QUESTION
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Euthanasia and Assisted Suicide
There are significant discussions regarding the right to live or die. According to Banovic, Turanjanin, and Miloradovic (2017), a more specific question is whether man has the right to the dignified end of life. Another particular issue is whether depriving life based on mercy is unpunishable or a crime. The response to these questions differs between nations. On the one hand, in case the country has decided to legalize the deprivation of life, it is essential to define the factors that inform the decision. On the other hand, when there is a legislator that takes a counter view, the same question arises. In this regard, physician-assisted suicide and euthanasia are inexhaustible areas for various contexts of law, religion, medicine, morality, and philosophy. It is first essential to define the two terms of euthanasia and assisted suicide. As adapted from the European Association for Palliative Care (EAPC), euthanasia refers to a doctor of any other individual that intentionally ends one’s life through the administration of drugs based on the person’s request (De Lima et al., 2017). Assisted suicide, on the other hand, entails an individual assisting the other to terminate their own life intentionally at the individual’s request. Notably, the request is voluntary and competent.
This paper entails an outline for euthanasia and assisted suicide ethical dilemma. The key sections involved are the ethical dilemma, desired outcome, ethical principles, ethical theories, the procedure for making the ethical decision, and policy that applies to the ethical issue.
The Ethical Dilemma
Globally, states are making it easier for people to choose their death with regard to time and approach. However, doctors have begun to worry about the consequences. According to Christopher de Bellaigue (2019), euthanasia in the Netherlands has been legal for long. The central dilemma in making the decision affects the doctors in the long run. In 2002, the legalization of euthanasia for individuals experiencing unbearable suffering and no improvement prospects was done, which allows physicians to complete assisted suicide according to the patient’s advanced directives. The main concern is the challenge that the legislation poses to the precept regarding life as precious regardless of the medical condition. To doctors, the central concern is that the legalization opens several ethical malpractices and that the assisted dying cases have increased.
For individuals that have written the advance directives, the euthanasia decision is based on the fact that in case their mental welfare deteriorates beyond a particular point and cannot identify the family members, they should be euthanized. However, there are concerns about the increasing rate of euthanasia cases. Critiques of such an argument are based on establishing that the patient is indeed suffering unbearably because one cannot explain. Doctors, therefore, face the challenge of abiding by the advanced directives. The malpractice cases in this regard involve determining the right time for administering the assist suicide mechanism and following the patient’s decision when there are alternatives.
The Ethical Situation and Desirable Outcomes
Several nations have continued to legalize euthanasia. According to Christopher de Bellaigue (2019), euthanasia will become among the available options in the possible deaths approach in case western society continues to follow the Canadian, Dutch, and Belgian examples. For war veterans, baby boomers at an advanced age, and individuals struggling with chronic conditions, a civilized death according to the individual’s preferred time is a right that states are continuously regulating. However, although euthanasia appears to address an ethical and moral conundrum, others arise, especially on the limits. There are also concerns presently that doctors are facing legal actions based on malpractice allegations related to assisted suicide and euthanasia. For instance, as described by Christopher de Bellaigue (2019), there are dementia suffers that have asked to be killed at the right time according to the advance directive. However, when a physician made the patient assessment and established the right time according to the identified terms, the individual resisted. The doctor, therefore, resolved to drug and restrain the individual, after which she submitted to the fatal injection. The doctor has, however, been summoned and has defended her actions based on the patient’s requests. Besides, the patient was incompetent, and the protests before the assisted suicide were not relevant.
There are two sides to the situation described above. Primarily, the doctor is expected to respect the individual’s autonomy and decide the right time to offer a suicide pill or injection. Based on the advanced directive, this decision is left to the physician. However, the question arises of what happens if there is an alternative. Does the physician still proceed with assisted suicide? On the other hand, the individual’s relatives may question the right decision and request for justifications. These aspects may have an impact on the physician’s psychological welfare. Using the case of California, the AB 15 outlines the key elements in the physician-assisted suicide (Assembly Bill No. 15). Among the core aspects in the bill is that physicians are immune to the criminal charges or decisions provided all the stages were followed, such as confirmation of the prognosis and the decision being made by two physicians. However, the physicians may still be affected by the relatives’ concerns and arguments regarding the death of their family members.
My desired outcome for the case is that the physicians should be allowed to make the final decision. For instance, some studies provide insights that dementia patients or those at the advanced cancer stages could live longer with new medications and evidence-based practices. Besides, there will be several cases and scenes of unutterable grimness. In this regard, the patient’s right, autonomy, and respect to one’s decisions should not govern the doctors’ actions. The merits of the malpractice cases should be evaluated in-depth to establish if the doctor made the right call to determine the right time for the administration of the fatal pill or injection.
Relevant Ethical Principles
The ethical principle that applies to the ethical dilemma is Autonomy. According to Zhu, Zhang, and Lu (2020), autonomy refers to the individual’s right to freedom, independence, and self-determination. In the healthcare context, autonomy is concerned with the practitioner’s obligation to respect the rights and decisions of the clients regarding their health. Autonomy is respected regardless of whether the physician agrees with the individual’s decision. In this dilemma, the patient’s decisions are outlined in the advanced directives. However, the physician should not be subjected to legal action after making the right call according to personal judgment. On the other hand, the physician cannot assist the individual to take own life if there are still options. The healthcare providers should further discuss the decision with the patient’s relatives and present other available options. This is aimed at averting the psychological impacts that the euthanasia decision may have on the physician if there were alternatives. The healthcare provider should not be sued based on this action.
Autonomy in this ethical dilemma is presented in two ways. Primarily, there is the patient’s autonomy, which is presented in the form of an advanced directive. The second approach involves the physicians' respect for the individual’s decisions. As described by Greaney and O’Mathuna (2017), respect to the patient’s autonomy is the foundation of tension, especially in cases where there are conflicts in choices. On the other hand, autonomy may occasionally result in professional responsibility and accountability issues for the individual’s welfare. In the ethical dilemma, the physician may present a different opinion concerning the right time or present an alternative approach. The inability by the patient to express confirmation to the autonomy in the advanced directive for the physician-assisted suicide has a severe impact on the conversation. On the one hand, the physician is immune to deciding against own wish. On the other hand, there should be respect for the patient’s autonomy in the advanced directive.
The second ethical principle that relates to the dilemma is beneficence. According to McCullough (2020), beneficence ethical principle is concerned with the nurse’s actions that promote good and doing what is right or best for the patient. Beneficence should not be confused with the non-maleficence principle, which entails avoiding harming. In the ethical dilemma that the physician faces, the healthcare provider aims at providing the best care to the patient. Doing what is right is centered on the physician’s knowledge regarding what is best for the patient. Administration of the injection or pill to kill the patient is not right, especially when there are alternatives that could prolong the individual’s life without pain. Also, in case the patient’s condition is worse, and nothing more can be done, the right decision to the patient’s good is to administer the euthanasia drug or injection.
In beneficence, the greater good informs the decisions by the healthcare provider. As described by Raus, Mortier, and Eeckloo (2018), the decisions should be founded on fostering the patient’s quality of care. In the ethical dilemma, there is an imbalance in the greater good, which is affected by the inability by the physician to complete the patient’s requests. From the facts, Christopher de Bellaigue (2019) notes that making the right decision for the greater good varies. To the physician, good is not achieved if there may be an alternative. In the situation described above, the individual’s resistance to the injection affects both the patient and the physician. Although the patient later submits, summoning the physician affect the individual’s mental well-being, which counters the greater good.
Ethical Theory
The ethical dilemma can be described using utilitarianism theory, which is centered on the individual’s ability to predict the action’s consequences. To a utilitarian, the ethically correct decision is one that yields the highest benefit to the majority of individuals (Rodger & Blackshaw, 2017). Two types of utilitarianism exist, including rule and act. Act utilitarianism entails the actions that benefit most people regardless of societal constraints and personal feelings. Rule utilitarianism is concerned with law and fairness. Rule utilitarianism aims at benefiting most people through just and fair means. In this dilemma, there are three stakeholders, including the patient, physician, and the individual’s family. When the physician decides regarding the right time, the patient resists. The injection cannot be provided since the patient has resisted, which does not yield the greatest benefit. The family’s involvement is reflected in the restraint and drugging of the individual before the best decision is made.
After the patient submits to the injection, the physician is summoned to respond and defend the action. Some of the reasons presented are the individual’s incompetence and the irrelevance of the protests. From the situation, act utilitarianism is reflected in making decisions that suit every individual, including the patient, physician, and the individual’s relatives. The euthanasia decision, therefore, aims at addressing the patient’s pain and condition. Rule utilitarianism, on the other hand, is reflected in following the advance directives. However, there are concerns over what the healthcare provider considers the best decision according to the situation.
Ethical Decision-Making Process
Doherty and Purtilo 6 step process for making an ethical decision involves the gathering of relevant information, identification of the ethical problem, using an ethical theory or approach to analyze the problem, explore all practical alternatives, act, and evaluating the process or outcome (Hendricks-Ferguson et al., 2018). In the first stage of gathering information, it involves examining the advanced directive, physician’s arguments, and all facts of the case. The second stage of identifying the ethical problem entails determining the gap and challenges that arise in the decision-making process concerning the euthanasia issue.
In the third stage, the ethical theory that can be applied in the decision-making process is utilitarianism to establish the right course of action for the decision. Both the act and rule utilitarianism aspects are applicable in this case. The central concern is making the decision that best suits all stakeholders, while acknowledging the legal aspects, such as advanced directives and the assisted-suicide act. The fourth stage involves exploring practical alternatives. The alternatives in this dilemma include the medical options, proceeding with the euthanasia, or wait longer for the patient to improve. In the fifth stage, the action involves the right decision according to the merits and disadvantages of the different options, such as exploring alternatives or proceeding with the decision. The final stage involves process and outcome, where the results are examined based on the satisfaction of the decision that has been made.
Applicable Policy
Euthanasia is not legal in the US. However, there are physician-assisted suicide is legal in nine states in the US. According to CNN (2020), several conditions should be met, including the individual having a terminal illness and the prognosis indicating that the patient has at most six months to live. Further, the physicians cannot be prosecuted for prescribing drugs that hasten death. In California, for instance, the ABX2-12 End of Life Option Act that was signed into law in 2015 October posits that the healthcare provider is not subject to the suspension, loss of privileges, or membership loss due to compliance with assisted suicide (Bourgeois et al., 2018). The application of this act in the dilemma is based on the challenge that physicians face when making the decision. The healthcare provider in this regard should not be penalized or terminated for acting in the best interests of the patient. This is among the reasons raised to counter the law or policy concerning the respect to the patient’s autonomy. The California Act can be used in decision making to evaluate the patient’s actions.
Reflection on the Outcome
As I develop this paper, the original outcome of acquitting the physician of any malpractice would still be the most desirable option considering there are justifications to one’s decisions. Regardless of whether the patient has agreed to assisted suicide according to the advanced directives, it is essential to consider the psychological impacts that such a decision may have on the physician if there were alternative options and the individual acted according to the best outcome. The physician’s judgment that is supported by facts and evidence should be listened to and the malpractice claims investigated before making the decisions. The legal actions, such as termination of the individual’s license, should not be the ultimate decision when the physician does not respect the client’s choices, especially regarding euthanasia.
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| Subject | Nursing | Pages | 3 | Style | APA |
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Answer
Euthanasia and Assisted Suicide
There are significant discussions regarding the right to live or die. According to Banovic, Turanjanin, and Miloradovic (2017), a more specific question is whether man has the right to the dignified end of life. Another particular issue is whether depriving life based on mercy is unpunishable or a crime. The response to these questions differs between nations. On the one hand, in case the country has decided to legalize the deprivation of life, it is essential to define the factors that inform the decision. On the other hand, when there is a legislator that takes a counter view, the same question arises. In this regard, physician-assisted suicide and euthanasia are inexhaustible areas for various contexts of law, religion, medicine, morality, and philosophy. It is first essential to define the two terms of euthanasia and assisted suicide. As adapted from the European Association for Palliative Care (EAPC), euthanasia refers to a doctor of any other individual that intentionally ends one’s life through the administration of drugs based on the person’s request (De Lima et al., 2017). Assisted suicide, on the other hand, entails an individual assisting the other to terminate their own life intentionally at the individual’s request. Notably, the request is voluntary and competent.
This paper entails an outline for euthanasia and assisted suicide ethical dilemma. The key sections involved are the ethical dilemma, desired outcome, ethical principles, ethical theories, the procedure for making the ethical decision, and policy that applies to the ethical issue.
The Ethical Dilemma
Globally, states are making it easier for people to choose their death with regard to time and approach. However, doctors have begun to worry about the consequences. According to Christopher de Bellaigue (2019), euthanasia in the Netherlands has been legal for long. The central dilemma in making the decision affects the doctors in the long run. In 2002, the legalization of euthanasia for individuals experiencing unbearable suffering and no improvement prospects was done, which allows physicians to complete assisted suicide according to the patient’s advanced directives. The main concern is the challenge that the legislation poses to the precept regarding life as precious regardless of the medical condition. To doctors, the central concern is that the legalization opens several ethical malpractices and that the assisted dying cases have increased.
For individuals that have written the advance directives, the euthanasia decision is based on the fact that in case their mental welfare deteriorates beyond a particular point and cannot identify the family members, they should be euthanized. However, there are concerns about the increasing rate of euthanasia cases. Critiques of such an argument are based on establishing that the patient is indeed suffering unbearably because one cannot explain. Doctors, therefore, face the challenge of abiding by the advanced directives. The malpractice cases in this regard involve determining the right time for administering the assist suicide mechanism and following the patient’s decision when there are alternatives.
The Ethical Situation and Desirable Outcomes
Several nations have continued to legalize euthanasia. According to Christopher de Bellaigue (2019), euthanasia will become among the available options in the possible deaths approach in case western society continues to follow the Canadian, Dutch, and Belgian examples. For war veterans, baby boomers at an advanced age, and individuals struggling with chronic conditions, a civilized death according to the individual’s preferred time is a right that states are continuously regulating. However, although euthanasia appears to address an ethical and moral conundrum, others arise, especially on the limits. There are also concerns presently that doctors are facing legal actions based on malpractice allegations related to assisted suicide and euthanasia. For instance, as described by Christopher de Bellaigue (2019), there are dementia suffers that have asked to be killed at the right time according to the advance directive. However, when a physician made the patient assessment and established the right time according to the identified terms, the individual resisted. The doctor, therefore, resolved to drug and restrain the individual, after which she submitted to the fatal injection. The doctor has, however, been summoned and has defended her actions based on the patient’s requests. Besides, the patient was incompetent, and the protests before the assisted suicide were not relevant.
There are two sides to the situation described above. Primarily, the doctor is expected to respect the individual’s autonomy and decide the right time to offer a suicide pill or injection. Based on the advanced directive, this decision is left to the physician. However, the question arises of what happens if there is an alternative. Does the physician still proceed with assisted suicide? On the other hand, the individual’s relatives may question the right decision and request for justifications. These aspects may have an impact on the physician’s psychological welfare. Using the case of California, the AB 15 outlines the key elements in the physician-assisted suicide (Assembly Bill No. 15). Among the core aspects in the bill is that physicians are immune to the criminal charges or decisions provided all the stages were followed, such as confirmation of the prognosis and the decision being made by two physicians. However, the physicians may still be affected by the relatives’ concerns and arguments regarding the death of their family members.
My desired outcome for the case is that the physicians should be allowed to make the final decision. For instance, some studies provide insights that dementia patients or those at the advanced cancer stages could live longer with new medications and evidence-based practices. Besides, there will be several cases and scenes of unutterable grimness. In this regard, the patient’s right, autonomy, and respect to one’s decisions should not govern the doctors’ actions. The merits of the malpractice cases should be evaluated in-depth to establish if the doctor made the right call to determine the right time for the administration of the fatal pill or injection.
Relevant Ethical Principles
The ethical principle that applies to the ethical dilemma is Autonomy. According to Zhu, Zhang, and Lu (2020), autonomy refers to the individual’s right to freedom, independence, and self-determination. In the healthcare context, autonomy is concerned with the practitioner’s obligation to respect the rights and decisions of the clients regarding their health. Autonomy is respected regardless of whether the physician agrees with the individual’s decision. In this dilemma, the patient’s decisions are outlined in the advanced directives. However, the physician should not be subjected to legal action after making the right call according to personal judgment. On the other hand, the physician cannot assist the individual to take own life if there are still options. The healthcare providers should further discuss the decision with the patient’s relatives and present other available options. This is aimed at averting the psychological impacts that the euthanasia decision may have on the physician if there were alternatives. The healthcare provider should not be sued based on this action.
Autonomy in this ethical dilemma is presented in two ways. Primarily, there is the patient’s autonomy, which is presented in the form of an advanced directive. The second approach involves the physicians' respect for the individual’s decisions. As described by Greaney and O’Mathuna (2017), respect to the patient’s autonomy is the foundation of tension, especially in cases where there are conflicts in choices. On the other hand, autonomy may occasionally result in professional responsibility and accountability issues for the individual’s welfare. In the ethical dilemma, the physician may present a different opinion concerning the right time or present an alternative approach. The inability by the patient to express confirmation to the autonomy in the advanced directive for the physician-assisted suicide has a severe impact on the conversation. On the one hand, the physician is immune to deciding against own wish. On the other hand, there should be respect for the patient’s autonomy in the advanced directive.
The second ethical principle that relates to the dilemma is beneficence. According to McCullough (2020), beneficence ethical principle is concerned with the nurse’s actions that promote good and doing what is right or best for the patient. Beneficence should not be confused with the non-maleficence principle, which entails avoiding harming. In the ethical dilemma that the physician faces, the healthcare provider aims at providing the best care to the patient. Doing what is right is centered on the physician’s knowledge regarding what is best for the patient. Administration of the injection or pill to kill the patient is not right, especially when there are alternatives that could prolong the individual’s life without pain. Also, in case the patient’s condition is worse, and nothing more can be done, the right decision to the patient’s good is to administer the euthanasia drug or injection.
In beneficence, the greater good informs the decisions by the healthcare provider. As described by Raus, Mortier, and Eeckloo (2018), the decisions should be founded on fostering the patient’s quality of care. In the ethical dilemma, there is an imbalance in the greater good, which is affected by the inability by the physician to complete the patient’s requests. From the facts, Christopher de Bellaigue (2019) notes that making the right decision for the greater good varies. To the physician, good is not achieved if there may be an alternative. In the situation described above, the individual’s resistance to the injection affects both the patient and the physician. Although the patient later submits, summoning the physician affect the individual’s mental well-being, which counters the greater good.
Ethical Theory
The ethical dilemma can be described using utilitarianism theory, which is centered on the individual’s ability to predict the action’s consequences. To a utilitarian, the ethically correct decision is one that yields the highest benefit to the majority of individuals (Rodger & Blackshaw, 2017). Two types of utilitarianism exist, including rule and act. Act utilitarianism entails the actions that benefit most people regardless of societal constraints and personal feelings. Rule utilitarianism is concerned with law and fairness. Rule utilitarianism aims at benefiting most people through just and fair means. In this dilemma, there are three stakeholders, including the patient, physician, and the individual’s family. When the physician decides regarding the right time, the patient resists. The injection cannot be provided since the patient has resisted, which does not yield the greatest benefit. The family’s involvement is reflected in the restraint and drugging of the individual before the best decision is made.
After the patient submits to the injection, the physician is summoned to respond and defend the action. Some of the reasons presented are the individual’s incompetence and the irrelevance of the protests. From the situation, act utilitarianism is reflected in making decisions that suit every individual, including the patient, physician, and the individual’s relatives. The euthanasia decision, therefore, aims at addressing the patient’s pain and condition. Rule utilitarianism, on the other hand, is reflected in following the advance directives. However, there are concerns over what the healthcare provider considers the best decision according to the situation.
Ethical Decision-Making Process
Doherty and Purtilo 6 step process for making an ethical decision involves the gathering of relevant information, identification of the ethical problem, using an ethical theory or approach to analyze the problem, explore all practical alternatives, act, and evaluating the process or outcome (Hendricks-Ferguson et al., 2018). In the first stage of gathering information, it involves examining the advanced directive, physician’s arguments, and all facts of the case. The second stage of identifying the ethical problem entails determining the gap and challenges that arise in the decision-making process concerning the euthanasia issue.
In the third stage, the ethical theory that can be applied in the decision-making process is utilitarianism to establish the right course of action for the decision. Both the act and rule utilitarianism aspects are applicable in this case. The central concern is making the decision that best suits all stakeholders, while acknowledging the legal aspects, such as advanced directives and the assisted-suicide act. The fourth stage involves exploring practical alternatives. The alternatives in this dilemma include the medical options, proceeding with the euthanasia, or wait longer for the patient to improve. In the fifth stage, the action involves the right decision according to the merits and disadvantages of the different options, such as exploring alternatives or proceeding with the decision. The final stage involves process and outcome, where the results are examined based on the satisfaction of the decision that has been made.
Applicable Policy
Euthanasia is not legal in the US. However, there are physician-assisted suicide is legal in nine states in the US. According to CNN (2020), several conditions should be met, including the individual having a terminal illness and the prognosis indicating that the patient has at most six months to live. Further, the physicians cannot be prosecuted for prescribing drugs that hasten death. In California, for instance, the ABX2-12 End of Life Option Act that was signed into law in 2015 October posits that the healthcare provider is not subject to the suspension, loss of privileges, or membership loss due to compliance with assisted suicide (Bourgeois et al., 2018). The application of this act in the dilemma is based on the challenge that physicians face when making the decision. The healthcare provider in this regard should not be penalized or terminated for acting in the best interests of the patient. This is among the reasons raised to counter the law or policy concerning the respect to the patient’s autonomy. The California Act can be used in decision making to evaluate the patient’s actions.
Reflection on the Outcome
As I develop this paper, the original outcome of acquitting the physician of any malpractice would still be the most desirable option considering there are justifications to one’s decisions. Regardless of whether the patient has agreed to assisted suicide according to the advanced directives, it is essential to consider the psychological impacts that such a decision may have on the physician if there were alternative options and the individual acted according to the best outcome. The physician’s judgment that is supported by facts and evidence should be listened to and the malpractice claims investigated before making the decisions. The legal actions, such as termination of the individual’s license, should not be the ultimate decision when the physician does not respect the client’s choices, especially regarding euthanasia.
References
Assembly Bill No. 15. Retrieved August 15, 2020, from https://www.deathwithdignity.org/wp-content/uploads/2015/10/2015-CA-End-of-Life-Option-Act.pdf
Banović, B., Turanjanin, V., & Miloradović, A. (2017). An ethical review of euthanasia and physician-assisted suicide. Iranian journal of public health, 46(2), 173.
Bourgeois, J. A., Mariano, M. T., Wilkins, J. M., Brendel, R. W., Kaplan, L., & Ganzini, L. (2018). Physician-assisted death psychiatric assessment: a standardized protocol to conform to the California End of Life Option Act. Psychosomatics, 59(5), 441-451.
Christopher de Bellaigue (2019). Death on demand: has euthanasia gone too far? The Guardian. Retrieved August 1, 2020, from https://www.theguardian.com/news/2019/jan/18/death-on-demand-has-euthanasia-gone-too-far-netherlands-assisted-dying
CNN (2020). Physician-assisted suicide fast facts. CNN Editorial Research. Retrieved August 15, 2020, from https://edition.cnn.com/2014/11/26/us/physician-assisted-suicide-fast-facts/index.html
De Lima, L., Woodruff, R., Pettus, K., Downing, J., Buitrago, R., Munyoro, E., ... & Radbruch, L. (2017). International association for hospice and palliative care position statement: euthanasia and physician-assisted suicide. Journal of palliative medicine, 20(1), 8-14.
Greaney, A. M., & O’Mathúna, D. P. (2017). Patient autonomy in nursing and healthcare contexts. In Key Concepts and Issues in Nursing Ethics (pp. 83-99). Springer, Cham.
Hendricks-Ferguson, V. L., Ruebling, I., Sargeant, D. M., Kienstra, K., Eliot, K. A., Howell, T. G., ... & Armstrong, K. (2018). Undergraduate students’ perspectives of healthcare professionals’ use of shared decision-making skills. Journal of Interprofessional Care, 32(4), 481-489.
McCullough, L. B. (2020). Beneficence and wellbeing: A critical appraisal. The American Journal of Bioethics, 20(3), 65-68.
Raus, K., Mortier, E., & Eeckloo, K. (2018). The patient perspective in health care networks. BMC Medical Ethics, 19(1), 1-8.
Rodger, D., & Blackshaw, B. (2017). An introduction to ethical theory for healthcare assistants. British Journal of Healthcare Assistants, 11(11), 556-561.
Zhu, L., Zhang, S., & Lu, Z. (2020). Respect for Autonomy: Seeking the Roles of Healthcare Design From the Principle of Biomedical Ethics. HERD: Health Environments Research & Design Journal, 1937586720908508.