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Legal and Ethical Issues in Nursing: Difficulties in Decision Making

Discussion of the Ethical Decisions

Many critically sick patients are in uncontrollable pain and encounter an unbearably deprived quality of life (Burkhardt & Nathaniel, 2008). Many of them would choose to terminate their lives instead of continuing till their bodies at last give up. Is it ethical for anyone to deny them their desire? There is a deficiency of palliative care programs in the US, which is a great ethical failure, a slack on the responsibility of health institutions to attend to the requirements of the patients and alleviate their pain and agony, while it is totally achievable to do it. When recuperating from sickness, a feeding tube could be supportive. However, a feeding tube may lead to more distress at the end of life when judged against the failure to eat. Moreover, Ann may have made a conscious choice while refusing to eat for understanding that her time to pass away was near. In this regard, it would be unethical to insert a feeding tube as it would appear as forcing her to live with pain against her wish. It is ethical to allow a suffering patient die with dignity and in agreement with her wish (Raus, Sterckx, & Mortier, 2011). Forcing Ann to live longer in pain infringes her personal choice, in addition to human rights.

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Critically ill patients have the choice of speeding up death through treatment refusal. Moreover, in cases where a terminally ill person might not be in a position to exercise this alternative, assisted suicide has been legalized (Steck, Egger, Maessen, Reisch, & Zwahlen, 2013). In this regard, forcing terminally ill patients to live against their wish is discriminating against them due to their physical limitations. Should the terminally ill patients be offered a similar suicide alternative as the one given to able-bodied individuals? Ann should be assisted to die but not forced to live in suffering and pain. In the US, physician-assisted suicide is legal in states such as Washington and Oregon. The Oregon Death with Dignity Act turned out to be applicable in 1994 to decriminalize the death of the terminally ill patients under some conditions; similarly, Washington established the Washington Death with Dignity Act in 2008. In other nations, it is unlawful to assist the terminally ill kill themselves and a judgment of detention for up to fourteen years could be issued. Nonetheless, even in such countries the system could reach the decision of not taking legal measures against physician-assisted suicide after considering the condition of the patient.

Advice to Frank and Sarah

As a nurse, I would inform Frank and Sarah that a feeding tube is equivalent to a breathing machine in that they both support the life of a terminally ill patient. Rather than allowing Ann to lie there and die of starvation, which could appear as murder, I would advise Frank and Sarah to seek physician-assisted suicide from a doctor, which could entail the application of euthanasia. Since Ann had told Frank her dying wishes, she could have intentionally refused to eat for her condition to deteriorate and die. On this note, the application of euthanasia would be advisable to terminate her life with the purpose of alleviating her pain, as well as ending suffering. To permit a critically ill patient such as Ann to terminate her life is the only benevolent, rational, and kind option (Deschepper, Distelmans, & Bilsen, 2014). The failure to assist in ending her life would be compelling her to live in pain and suffering, in opposition to her wish, which is not right.

References

Burkhardt, M., & Nathaniel, A. (2008). Ethics and issues in contemporary nursing. New York: Delmar Cengage Learning.

Deschepper, R., Distelmans, W., & Bilsen, J. (2014). Requests for euthanasia/physician-assisted suicide on the basis of mental suffering: Vulnerable patients or vulnerable physicians? JAMA Psychiatry, 71(6), 617-618.

Raus, K., Sterckx, S., & Mortier, F. (2011). Is continuous sedation at the end of life an ethically preferable alternative to physician-assisted suicide? The American Journal of Bioethics, 11(6), 32-40.

Steck, N., Egger, M., Maessen, M., Reisch, T., & Zwahlen, M. (2013). Euthanasia and assisted suicide in selected European countries and US states: Systematic literature review. Medical care, 51(10), 938-944.

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