Discuss about the Report for Ethical Dilemma in Legislation of Euthanasia.
Ethics is the science relating to moral actions and one’s value system. Nursing ethics deals with principles or morality in patient care (Basavanthappa, 2003). An ethical dilemma occurs in all the settings of the hospital and the nurse has to select either of the option by considering ethical principles. Euthanasia in palliative care setting is more common as it has the terminally ill patients. Some patient may request and some may not accept euthanasia. Euthanasia should never be practiced until patient request it. There is ‘No Right’, ‘No Wrong’ in Euthanasia.
“Ethics has to do with action we wish people would take, not actions they must take”- (Basavanthappa, 2003, p 10). The ethics are nothing but the rules and principles that influence the conduct of a person. Basically it deals with deciding what is good or bad for the people. Nurses do follow nursing ethics which guides them in patient care. It also states the duties of nurses in regard to client’s care and provides professional standards for nursing practice. Albert Camus (n.d.) said, “A man without ethics is a wild beast loosed this world”. Nurses who care for the patient always land up with an ethical dilemma as like standing on the wall so as to fall either in red sea or in black sea. An ethical dilemma is a situation that enables a nurse to decide between two options which are desirable or not. Nurses encounter ethical dilemmas daily in wherever hospitals or health care centers they practice (Basavanthappa, 2003, Fant, 2012). There is ‘no correct solution’ to any of the ethical dilemma (Mitchell, 2015). The ethical issues in palliative care often arise related to the worsening signs and symptoms such as uncontrollable pain, severe breathing difficulty and the method of treatment for the terminally ill patient. The end of life issues also arise due to the cultural aspect of the patient. Ethical dilemma usually arises in case of giving euthanasia for patients in palliative care. Euthanasia (good death) means the deliberately killing a terminally ill patient to put the out of their misery and sufferings (Ologies, 2008, medical dictionary). Euthanasia should never be practiced as the life is the most precious and no person has any rights to kill a person until he/she dies naturally. There is often conflict between the medical professionals as to practice euthanasia or not and at what times it has to be practiced (Eric, 2016). So, this essay will discuss against the legislation of euthanasia in Australia especially in palliative care.
Today, the world has become increasingly complex and man faces troubles in all the aspects. Ethical issues often arise at the end of life of a person. These issues often frighten the people about their death. Dorobuchi (2014) states that an ethical dilemma is a critical situation that often arises which requires the intellectual, moral and ethical standard in a particular situation for a person. As per the definition, the nurses have to use these standards to make a proper decision. We know that ethical dilemma is a problem without a proper resolution. The definition for ethics varies from a nurse to a nurse and settings they practice. There are many ethical issues that the nurses can encounter in the workplace.
Ethical dilemma often arises in palliative care settings as it has terminally ill patients such as cancer patients, HIV/AIDs, neurological patients, etc. the nurses faces moral and legal issues in these settings. The World health Organization has defined that palliative care is an approach to improve the quality of life of patients and their families with problems associated with life-threatening illness by treating pain and alleviating sufferings (WHO, 1988, Norval, 2008, Brown, 2015). The nurses those who are taking care of palliative care patients encounter ethical, legal and moral issues.
The practice of euthanasia is legal in few countries. In Australia, it was considered as illegal, but it was legalized for some period of time in the Northern Territory (Ebrahimi, 2012). In 1995, the Northern Territory of Australia has passed an act for the terminally ill patients as ‘The Rights of the Terminally Ill Act’ (ROTI) to protect the patient’s rights (Woodruff, 1999). But it did not come into effect due to some legal challenges. In March, 1997 it was repealed by the Australian country. The law in Australia is unclear (Komesaroff, 2015).
Euthanasia poses an ethical dilemma in palliative care (Macleod, 2015, Deborah, 2014). It is always said that ‘a nurse is not trained to end but to save patient’s life’. In recent years due to increased technology, the development of palliative care, use of pain management techniques and effective use of terminal sedation has reduced the need for euthanasia (Woodruff, 1999, Deborah, 2014). In a report given by Waddell (1996), it is noted that 86% of the public chose palliative care, 9% chose physician-assisted suicide and only 5% chose euthanasia when palliative care was given as an option to the public.
Is euthanasia a right or a wrong practice for a terminally ill patient? Yes, it’s definitely a wrong practice. Euthanasia is also called as mercy killing, happy death or painless death (Close, 2014). Euthanasia is defined as a deliberate method used to end the life of a patient so as to relieve the suffering of a patient (Walton, 1995). A study conducted by Graber (1999) identifies that 8% of the people will not consult the physicians if they performed euthanasia.
Euthanasia has many types as voluntary, involuntary and active, passive type. Voluntary means euthanasia performed at the request or consent of terminally ill patients otherwise it is called as non-voluntary type. Active type involves injecting medications to directly bring the patients to death with or without patient’s consent whereas in passive euthanasia they bring the death by withdrawal of means of life support such as IV fluids, ventilator, etc (Bartels, 2010). In 1996, Emanuel identified that 27% of the public and 19% of cancer patients will change their physician if know that he/she practiced euthanasia (Emanuel, 1996).
The nurses should take decisions by considering their ethical principles, code of ethics, professional standards, their beliefs, thought, experiences and personal values. They have to take decisions by following the ethical principle always by using an ethical framework. This ethical framework is consisting of the ethical principles as autonomy, beneficence, non-maleficence, truth telling and justice (Woodruff, 1999). It is very important to have a framework to deal with the ethical crises.
Autonomy means self determining action. It involves an ethical action taken by allowing the patient to make decisions independently. The most important fundamental ethical principle in health care setting is giving respect for client’s individual autonomy. In South Australia, consent should be got from the patient before medical treatment which is supported by ‘Consent to Medical Treatment and Palliative Care Act 1995’ (Woodruff, 1999). Euthanasia should be based on patient’s choice. As the patient has right of autonomy, they can also request for voluntary euthanasia. But we have to inform them that the palliative measures are available and medications are available to symptoms such as severe pain, anxiety, dyspnea, insomnia, etc (Chao, 2002). It should never be legalized. Patterson (2005) argues that most of the terminally ill patients might not have sound mind to take decision about euthanasia and so autonomy may not used.
Beneficence defines as doing some good for the patient. Basically, this principle includes the four following components as a nurse should not cause any harm to a patient, should prevent harm, remove harm and promote good. Euthanasia may benefit in case of severe pain or illness to alleviate suffering (Woodruff, 1999). But sometimes medications could be given to minimize these symptoms and could prevent euthanasia.
Non maleficence refers as not to do harm and to prevent harm for the patient which is a fundamental duty of the health care professionals. The term harm includes physical, psychological and social injury. This principle prohibits the practice of euthanasia to terminally ill patients until they request voluntarily. The principle of justice refers to fairness or equality. It is the basic principle that each person has equal right to the liberty available to everyone. Medical professionals should treat all the patients equally based on the patient’s need (Woodruff, 1999).
Truth telling (veracity) means telling truth always. It involves getting informed consent by informing their condition to the patient. If the patient gives consent for euthanasia, it has to be practiced. It is the basis for effective interpersonal relationship between nurse and the patient. It is a difficult situation for the nurses so as to inform their condition or not (Bandman, 2002). The medical professionals should inform the patients about the available life saving measures to save the life of the patient.
Euthanasia is not at all a solution for any of the palliative care patients. Recent technologies have improved pain management strategies and methods to prolong life of a patient (Woodruff, 1999, Gorsuch, 2009). A nurse has to explain the patient about the available methods of treatment and help them to avoid euthanasia. A nurse has to function according to Nightingale’s pledge which states that nurses should provide patient care with conscience and dignity.
Basically the practice of euthanasia is considered as illegal as it violates the moral belief of a patient. Yet it could be practiced at certain circumstances at the request of a patient and if living is more dangerous than dying. Euthanasia is akin to murder (Ebrahimi, 2012). Some might even go as far as to suggest that anything less than aggressive treatment and all available means to save and prolong life are also murderous acts. Once legalized, euthanasia will be increasingly performed on those even with less severe pain, distress or disability. An activity will become a habit which modifies the character and becomes a destiny of the person. Therefore euthanasia should never be practiced unless requested by the patients.
Reference
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