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Euthanasia: Ethical Concepts and Nursing Challenges The arguments in support of or against assisted death, such as euthanasia, have traditionally been focused on almost the same concepts and ideas of bioethics, such as beneficence, autonomy, professional integrity of people involved, non-maleficence as well as societal consequences for that decision. Similar to any other complicated ethical problem, the argument can be developed on both sides. The attitude of nurses towards euthanasia is quite a complex issue. However, the main idea is that while facing death and suffering and undertaking all efforts to stop pain and suffering, the nurses should understand that euthanasia has nothing to do with respect for patients autonomy and quality of life but rather with non-maleficence, sanctity of life and slippery slope.
Euthanasia is often related to the persons right for autonomy, the main principle that deals with the patients right to make the choice of his or her own. For example, the patient's right to accept or refuse some medical therapies can serve as such an example. At the same time, there are two major conditions, which are generally accepted to be necessary for autonomous actions, namely, agency (the persons ability to act internationally) and liberty (the persons freedom from possible controlling forces and influences) (Verpoort, Gastmans, & De Bal, 2004). Beneficence is referred to as an obligation to make a positive contribution to the welfare of the patient. The supporters of euthanasia, however, often claim that nurses' decision to assist a patient in his desire to die is nothing but ethically acceptable decision to stop his or her sufferings (Kuhse & Singer, 1993). Yet, it should be mentioned that this kind decision cannot be ethical, and assisting a patient in his or her decision to die can never be an act of benevolence, as it violates the important idea of sanctity of life.
It should be also noted that if euthanasia will be legalized, the medical practice will inevitably expand from those patients with diseases and illnesses, which pose a threat to the patient's life, who are able to make an informed and free decisions to the patients, who are incapable of refusing or choosing aid in their decision to die (Verpoort, Gastmans, & De Bal, 2004). To put it differently, the nurses should understand that there may be some patients, who may decide to refuse medical treatment and to choose death not because of their own free will, but because they are coerced into this decision by communities of their families who, due to any reason, have no desire or are incapable of caring for these patients. Also, the lack of patients access to quality care (for example, palliative care) can also force patients to ask for assisted death as the only way out. In addition, there is also a concern that some categories of patients (for example, the patients with mental disability) will feel a pressure from the part of communities or families or even some clinicians who decide that the quality of life of the patient with dementia or any mental disability is poor. Moreover, it should be taken into consideration that euthanasia as a form of assisted suicide will be viewed and accepted as a kind of substitution for palliative care rather than being an option after all possible measures to relieve physical and psycho-spiritual distress have failed.
It should be also noted that there are other ethical issues for nurses involved. What concerns nursing attitudes toward euthanasia, according to Verpoort report (Verpoort, Gastmans, & De Bal, 2004), who examined comprehensive quantitative studies that had used the questionnaires also used by Young et al (Young, Volker, & Rieger, 1993) and Kuhse and Singer (1993), there is an evidence that relatively large percentage of nurses consider it acceptable to assist patients in his decision to die. According to them, the percentage of the nursing attitudes in support of euthanasia ranged from 14 to 78 per cent (Verpoort, Gastmans, & De Bal, 2004). At the same time, in the studies that were not based on questionnaires, developed by Young et al (Young, Volker, & Rieger, 1993) and Kuhse and Singer but asking a question concerning nurses decision about euthanasia and legalization of it in the nearest future, the results were mostly positive (the percentage of positive attitudes ranged from 23 to 61 per cent, respectively (Verpoort, Gastmans, & De Bal, 2004). What concerns ethical issues involved, according to Verpoort, Gastmans, & De Bal (2004), the percentage of positive nurses responses, who were asked whether assisted suicide could be justified ethically, ranged from 21 to 70 per cent.
However, the nurses considered that only under certain conditions (for example, if the patient suffers from terminal illness) euthanasia could be ethically justified. In such a way, a wide gap between nurses decisions on ethical nature of euthanasia may serve as a witness of the complexity of the issue involved. Therefore, a more thorough examination should be done, especially in terms of ethical content of the issue, to understand the position of nurses against euthanasia. Basically, nurses play an important role in taking care of elderly people and people suffering from terminal il nesses at the end of their lives. In their daily practice nurses face necessity to assess and manage patients pain and other symptoms of the il nesses. They need to address the patients psycho-spiritual need, assist both patients and their family members in acknowledging and clearly articulating their values, beliefs and goals governing the important decisions they make.
Nursing practice involves discussing the patients' choices of desired medical treatment, and assisting patients and their family members to article their wishes and needs for required care. In their daily practice nurses are guided by various resources assisting them in fulfilling the abovementioned roles. Yet, there are relatively few resources able to provide nurses with guidelines concerning euthanasia. To a certain extent this can be explained by the fact that it is quite difficult to provide guideline concerning the subject that is, in fact, illegal (Ersek, 2004). It should be also mentioned that the vast majority of hospice and other professional nursing establishments have clearly articulated their attitude against assisted death and euthanasia. At the same time, according to the surveys, nurses in various clinics, hospitals and hospices reported to receive patient's and their family members' requests for assistance in the patient's dying.
For example, according to Asch, almost 17 per cent of the 852 critical care nurses reported that they had faced requests from the patients or their family members to assist patients in suicide or to perform euthanasia (Ersek, 2004). According to Matzo and Emanuel's surveys to Oncology Nursing Society members, 30 per cent out of 441 respondents (75 per cent response rate) claimed that they had been asked at least once to perform an euthanasia (Ersek, 2004). Moreover, during their nursing practice, approximately 20 per cent of the nurses reported to receive at least one request for assisted death or euthanasia, and about 22 per cent of the nurses received the request for a lethal injection. In such a way, it is possible to come to important conclusions. Firstly, obviously, as far as the nurses have to witness the patients's uttering, they need to be educated correspondingly and to get adequate and appropriate support in their actions to ameliorate patients suffering. Also, the nurses should be prepared to examine, acknowledge and identify their personal responses and attitudes toward the patient's suffering.
In case the nurses fail to identify their personal distress, there is a very low probability that they will be capable of identifying comprehensively whose suffering is indeed being addressed by rendering this kind of assistance in the patients decision to die (Ersek, 2004). Also, the second important conclusion involves ethical issues and nurses challenges in their daily practice. According to the studies, there is a confusion and lack of understanding concerning the nurses capability to differentiate between euthanasia, assisted suicide and relief of the patients suffering (Ersek, 2004). This is very important, because in case the nurses have difficulties in understanding the difference between ethical behavior and assisting in suicide, it may lead to unknowingly acting in the way that may result in legal responsibility. Thirdly, the nurses definitely require appropriate and careful guidance in discerning the legal and moral distinctions among different nursing actions.
The nurses require support in making decisions concerning necessary medical interventions as well as assistance in dealing with complicated clinical situations (Young, Volker, & Rieger, 1993). To a certain extent this is supported in Matzo and Schwarz study, according to which one out of four nurses experience distress and uncertainty while dealing with difficult clinical situations. In such a way, although the nurses need to take into consideration the societal and professional perspectives concerning euthanasia and related actions, the individual nurse often faces the necessity to make a decision for himself or herself concerning whether to take part or not in any kind of assisted death. Obviously, this kind of ethical decision evolves careful ethical discernment that involves professional, sociocultural, religious, personal and family influences (Verpoort, Gastmans, & De Bal, 2004). The nurses employed in palliative care and hospice sectors need to have their own clearly defined moral standpoint in relation to this issue.
This standpoint needs to take into account nurses personal beliefs and values, and, at the same time, to take into account societal and professional views. Moreover, it is important to acknowledge that nurses need to make ethical decisions that value individual differences. For example, some nurses may still decide to take part in assisted death or to perform euthanasia irrespectively of legal and professional sanctions (Kuhse & Singer, 1993). At the same time, some nurses will decide to refuse from taking part in such actions, even in case euthanasia will be a legal status. In both cases it is crucial for nurses to understand their own rights and to be fully aware of possible ethical and legal implications of their actions. No doubt, participation in performing euthanasia or assisted suicide is unethical decision.
It is very important to understand that a helpful step in assisting nurses in their attempts to make legal and moral distinctions concerning end-of-life nursing care mostly refers to the capability to describe, acknowledge and assume specific care-related actions and roles in their daily practice of reacting to the patients request in assistance in dying. For example, the Oregon Nurses Association (ONA) assesses the nurses roles in relation to the Death with Dignity Act and defines both acceptable and unacceptable actions for nurses, whether they choose to take or refuse from taking part in this kind of suicide (Ersek, 2004). Also, there is another role for nurses to be obligatory taken into consideration. Being individuals and professionals, the nurses in their daily practice should always actively participate in policy development concerning end-of-life practices and choices.
This is crucial to make sure that the patients, irrespectively of their condition and il nesses always have access to the full range of health care options at the end of their lives. References Ersek, M. (2004). The Continuing Challenge of Assisted Death. Journal of Hospice and Palliative Nursing, 6 (1), 46 - 59. Kuhse, H. , & Singer, P. (1993). Voluntary euthanasia and the nurse: an Australian survey.
International Journal of Nurs Studies, 30, 31122. Verpoort, C. , Gastmans, C. , & De Bal, N. (2004). Nurses attitudes to euthanasia: a review of the literature. Nurses' Ethics, 11, 34965. Young, A. , Volker, D. , & Rieger, P. (1993).
Oncology nurses attitudes regarding voluntary, physician assisted dying for competent, terminally ill patients. Oncology Nursing Forum, 20, 44551.
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Research essay sample on Euthanasia Ethical Concepts And Nursing Challenges
