Increasingly euthanasia continues to be a subject of ethical debate in most countries. It is a subject that has positioned medical practitioners, human rights groups, religious groups and moralists in opposite sides of a never ending debate on the appropriateness of euthanasia. Active euthanasia refers to the administration or injection of lethal drugs by any other person other than the person concerned with the intentions of ending a patients’ life at the patients explicit request.
Most euthanasia legislations and the literature on euthanasia mainly consider the role and responsibility of doctors in the process,however, euthanasia also concerns nurses. This is as a result of their role as caregivers of dying patients, and their expertise in palliative care; they are closely involved in the process of caring for persons who have requested euthanasia. Nurses’ role in caring for these patients, in addition to their feelings about their involvement in euthanasia is very complex. Personal conflict, moral uncertainty, frustrations, fear, secrecy and guilt are some of the things that nurses have to experience in the course of caring for a patient. It is therefore appropriate that in the debate on the appropriateness of active euthanasia nurses are critically informed and their stand in support of a particular side is informed by information and knowledge, similar to how the principle of autonomy is applied on patients.Various arguments have been put forward to support either side of the debate on active euthanasia. These are:
Arguments for Active Euthanasia
While active euthanasia is illegal, there are proponents who have advocated for its legality. Arguments for the legalization of active euthanasia have centered on the magnitude of suffering and autonomy of the patient. In general four moral arguments have been raised for the legitimacy of active euthanasia. These are: respect for autonomy; the mercy argument; the bibliographical/biological distinction; and the bare difference argument.
The respect for autonomy argument is founded on the principle of autonomy. It posits that individuals should have the right to self-determination concerning all aspects of their lives, including the manner and time of their death. It maintains that a physician is obligated to respect a patient’s choice and this involves providing knowledge, equipment, and assistance to enable the patient die if that is her or his choice. This is an obligation of the physician which is yet to be recognized by the medical profession or the law of the United States.
The mercy argument is founded on the principle of medical mercy which states that: “where possible one ought to relieve the pain and suffering of another person, when it does not contravene that persons’ wishes…. and where it will not violate other moral obligations…”
The biological distinction argument draws a distinction between human organ’s biological life and a person’s biographical life. It states that moral status is granted only to human beings with a biographical life. That is, “the sum of one’s aspirations, decisions, activities, projects, and human relationships”. This argument maintains that any person who is considered to have lost his biographical life should euthanize.The last argument put forward by proponents of active euthanasia is the bare difference argument. This argument aims at erasing the distinction that has been put between active and passive euthanasia by showing that both result to the same end. It states that the active/passive distinction is a distinction without a difference. There is no difference between intentionally killing someone and allowing someone to die, in the end they are both dead as a result of the physician’s actions or failure to act. The conclusion being that of passive euthanasia is sometimes justifiable, then it follows that active euthanasia is sometimes justifiable.
Arguments against Active Euthanasia
Arguments against active euthanasia center on the sanctity of life as well as on the disruptive and dislocating social results if the taboo against killing were to be disregarded even in cases in which suffering would be alleviated. The arguments against active euthanasia are primarily based on: the sanctity of life doctrine; the possibility of misdiagnosis and recovery; risk of abuse; non-necessity; discrimination which may be seen as a variant of sanctity of life; irrational or mistaken or imprudent choice; and the slippery slope argument.
There are three common arguments conventionally put forward as basis for argument against active euthanasia. The first arguments bring up the moral aspect of the debate, concluding that there is a morally important difference between doing and allowing. This argument maintains that intentionally ending human life is morally inappropriate as it violates the caregiver’s commitment to the preservation of life by going against the non-maleficence principal. According to this argument, it is part of the caregiver’s role as a provider of care to preserve life. Thus if a caregiver deliberate behaves in such a way that the death of the person for whom he or she has been caring will result, then that caregiver behaved immorally. The second argument against active euthanasia has religious connotations. It posits that that physicians taking part in euthanasia is playing God and that playing God is wrong. The third argument against euthanasia concludes that physicians should not take part in active euthanasia as it is not part of their role as physicians to do so.
While agreeing that both sides of the arguments are convincing in terms of advocating for and against active euthanasia, my personal opinion is that active euthanasia should not be allowed. This is for the reason that I uphold the sanctity of life. Active euthanasia demeans the sacredness of human life and violates fundamental moral prohibitions against killing human beings.
SUMMARY OF JOURNAL ARTICLE
Pro-Euthanasia Article: Eberl, J. T. (2012). Religious and Secular Perspectives on the Value of Suffering. National Catholic Bioethics Quarterly, 12(2), 251-261.
This paper presents a summary of some of the arguments that advocates of active euthanasia and physician-assisted suicide have argued. These arguments have been based to a large extent on the premise of a patient’s pain and suffering being enough a justification for ending a patients life if he autonomously so choses. This is consistent with the autonomy principle which maintains that a person with decision making capacity ought to be allowed to make health care decisions for themselves. However, it goes against the principle of beneficence that dictates the provision of care that enhances the patient’s well being and reduces the risk of harm, as it doesn’t allow health care providers to enhance their well being by attempting to reduce the pain and suffering.
The author posits that a patient’s pain and suffering are a sufficient justification for active euthanasia. The author adds that the non-utilization of life-sustaining treatment, the use of pain-relieving medication that may hasten a patients’ death, and palliative sedation may be morally acceptable means of alleviating pain and suffering. The underlying idea that was put across by this articled is that suffering is evil. Therefore one function of caregivers is to prevent and if possible, end suffering. Hence actions involving assisted suicide and euthanasia to achieve such a goal would and should be permissible. An extreme extension of the argument presented by the author is that all suffering is evil, and therefore caregivers ought to always strive to end any suffering
Pro-Euthanasia Article: Begley, A. M. (2009). GUILTY BUT GOOD: DEFENDING VOLUNTARY ACTIVE EUTHANASIA. Nursing Ethics, 15(4).
This article by Begley is presented as a justification for active euthanasia from a virtue point of view. It was written with the objective of spawning debate and contesting the assumption that killing is necessarily vicious in all circumstances. Professionals in the field of healthcare provision more often than not are torn between informing their action from virtue and acting from duty.
The author presents a case which he uses to defend his position of defending voluntary active euthanasia. He states that adopting a virtue approach takes account of the compassionate response and acknowledge action-guiding, provided the circumstances are appropriate. He adds that as an individual feels empathy and compassion, benevolent action must proceed from the feelings. The authors adds that while laws and rules may prevent an individual from performing certain responsibilities as medical practitioners, in certain times a virtue ethics approach needs to be employed to prevent a situation where a legal system punishes the good person.
The article posits that nurses and doctors needs to have the freedom to respond compassionately in certain situations where active assisted killing is necessary to rid of the patient some form of suffering or pain. It states that the law conflicts with the possibility of a compassionate response and creates tensions between professionals, clients and their families. This article therefore, communicates that in certain situations active euthanasia should be allowed especially in situations where based on the physician judgment and not the law of the land sees it fit to perform euthanasia on a patient.
Pro-Euthanasia Article: Lois, R. R. (2009, September). Nursing And Euthanasia: A Review of Argument-Based Ethics Literature. Nursing2014 Critical Care, 4(5), 15-17.
This article presents asynopsis of the nursing ethics opinions on euthanasia in general, and on nurses involvement in euthanasia in particular through an argument based literature review. The author states that through an in-depth study of the presented arguments, both for and against, nurses will be better positioned to engage in the euthanasia debate.
The authors of the article review and appraise various sources and publications in peer reviewed journals, with the arguments for and against euthanasia being based on their association and guidance by the principles of beneficence, respect for autonomy, justice and non-maleficence. The article presents ethical arguments related to the nursing profession.From a care perspective, the article discusses points of views that evaluate to what extent active euthanasia can be viewed positively or negatively as a form of good nursing care. Most of the arguments presented in the principle, profession, and care oriented approaches to nursing ethics are made use of both pro and contra euthanasia in general, and nurses involvement in euthanasia in particular.
Against Euthanasia Article: Neurology Today. (2009, October 15). How to Handle End-of-Life Care Decisions with Families of Demented Patients. Neurology Today, 9(20), 14-15.
This article gives arguments against the decision to actively end a patient’s life through euthanasia, especially involuntary active euthanasia. The article begins with a patient’s case where a daughter wants a physician to end the life of her Alzheimer parent who is bedridden, does not communicate and chokes when fed. The daughter wants the physician to give her medication to “end her sufferings”.
The authors’ predominant argument against active euthanasia is that it is an illegality and a contravention of criminal law, and that it also has ethical connotations that go against established medical and nursing standards. The author adds that, in voluntary active euthanasia, when a capable patient or person himself ask that a physician toinjects a lethal injection that would result to her death is proscribed in the United States and in many other countries except for Netherlands, Belgium, and Switzerland.
The author further adds that active euthanasia that is involuntary can be a ground for a charge of homicide against the physician, although in many cases, the physician is not charged and grand juries more often than not decline to pass on homicide prosecutions for physicians who are charged because of their compassionate motive. In addition to the illegality of active euthanasia, the author states that involuntary active euthanasia is unethical. The author states that even the scholars who are proponents of the ethical appropriateness of voluntary active euthanasia as well as physician-assisted suicide, citing arguments for the primacy of respecting a persons autonomy rights of self-determination, draw the line against allowing involuntary active euthanasia which is considered to be wrong.
Against Euthanasia Article: Robley, L. (2009, September). Nursing Ethics: Reigniting the debate over assisted suicide. Nursing Critical Care, 4(5), 15-17.
This article discusses the debate on assisted suicide which the author identifies is a product of the understanding and awareness that a large number of the united population is made up of the aging and the aged. It also comprehends that with the inception of healthcare reforms, the question on assisted suicide and natural death will intensify and become a national issue, and therefore there is aneed for medical practitioners, especially nurses, to be well-informed in so as to be in a position to contribute clarity and information on the active euthanasia debate.
The articles presents different views of assisted death, however, it leans more towards covering what the Oregon law states with regards to active euthanasia. This, the author identifies as the opinion of the person such as his or her request for assisted suicide, the number of physicians who must be present to determine that the person is competent and the provision of information about hospice.
The articletakes a firm stance against active euthanasiastating that assisted suicide is wrong. The author stand on active euthanasia borrows heavily from the American Nurses Association(ANAs) code of ethics for nurses who call for nurses to provide supportive care to dying patients, and intervening to enable patients to live with as much physical, social and emotional, as well as spiritual well-being as possible. The article adds that the American Nurses Association (ANAs) position statement on assisted suicide dictates that persons engaged in the nursing profession should not be involved in assisted suicides, but it should always be their goal to provide comprehensive care of the ill and the dying to increase their chances of living longer.The article, in objection to active euthanasia adds that if euthanasia is allowed, there will arise a loophole misuse. It insinuates that as the practice becomes more prevalent, terminally ill patients may opt for active euthanasia, even if they oppose the practice or do not truly want to end their own lives. Patients may feel guilty if they do not consent to being euthanized and may come to believe that their loves one expect them to consent; that their loved ones want to be spared the costs associated with a long, slow death.
Against Euthanasia Article: Stevens, K. R. (2009). Emotional and Psychological Effects of Physician-Assisted Suicide and Euthanasia on Participating Physicians. Issues in Law & Medicine, 21(3), 187-200.
This article reviews and evaluates the debate on the uprightness of active euthanasia by looking at the emotional and psychological effect that physician-assisted suicide and active euthanasia has on the physicians who are involved in the process.
It reviews various medical journals, legislative investigations and the public press to determine what has been reported with regards to the impactof the administration of active euthanasia on physicians who have been personally involved in active euthanasia andPAS. He makes use of the findings from various literatures to come into a conclusion with regards to whether active euthanasia should be an accepted practice or not.
He argues that the move away from the primary beliefs of the medical profession to heal and promote human wholeness can have substantial influence on many participating physicians. The findings of his literature review reflect a deep negative effect of euthanasia on physicians. Participating physicians are profoundly adversely affected, shocked by the suddenness of the death of a patient, and caught up in the patient’s drive for assisted suicide, having a sense of powerlessness, and feeling isolated. These after effects of active euthanasia on the physicians, the author states are enough reasons to advocate for a shift of opinion away from active euthanasia.
The author further adds that there has been evidence of pressure on and intimidation of physicians by patients to assist in suicide. This further compounds on the already strained psychology of the physician and adversely affects them emotionally and psychologically. The author therefore advocates against the practice of active euthanasia. This article objects to active euthanasia from the perspective of the physician who is responsible for carrying out the procedure. The conclusion was that since the act of euthanizing a person affects the physician adversely in terms of his emotional and psychological well being, it will benefit both the patient as well as the physician if active euthanasia is illegalized.
Definition of Terms
Autonomy: this principle is based on respect for the individual and was influenced by Kantian ethics. It proscribes that persons with decision making capacity ought to be allowed to make health care decisions for themselves (Coyle, 2014). Persons considered to have the ability can appoint another person make decisions on their behalf. Under this principle, consent cannot express autonomy unless it is informed and is made without undue influence. Informed consentrefers to the process in which patients with decision making competence are furnished with information ona treatment or procedure that they maydesire to undergo. Patients need to have adequate information to be able to weigh the possible benefits, risks and consequences of opting to accept or forgo a treatment, procedure or intervention. The disclosure of information to the person as well as the active participation of the patientisimperative to this process. Autonomy in healthcare focuses on informed consent. It is strongly emphasized in the Belmost principles that special care must be taken to make sure that patients without competency are sufficiently protected.
Beneficence: this principle refers to doing good. This involves providing care that enhances the patient’s well being and reduces the risk of harm. The Belmont principle also addresses research subjects. Research that can present risks of harm to the subject can still be performed within the principals if the subject has given informed consent. The team charged with the provision of healthcare works collectively to minimalize the risk of the patient and optimize patient benefit. This entails encouraging the patient and family to ensure that their voice is heard.
Non-maleficence: this principle is a reflection of the Hippocratic oath that states: “I will use treatment to help the sick according to my ability and judgment but I will never use it to injure or wrong them.” This principle assigns a duty to avoid harm and minimize the risk of harm. It involves the weighing down of relative risks and benefits of any action or inaction to the patient(Coyle, 2014).However, it is worth noting that in particular situations there arises tension between the principles of non-maleficence and beneficence depending on the lens of the beholder and differing goals and values.
Justice: This principle refers to the provision of fair and equitable healthcare and it comprises of the just distribution of limited resources. All persons must have access to hospice care and palliative care service, support and intervention; and the care provided must be based on patient need regardless of socioeconomic state or social status(Coyle, 2014).
Begley, A. M. (2009). GUILTY BUTGOOD: DEFENDING VOLUNTARY ACTIVE EUTHANASIA. Nursing Ethics, 15(4).
Coyle, N. (2014, February). Palliative Care, Hospice Care, and BioEthics: A Natural Fit. Journal of Hospice and Palliative Nursing, 16(1), 6-12.
Eberl, J. T. (2012). Religious and Secular Perspectives on the Value of Suffering. National Catholic Bioethics Quarterly, 12(2), 251-261.
Lois, R. R. (2009, September). Nursing And Euthanasia: A Review of Argument-Based Ethics Literature. Nursing2014 Critical Care, 4(5), 15-17.
Neurology Today. (2009, October 15). How to Handle End-of-Life Care Decisions with Families of Demented Patients. Neurology Today, 9(20), 14-15.
Robley, L. (2009, September). Nursing Ethics: Reigniting the debate over assisted suicide. Nursing Critical Care, 4(5), 15-17.
Stevens, K. R. (2009). Emotional and Psychological Effects of Physician-Assisted Suicide and Euthanasia on Participating Physicians. Issues in Law & Medicine, 21(3), 187-200.
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