aimed to assess mental health nurses’ attitudes and role regarding euthanasia connected with unbearable mental suffering. The research has shown that most nurses supported MAiD and claimed that although a patient’s health condition may be hopeless, there are no reasons to refuse the concept of unconditional orientation towards life (Demedts et al., 2018). More specifically, the nurses claimed that there was no reason for choosing death over suffering because people cannot make such choices, as their consciousness is faded by the pain they experience.

Considering the existence of euthanasia for patients with mental disorders, the opinion of the nurses does not differ drastically from similar situations with other patients. Nurses also noted that the possibility of discussing euthanasia with the patients depended on the severity of their illnesses but still exists (Demedts et al., 2018). In other words, medical nurses claim that the more severe is the disease of a mental health patient, the less likely the procedure of euthanasia is to take place (Demedts et al., 2018). Hence, the opinions on the relevance of making euthanasia available for patients with mental disorders are not one-sided. Implementing new measures in this field of medicine requires a solution based on some scientific research.

Thus, from the mental health nurses’ point of view, even the patients with mental health disorders can state their willingness to have euthanasia if their condition allows them to express their thoughts clearly. In countries where euthanasia is legalized, the attitude to a person reflects the respect and value of this person’s desires, sometimes despite the limitations that the state of health and mind brings to life. Therefore, according to nurses, the patient’s will is considered more important than any other condition, including his or her state of health, in solving questions regarding choosing between life and death.

Palliative Care and Euthanasia

Research is being continuously conducted on people’s attitudes towards such morally complex issues as euthanasia and people’s approach to it. For example, the study by Dierickx et al. (2018) reflects the frequency of using palliative care by people who request euthanasia. The main aim of the study was to review the probability of people wanting to have euthanasia in different situations. The research has shown that “palliative care services were involved in the end-of-life care of 70.9% of those who requested euthanasia”, highlighting that this usually is a well-thought decision (Dierickx et al., 2018, p. 119).

Also, the study has revealed that professionals and experts in palliative care accompanied the process of making the decision for or against euthanasia only in half of the cases (Dierickx et al., 2018, p. 119). Therefore, there may be a possibility that some critical factors regarding the patients’ psychological and physical state are not taken into account. However, the main finding of this study is that statistically, people are more likely to request euthanasia after getting palliative help than those who do not get it.

Conclusion

To conclude, although the necessity of euthanasia is doubted, it has already been legitimated in several countries and thus cannot be disputed as a fact. However, its relevance and the required qualification of medical staff related to medical assistance in dying are still discussed. Numerous studies on the topic show that nurses support euthanasia as a way of providing care to patients. Nevertheless, they face psychological difficulties in accepting this procedure as a part of the medical care they provide, which triggers the appearance of more barriers for spreading the use of the procedure. The medical staff understands that they often do not have enough knowledge or experience to maintain the appropriate quality of their services. Thus, euthanasia requires more research, which would provide the basis for improving the system globally.

References

Brassington, I. (2020). What passive euthanasia is. Brassington BMC Medical Ethics, 21:41, 1-13. Web.

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Cayetano-Penman, J., Malik, G., & Whittall, D. (2020). Nurses’ perceptions and attitudes about euthanasia: A scoping review. Journal of Holistic Nursing, 1-19. Web.

Demedts, D., Roelands, M., Libbrecht, J., & Bilsen, J. (2018). The attitudes, role & knowledge of mental health nurses towards euthanasia because of unbearable mental suffering in Belgium: A pilot study. Journal of Psychiatric and Mental Health Nursing, 25(7), 400-410. Web.

Dierickx, S., Deliens, L., Cohen, J., & Chambaere, K. (2018). Involvement of palliative care in euthanasia practice in a context of legalized euthanasia: A population-based mortality follow-back study. Palliative Medicine, 32(1), 114–122. Web.

Euthanasia: Historical background. (n. d.). PainAssist. Web.

Green, G., Reicher, S., Herman, M., Raspaolo, A., Spero, T., & Blau, A. (2020). Attitudes toward euthanasia—dual view: Nursing students and nurses. Death Studies, 1–8. Web.

Hosseinzadeh, K., & Rafiei, H. (2017). Nursing student attitudes toward euthanasia: A cross-sectional study. Nursing Ethics, 26(2), 496-503. Web.

Miller, D. G., Dresser, R., & Kim, S. Y. H. (2020). Advance euthanasia directives: a controversial case and its ethical implications. J Med Ethics, 45(2), 84-89. Web.

Monteverde, S. (2017). Editorial: Nursing and assisted dying: Understanding the sounds of silence. Nursing Ethics, 24(1), 3-8. Web.

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