Outline





I. Introduction
II. Euthanasia
III. Patients Right to Die
IV. Legal Issues With Euthanasia
V. Nursing Attitudes Toward Euthanasia
VI. Contributing Factors for Nurses
VII. Conclusion





Ethics and Morality of Euthanasia







Luke Westphal
NSG 316 H003
February 24, 2007

The role of a healthcare professional is a very trying role. Nurses and doctors alike are faced with difficult decisions everyday that interfere with their own personal beliefs and values. It is times like these that they have to put their own beliefs aside and have to follow the wishes of their patients, and sometimes this could mean life or death for their client. In these situations, the question is asked; what is more important, the rights and needs of the patient, or the law that is supposed to protect them. Euthanasia is a very tough subject to approach, and like all tough subjects, there is a light and dark side to it. It can be a very helpful tool for those patients that are in unbearable pain or other special situations that make them feel that they can no longer go on living, but it also tears families apart and sends some healthcare professionals to prison.
In Wikipedia, the free dictionary, euthanasia is defined as “the practice of terminating the life of a person or animal in a painless or minimally painful way in order to stop suffering or other undesired conditions in life.” Euthanasia is also sometimes referred to as mercy killing or assisted suicide and it is a practice that occurs all around the world in secret as well as in the public eye. In the healthcare field, euthanasia might be carried out by a physician or a nurse and could be anything from giving a lethal dosage of medicine to simply not resuscitating a client that is “coding” or “flat lining.” The nurse is a healthcare professional who is dedicated to taking care of their patients and doing what is in their patients best interest, but could letting their client die really be in their best interest? In a situation like this, the nurse needs to know what rights the patient has to exercise on behalf of their own health care.
In 1973, the American Hospital Association developed the Patient’s Bill of Rights. These are guidelines that healthcare professionals are expected to follow to ensure the respect and integrity of their patients. Under these guidelines it is stated that:
The patient has the right to make decisions about the plan of care before and during the course of treatment and to refuse a recommended treatment or plan of care if it is permitted by law and hospital policy. The patient also has the right to be informed of the medical consequences of this action. In case of such refusal, the patient is still entitled to appropriate care and services that the hospital provides or to be transferred to another hospital. The hospital should notify patients of any policy at the other hospital that might affect patient choice.
In compliance with this right, when a patient is admitted into a healthcare facility, if the patient is of sound mind, he/she has the choice of whether or not they want to be brought back to life no matter what the circumstances, or if the situation arises, they can opt out of treatment and be allowed to die without any intervention. Even though it is the nurse’s duty to save their patient’s life, it is first their duty to make sure their patient’s rights are upheld. On the other hand, what if a patient is not in immediate danger of dieing, but is in so much pain that living is not bearable to them. If the patient is bed ridden or on so much medication that they are barely coherent, are they really still living, or are they just existing in pain and sorrow? This is when a patient may ask their nurse or doctor to help them die with assisted suicide which could include an overdose of narcotic pain medicine or some other depressant that would slow the heart and breathing and would lead to the death of the patient. Whether standing aside and letting die, or actively taking a step to help the patient die, it is still euthanasia. Euthanasia is very hard to carry out and always leads to death of the patient, so when would it be an acceptable treatment?
Depending on how euthanasia is practiced, it can either be legal or illegal and could possibly have great consequences for the nurse who takes these actions. In the case of a patient who refuses treatment to be resuscitated, and then dies as a result of the nurse carrying out the client’s wishes, euthanasia is completely legal and it is the nurse’s duty to uphold the client’s right to refuse that treatment. However, Jack Kevorkian, a retired pathologist, was imprisoned in 1999 for the death of a man named Thomas Youlk, who was dieing from ALS, commonly known as Lou Gehrig’s disease. Youlk was shown to have full mental capacity when he made his decision to die, and Kevorkian administered an injection to help him pass away. Kevorkian video taped the episode and then aired it on the November 23, 1998 broadcast of 60 Minutes. He then went to trial in 1999 and was sentenced to 10-25 years imprisonment when convicted of Youlk’s murder. Kevorkian had claimed to have helped at least 130 more people die with machines that he had built called a “Thanatron” and another called a “Mercitron”. The thanatron was a machine that he equipped his patients with that had a host of toxic chemicals that the patient could control through an I.V. pump. The patients would then use the pump to administer the drugs to themselves, therefore taking their own lives. After Kevorkian lost his license to perform medicine, it was harder for him to get the chemicals necessary to use the thanatron and this is when he made his “mercy killer”, or mercitron. This device was a mask that the patient would wear that was hooked up to a carbon monoxide pump that they could then control and end their own lives. Kevorkian went to court numerous times over assisted suicide cases but they all ended in acquittal or were thrown out due to his clients ending their own lives with the machines. Then in the case of Thomas Youlk, it was proven that Kevorkian was the one who administered the medicine and therefore was responsible for the death which ended in his imprisonment. In Jack Kevorkian’s case, euthanasia is illegal, like it is in most states; however, this is not the case in the state of Oregon.
Ever since 1997, when the Death with Dignity Act was enforced, physician assisted suicide has been legal for terminally ill patients that are decision capable and have made repeated, documented request for an end of life treatment if they can administer the medicine themselves. It has been reported that in 2003, 67 prescriptions were written and 42 patients died after ingesting a lethal dose of medication (Oregon Department of Human Resources, 2004.) Among the most reported reasons for a patient to want to end their life are loss of autonomy, inability to take part in what makes life enjoyable to them, and the desire to control the manner of their death.
In the past, when studies were done on the topic of euthanasia, it was usually the physicians that were questioned about their involvement, but in 2004, a study was published in the International Journal of Palliative Nursing that addressed how American nurses are affected by the request of patients to help them die. In this study, ten professional nurses, each with 6-35 years experience and at least a master degree or higher, were interviewed about their own clinical experience with patients asking for help ending their lives and how the nurses responded. Each participant was interviewed twice about their experience for about two hours; the second interview was usually about a week after the first and was used to clarify the information. All the nurses interviewed reported that they had been asked to help with assisted suicide. Most of the nurses say that there’s a line they couldn’t cross, a moral line that was made up of their own personal, professional, and religious beliefs. Sophie, a home hospice nurse was quoted saying, “There is just a standard that I have. I could not live with myself if I knew that I broke one of the Ten Commandments”, but then acknowledged that, “I could do it. I am capable of doing it… I have to stay in check. It’s very powerful when someone turns to you and says “Help me die!” Some nurses reported differently. Even though some nurses know that if they intentionally administer a drug that they know will kill their patient they would be breaking a code of ethics, they have to ask themselves if they can live with that decision. A nurse named Jones who admitted to helping three of her patients die describes just this scenario. When asked about her reason in not consulting the Nurses Code of Ethics, she said, “… It would make me lose heart. It’s like not knowing the nurse practice act- if you don’t know the act and disobey it, it’s bad. But if you know the act and disobey it, it’s really bad.” Another nurse goes on to say, “I think there’s a higher code than the ANA Code of Ethics when it comes to ending life.”
According to the article Nurses ’ Attitudes to Euthanasia: a Review of the Literature, in the July 2004 issue of Nursing Ethics, there is a definite relationship between a nurse’s characteristics and the nurse’s attitude toward either the legalization of or taking part in euthanasia of a patient. Most commonly these characteristics are religious beliefs, nursing specialty, and the age of the nurse. When it comes to religion, the article states that the stronger the nurse’s religious faith, the more opposed they are to the practice and legalization of euthanasia, the less likely they are to stay with a patient under going euthanasia, and the less likely they would be willing to accept responsibility for performing euthanasia. Nursing specialty also plays an important role in the nurse’s attitude toward mercy killing. Studies were done on nurses that were specialist with oncology patients versus nurses who were non-oncologist working in maternity and other nursing departments. These studies showed that the non-oncologist were significantly more in favor of euthanasia than oncology specialist. Another study was done with a group that interviewed nurses from a whole array of specialty areas such as home care, geriatric care, intensive care, etc. This study showed that the more a nurse comes into contact with a terminally ill patient, the less they are in favor of legalization or taking part in euthanasia of a patient. The last most common characteristic tying a nurse to their beliefs and attitudes toward assisting a patient with their death is age. This study showed that the younger the nurse, the more willing they would be in helping a patient die, generally, nurses 40 and younger were more open to this idea than nurses older than forty. Even though these three characteristics can hold a heavy influence on whether or not a health care professional is willing to support or reject euthanasia, there is more to a decision like this than just religious affiliation, nursing specialty, and age.
Every nurse is going to have come from a different background and accordingly will have a different view on how to take care of their patients. A good nurse also recognizes that every patient or client is a unique individual and has unique circumstances and needs that need to be addressed and met. There is no such thing as a uniform nurse or generic patient, therefore, every situation is going to be a unique experience and is going to need to be handled accordingly. Euthanasia is a hot debate all around the world, and whether or not it gets legalized, nurses are going to come face to face with dying patients everyday that may or may not ask to be helped to pass on. This is an issue that has given and will continue to give nurses a moral dilemma throughout their careers, and every nurse will have to develop a system to help their patients as well as themselves live comfortably and confidently in the life or death choices they will have to make on a day to day basis.

References

Euthanasia, (2007, February 24) In Wikipedia, The Free Encyclopedia. Retrieved 10:04, February 25,2007, from http://en.wikipedia.org/w/index.php?title=Euthanasia&oldid-111018176
Jack Kevorkian. (2007, February 24). In Wikipedia, The Free Encyclopedia. Retrieved 10:14, February 25, 2007, from http://en.wikipedia.org/w/index.php?title=Jack_Kevorkian&oldid=11046832
Patient’s bill of rights. (2007, February 25) In Libraries, Kellogg Library. Retrieved 10:18, February 25,2007 from http://www.library.dal.ca/kellogg.bioethics.codes.rights.htm
Schwartz, J., Responding to persistent requests for assistance in dying: a phenomenological inquiry… including commentary by Kreegar L. (2004, May) In International Journal of Palliative Nursing. (INT J PALLIAT NURS), May 2004; 10(5): 225- 235 (30 ref). Retrieved February 24, 2007, from Electronic Journal Center database.
De Bal, N., Dierckx de, B., Gastmans, C., Verpoort, C. (2004). Nurses’ Attitudes to Euthanasia: A Review of the Literature. In Nursing Ethics, July 2004; 11: 349- 365. Retrieved February 24, 2007 from Electronic Journal Center database.

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