Introduction
Medical aid in dying has become a rampant phenomenon in the global health discourse as a controversial change in the contemporary healthcare industry. The concept is described as the inducement of death at a patient’s request, facilitated by a medical substance that can be self-administered or by a healthcare practitioner (Pesut et al., 2019). Consequently, it has sparked debate as over seven nations have legalized the practice, considering euthanasia an ethical practice in the medical professional realm.
While the practice is legalized in Canada, some provisions limit requests for medical aid in dying for adults over 18 years (Shaw et al., 2018). Under such conditions, the case is exacerbated when the idea is broached for pediatric patients. This forms the basis of this paper, which seeks to promote a position that medical aid in dying should not be extended to pediatric patients with terminal illnesses.
Current Trends
The importance of the subject of pediatric perceptions of medical aid in dying is based on the proliferation of pediatric deaths and chronic illnesses. Webster et al. (2020) offered that Canada estimated rates of up to 3500 deaths annually, whereby cancer and injury are the significant causes of death. However, children experience significant challenges before death when diseases are life-limiting, implying their progressive degeneration to death (Webster et al., 2020). A dying patient would require medical intervention to offer relief and manage this last stage of life. Hence, pediatric euthanasia is broached as a possibility to support the patient suffering from refractory circumstances. Contextually, Belgium is among the few countries that have extended euthanasia to minors, influencing significant conflict in the medical field (Raus et al., 2021).
Erikson’s developmental theory proposed that children are dependent on their parents for decision-making and are not entrusted with complete independence. The metaparadigm of pediatric care conceptualizes human development, arguing that children under 18 are still, to varying degrees, dependent on their parents (Cherry, 2022). This is a basis of contention whereby euthanasia is abhorred in some spheres of society. Consequently, researchers have advocated for palliative care from a family-centered perspective to alleviate the last stages of illness for patients.
Argument of the Issue
Propositions in Support of Medical Aid in Dying
Proposals for legalizing the practice are substantial and coherent. Cayetano-Penman et al. (2020) argued that medical aid in dying is an effective measure that is warranted as a mercy killing on the basis that patients are experiencing distressing conditions, exacerbated by the experience of unbearable suffering and extreme uncontrollable pain. The act is considered a mercy, especially for neonatal care, as argued on the premise of the Groningen Protocol, which justifies killing a child when they face hopeless, unbearable suffering (Rubenfeld et al., 2020). The inferred concept would be that the practice would be in the child’s best interest.
The idea of the child’s best interest is then considered under the rhetoric of beneficence, which is hard for doctors to achieve when the child has no grounds for self-determination. Verhagen (2023) stipulated that the legal stance offers a resolution that allows parental determination, thereby establishing a position on the best interests of the child. The parent is accorded autonomy, theorized to possess intimate, personal insight into the dying child, offering appropriate perspectives on the child’s quality of life (Verhagen, 2023). Therefore, the child is considered to have the freedom to lead a quality life, achieved through the alleviation of suffering.
From a medical and healthcare professional ethics standpoint, the process is presented as an effort that provides the ethical basis for action, thereby resolving potential maleficence in patient care. Verhagen (2023) revealed that neonatal care has complexities that place doctors at risk of ethical implications on the grounds of passive euthanasia. The case is expressed when they withdraw artificial ventilators or medicine and are held accountable for a patient’s death.
Legalizing euthanasia would allow the doctor to express their expert opinion and rely on parental determinism to decide the ethical course of care, allowing fewer complexities of ethical contradictions in healthcare (Verhagen, 2023). Erikson’s theory of development argued for the basis of children’s incapacity as decision-makers (Cherry, 2022). The situation is best expressed in the neonatal stage, when children have yet to form any decision-making or opinion expression (Verhagen, 2023). Then, a parent is responsible for doing what is in the child’s best interest.
Negative Impacts
There are rational arguments that have been presented against the practice of medical aid in dying. Social perspectives reject the idea of legalizing euthanasia because it erodes the societal norms of morality and the value of life (Verhagen, 2023). Enyimba and Ojong (2019) argue that approving such acts contradicts the ideal virtue of society, which preserves the intrinsic value of human life. The implication predicates that the death of a child on the grounds of compassion is immoral from a societal perspective.
Consequently, the idea has expanded that the accessibility of the option is argued to open a range of challenges associated with its misuse. Ladouceur (2018) highlighted the empirical finding that people make substantial requests due to non-pain-related reasons, implying that emotional distress on issues such as disability sparks unethical interests in euthanasia. The disposition that people in distress have the opportunity to seek such an option supports the idea that the value of life is displaced in a society that offers alternatives that consider it better to die than be disabled. Therefore, such thinking is abhorred in society, dissuading the prevalence and access to euthanasia.
Whereas parents are commonly the decision-makers of pediatric euthanasia, there are critics of the justification for their decision. Rubenfeld et al. (2020) opponents would argue that parents or doctors do not have valid measures of the patient’s burdens. Therefore, the decision is intricate, especially in the early stages of development. At the neonatal stage, Erikson argued that a child depends on parents for warmth, nurturing, care, and emotional development (Cherry, 2022). Their state of understanding may be immeasurable if the feeling is nonexistent from the start. Therefore, the choice is flawed, as pediatric patients are non-independent, and their perception of life is not yet mature.
Trends in the Medical Aid in Dying
Critics of medical aid in dying implementation have presented empirical justification that when these elements of euthanasia are extended in practice, they impact the patient care process. Cheng et al. (2022) argued that there is a high risk that the option for euthanasia impedes the patient and family’s consideration of alternatives such as palliative care. The argument was that, with the practice’s popularity amid controversies, public knowledge is focused on medical aid in dying, reducing local people’s willingness to suggest palliative care (Cheng et al., 2022). The hypothesis was developed to advocate that palliative care was a better recourse before euthanasia, requiring sensitization and education on the importance of life and alternatives to euthanasia. The proposition presents a demerit to the healthcare system, as it facilitates ineffective patient care processes.
Personal Standpoint
Following the comprehensive delineation and understanding of the issue, I am inclined to support the deregulation of euthanasia. In my opinion, the policy’s negative implications outweigh its positive impacts. I think that the social dynamics of patient care are integral to sustaining effective healthcare systems and maintaining the credibility of medical and nursing practice.
The contradiction with the central belief in preserving life is fundamental to the choice, highlighting that, with technology and innovation, there are better ways to handle end-of-life decision-making. While it is rationally implied that the killing is a mercy for the pain and suffering, the assumption ignores the emotions and the value the family and society place on the child’s life. Under such circumstances, it is essential to prolong life and allow the family sufficient time to accept the inevitable, but within a framework of therapeutic understanding.
Recommendations for Education
Palliative Care
The concept of medical aid in dying has been aligned with the impact on the accessibility of palliative care as an alternative course of action. According to the WHO, the phenomenon involves consistent and diligent care for the child’s body, mind, and spirit, extending to support for the family (Webstar et al., 2020). As such, the resolution to euthanasia is the first response to terminally ill patient care requiring pediatric nursing to effect a family-centered care plan.
Webster et al. (2020) prescribed that the procedure involves seeking alternative therapies that optimize the patient’s care beyond pharmacological intervention. The family members are significant in managing the patient’s sense of suffering, insinuating the possibility of social-based therapy. Nonetheless, Webster et al. (2020) argued that when deciding on the end of life, the best recourse during palliative care is the parents’ signing a DNR that allows them a sense of disassociation with complete responsibility when the child dies. Collectively, there are alternatives in medical care that assert the controversial legalization of euthanasia.
Continuous Sedation (CDS)
Terminally ill patients are considered to be in a gradual transition to their death, with significant awareness that there is no recourse to their treatment. As such, Badarau et al. (2019) acknowledged that there are instances in which palliative care is insufficient to provide relief to patients. Hence, they revealed the modern practice towards integrating CDS as a priority before euthanasia, progressive sedation of patients suffering physiologically and psychologically. The practice involves sedating patients, rendering them partially or completely unaware (Badarau et al., 2019). The procedure preserves life and supports the management of the last stages of life, enabling the family to find peace and appreciate the patient’s life.
Conclusion
In conclusion, the research offers compelling insights into current healthcare paradigms, with a comprehensive analysis of these trends in pediatrics. In this case, the discussion presents a significant inclination that dissuades the extension of euthanasia to minors. It states that medical aid in dying should not be provided to children with terminal illnesses. Instead, the study illustrates that other alternatives have to be considered for patients that preserve the quality of life, emphasizing the natural death of patients.
The research highlighted significant flaws that argue a basis to consider the legalization of the practice in nursing surrounding the intrinsic value and the significant disposition to misuse the model of management and care of pediatric terminally ill patients. Progressively, the implication of the application of the care is to reduce the impact of diseases and not to hasten death. Unlike euthanasia, the option is an alternative with minimal control at the time of death. Instead, the program supports a position against the direct instigation of death.
References
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