The History of Euthanasia and Its Future - Essay Example

 The History of Euthanasia and Its Future I. Case of Euthanasia Euthanasia has become the centre of debate and legal cases in the western countries. Whether or not it is ethically or morally right in the eyes of men to discontinue these life support devices is discussed in this paper. Hence, a case of a client John McNotten is presented in this paper. John McNotten, a 49 – year old, male, married was admitted due to sudden loss of consciousness. On physical examination, the patient was unconscious with the following vital signs: BP: 80/50 mmHg, HR: 50, RR: 13. He was immediately placed on artificial respiratory support, and was admitted to the intensive care unit. Diagnosis: Ruptured Cerebral Aneurysm. On the seventh hospital day, the client went to cardiac arrest. The wife decided not to submit to any other forms of treatments and life support devices that may prolong the life of her husband on the basis of the will and testament furnished by the client himself before he went into cardiac arrest. In his will, he stated not to prolong his life beyond ordinary means in cases of medical conditions and emergencies. The nurse on duty respecting the principle of autonomy had let the wife sign a waiver. On the contrary, the parents of John McNotten reacted on his wife’s decision removing his life support, and charged the nurse on duty, Maria, with a first –degree murder for cooperating with the wife in the death of their son. The wife testified that she absolutely didn’t consider it as a murder since her husband himself left a will and testament on his medical care and was thankful that someone had respected the decision of her husband to die peacefully. Had John McNotten’s life extended through the administration of extraordinary means, he would still live a vegetative life. Was the nurse right on her decision respecting the will of her client and his wife? Euthanasia is a sensitive case to deal with by both medical practitioners and the family. As a practising nurse, it is our obligation to understand the legal, moral, and ethical concerns that surrounds the controversial issues of euthanasia. II. History of Euthanasia: To understand better what euthanasia is all about, we need to have a glance on the history of euthanasia. Looking back in the year 400 B.C., the Father of Medicine, Hippocrates, made an oath that up to this day, being used by the physicians in their practice. In this oath, it is noted that a physician will “give no deadly medicine to any one if asked, nor suggest any such counsel.” (Euthanasia.com, 2009). In the 14th through 20th century, the common law tradition of Anglo – American punished or disapproved suicide and assisting suicide (Euthanasia.com, 2009). In the 19th century, the United States remained to believe that suicide is a grievous and wrongful act, which is confirmed from a fact that anyone who counsels in the idea of committing suicide is the principal person who is guilty of murder (Euthanasia.com, 2009). In the year, 1828, it was noted that assisting suicide was explicitly outlawed in the Earliest American statute. A criminal code was drafted by the New York commission led by Dudley Field between 1857 and 1865 prohibiting anyone to aid a suicide and furnish a deadly weapon or poisonous drug to another person with intent of taking his own life (Euthanasia.com, 2009). In 1920, authored a book by Alfred Hoche, M.D. which helped in supporting Nazi Germany’s involuntary euthanasia arguing that patients can obtain death assistance from a physician under very carefully controlled conditions (Euthanasia.com, 2009). In 1935, a society known as The Euthanasia Society of England was formed to promote euthanasia, under the name of The Euthanasia Society of England (Euthanasia.com, 2009). In 1939, mercy killing of the sick and disabled was ordered by Hitler amidst the turmoil of war outbreak. The euthanasia program of the Nazi’s which first focused on newborns and very young children was programmed to eliminate “life unworthy of life.” During this time, children up to three years old were registered by Midwives and doctors showing symptoms of mental retardation, and physical deformity. This program had later expanded euthanasia to older disabled children and adults (Euthanasia.com, 2009). In 1995, euthanasia bill, which tool effect in 1996 was approved by Australia’s Northern Territory; however, in 1997, this was later overturned by the Australian Parliament (Euthanasia.com, 2009). In 1998, assisted suicide was legalized by the US State of Oregon. In 1999, 10 – 25 years of imprisonment was sentenced to Dr. Jack Kevorkian for giving Thomas Youk a lethal injection. In the year 2000, euthanasia was legalised in the Netherlands. In the year 2002, euthanasia was also legalised in Belgium. Lately, in 2008, assisted suicide was legalised in the US State of Washington (Euthanasia.com, 2009). III. Definition of Euthanasia: Euthanasia or “mercy killing” comes from a Greek words eu, which means good, and thenatos, meaning death. When combine together, this would mean “good death” (LeBaron, 1999; Kozier, et al., 2004; Arizona Right to Life, 2007). Euthanasia is defined as helping an individual who is suffering to die with dignity (American Life League, 2005). Euthanasia is considered as the merciful thing that an individual can do to their loved ones, and is referred to by others as physician assisted suicide, mercy killing; death aided by the physicians, or imposed death (American Life League, 2005). Arizona Right to Life (2007) noted that a “person may euthanize themselves or have another person euthanize them.” Euthanasia is done to individuals whose lives they considered as valuable. On the other hand, these individuals indeed have infinite worth since in the religious point of view, they were created in the “image and likeness of God” (American Life League, 2005). However, these individuals are tagged as living along and are convinced to have a meaningless lives and are not worthy of living (American Life League, 2005). Furthermore, these individuals usually have illnesses that are life – threatening (American Life League, 2005). Currently, the usage of assisted suicide has been expanded, and includes individuals whose lives are not worth living in the eyes of the society. Euthanasia has been claiming many lives of individuals whose quality of life has been misjudged by others as unworthy even if they have illnesses, are handicapped, or are severely mentally ill (American Life League, 2005). The important issue that must be dealt with into this paper is whether an individual is legally, morally, and ethically responsible to decide for himself when it is the time for themselves or their loved ones to die and go. Is it legally right for the client’s parents and siblings to file a legal action against the wife and the nurse on duty with passive euthanasia as their ground? IV. Classifications of Euthanasia Euthanasia is classified into active and passive euthanasia. A. Active Euthanasia Active euthanasia engages in an action that brings directly the death of a client. A perfect example is lethal injection of medication to end the suffering of a client. Nevertheless, active euthanasia remains to be forbidden by law regardless of the intent of the caregiver which will subsequently result to criminal murder charges (LeBaron, 1999; Kozier, et al., 2004). Despite of criminal charges posted by law, some countries or states permit client assisted suicide to those who are severely ill patients, and those who are nearing death as well as those individuals trying to commit suicide (Kozier, et al., 2004). Kozier et al (2004) added that in their practice, a nurse must recall that “legality and morality are not one and the same” and determining when an action is legal or not is one of the many aspects in deciding whether such action is ethical or not. Kozier et al (2004) reminded that active euthanasia as well as assisted suicide remained to be Code for Nurses violation. B. Passive Euthanasia On the other hand, passive euthanasia suggests that extraordinary means of life support are withdrawn. A great example would be the removal of a ventilator or withholding any attempt to revive a client, such as do not resuscitate (DNR), signed by the immediate family member. Any action that kills indirectly a victim by means of withholding devices that sustains life as well as food and water is considered as passive form of euthanasia (LeBaron, 1999; Arizona Right to Life, 2007). Strictly, the case of John McNotten can be considered as a passive form of euthanasia. Had it not been for the moral Principle of Respect for Autonomy, the nurse on duty, Maria, will be charged with a first – degree murder. Brent (2001) described the Principle of Autonomy as the freedom of choice of an individual or a liberty interests. However, Brent (2001) emphasised that a fine line exist in the application of this principle. This occurs between respect of autonomy and the abandonment of uninsured, underinsured, physically disabled, chronically and mentally ill individuals, adolescent and elderly patients. In this case, the patient is giving justice to his wife and his attending nurse through the written will and testament noting that no extraordinary means to prolong his life must be further implemented. On the contrary, giving a will and testament that states not to extend his own life through extraordinary means is not considered as suicide on the part of the patient, since Mr. McNotten did not deliberately take his own life (Med Help, 2009). V. Life Sustaining Treatment and Termination A. Treatments that Sustains Life Treatments that include antibiotics, transplant of organ, and the use of advance technological devices such as ventilators does not necessarily restore the health of a client but help in prolonging life. A conscious client may have directives what they would want later on, and may specify whether to forego life sustaining measures (Kozier, et al., 2004). It must be emphasized that nurses must understand that a decision to withdraw treatment is not parallel with the decision to withdraw care of a client. Hence, as the illness of a client progresses, sensitive care and comfort measures must ensured by the nurses to their clients. As a nurse, keeping the family and client well informed on the process, and correct any misunderstandings about life – sustaining treatment, and which treatments rendered to the clients are life – sustaining treatments are many of the examples of the duties of a nurse. A nurse must understand that it is a part of an ordinary nursing practice and moral obligation to provide food and fluids to their clients; however, when these will be administered by tube to a dying client for a prolonged time, then, this act will be considered to be an extraordinary obligation or heroic measure. (Kozier, et al., 2004). Kozier et al. added that if it is determined to be more harmful to the client to administer foods and fluids, then a nurse is morally obligated to withhold it. On the other hand, patient’s refusal of food and fluids must also be honoured by the nurse. The aforementioned has been supported by the moral principle of autonomy exemplified in the ANA Code of Ethics for Nurses (Kozier, et al., 2004). VI. Legal Issues on Euthanasia Euthanasia, as a painless act of putting a person suffering from incurable or distressing disease to death is legally wrong in Canada and United States regardless of its compassion, moral conviction, or good intentions. This act leads to criminal homicide charges or civil law for withholding treatment that a client deserves or unacceptable standard of care provision (Kozier, et al., 2004). It must be kept in mind that the meaning of a quality of life and the ability of medical professionals to prolong the quality of life has been considered as indefinite because of the advancement of technology in taking care of the patient (Kozier, et al., 2004). Some people may believe that it is a desirable and acceptable practice to withhold artificial life – support measure or even life support withdrawal to terminally ill clients or those clients who are incurably disabled (Kozier, et al., 2004). Nevertheless, a desirable and acceptable practice would not signify that such action is a legal act. In the United States, all forms of euthanasia is considered to be an illegal act, except in the states where the statues of right to die, and living will is existing (Kozier, et al., 2004). As discussed in the early part of this paper, the State of Oregon approved the Death with Dignity Act, the first US physician – assisted suicide law in the 1990’s. However, this has been greatly abused when it was found out that a total of 129 persons died from the prescriptions obtained under the aforementioned act from 1998 to 2002 (Kozier, et al., 2004). Following the action of Oregon, a number of states also proposed the law of right to die. VII. Ordinary versus Extraordinary Means Arizona Right to Life (2007) noted that many ways to extend or support life of an individual has been created by modern medicine, but this would not mean that a nurse has a moral and legal obligation to extend or support the life of her client using these modern methods. Through this way, an ordinary means to extend one’s life must be crucially differentiated from the extraordinary means (Arizona Right to Life, 2007). A. Ordinary Means An ordinary means of treatment include food and water delivered orally or through feeding tube. Also, a normal administration of medicine such as penicillin is scientifically reliable as well as statistically useful treatment method within ordinary means. This manner of treatment does not place the patient and his family on an undue burden (Arizona Right to Life, 2007). B. Extraordinary Means On the other hand, due to its high cost, a client is not obligated to go through an extraordinary treatment, not counting that it only offers small benefits to the patient. This has been exemplified in the case of John McNotten where the client wrote in his living will and testament that any treatment that must be administered to him must only be limited to ordinary means. Extraordinary means also obligates the family to withstand the high cost of medical treatment, not counting their endurance to survive mental, psychological, and emotional pain seeing their dying love ones. VIII. Persistent Vegetative State A persistent vegetative state is a condition when a person does not show any elements of being conscious over a significant period (Arizona Right to Life (2007). This individual has only a minimal brain electrical activity. Clients under this condition cannot communicate nor perceive the world outside nor they are aware that they exist (Arizona Right to Life, 2007). As a nurse, it is still morally wrong to refer a client in this state as “vegetable” since they are still human beings (Arizona Right to Life, 2007). Moreover, many individuals in the “persistent vegetative states” woke up while other patients were misdiagnosed being in persistent vegetative state (Arizona Right to Life, 2007). IX. Living Will versus Will to Live: A. Living Will A living will is an advanced directive given to the medical personnel or family members, for them to follow in cases when an individual is incapable of rendering his consent to receive or refuse treatment (Arizona Right to Life, 2007). Living wills can be abused and is considered as dangerous among individuals having an attitude towards euthanasia, life, and appropriate treatment living will are incapable of (Arizona Right to Life, 2007). In the case of John McNotten, a living will was furnished by him before he was unconscious and incapable of deciding for himself. The client opted to be treated by ordinary means and refused to submit to any extraordinary way of treatment no matter what will happen to him in the future. The client and his family are not obligated to submit to extraordinary means of treatment due it high cost and little benefit. It is therefore legal, ethical, and morally right that Mr. McNotten’s wish must be followed with utmost respect by his caregivers and immediate family members. The loophole of this case is that the parents and the siblings of the client were not directly informed in the decision of the client’s care plan. The wife, together with his immediate family members must be one in their decision on the client’s care so that cases like this can be prevented in the future. After all, the living will of the client must be respected by everyone. B. Will to Live On the other hand, the “will to live” is a legal document giving a medical proxy to an individual that is trusted who is knowledgeable on the type of life support and medical treatment considered ethical by the patient (Arizona Right to Life, 2007). It is important to note that in an advanced medical directive, the key is not to consent to the will ambiguities to provide sanction euthanasia among the doctors or unscrupulous relative (Arizona Right to Life, 2007). X. Proposed Protocol to Avoid the Current Scenario Euthanasia turned out to be the focus of debates in the medical practice today. The issue lies whether or not it is ethically, legally, and morally right to perform euthanasia. Looking back at the scenario, it can be recalled that the patient had an acute cerebral aneurysm, but prior to this, he had written in his last will and testament not to engage to any form of extraordinary means of treatment to save his family from any added cost during his treatment as well as spare them from any form of emotional, physical, and psychological dilemma. In every scenario that a nurse gets into, he must not only look unto what is lesser evil, but to what is legal as well as ethically and morally right. To avoid misunderstandings, the following protocol must be practised to ensure that the aforementioned scenario can be prevented. A. Euthanasia as a Legal Rightful Act With the advent of modernisation, medical practice is advancing, and more people are placed on life sustaining devices despite of being diagnosed to be in the state of brain dead; however, even in the midst of healthcare innovation, a nurse must remember that she pledged to save lives, and it is a wrongful act to facilitate actively or passively a person’s death. What may others think as legally right is not all the time right in the eyes of God and man. It is only God can take the life of a person and anything beyond that is considered illegal under the law of man and the universe. A nurse must not conform to the world and influence around him, but must hold on to what he believes as ethically and morally right. To avoid the scenario of John McNotten, having his attending nurse sued by his family because of their belief that she cooperated with her wife in “killing” the husband by means of euthanasia, the nurse must not only inform the patient’s wife on any medical procedures but the entire family as well. Although, in the strict sense, the nurse is not held liable on the death of her client, but some people cannot understand the Principle of Autonomy. For this reason, it is best to gather every member of the family and explain the principle behind such action, and it is therefore safe to say that a nurse must adhere to this principle. B. The Morality behind Euthanasia As a nurse, we must go back to the core values inculcated to us when we were yet students. What does the society believes in cannot be perceived as ethically and morally right, and it would not be the basis on our judgment and governance in our nursing practice. Furthermore, what a person or society believes in as morally and ethically right when it is not actually right is still morally right for them. Other states in the United States are adapting to this pattern. However, it must be well emphasised that the law of the land are not the basis of our core values, but are basically rules that may necessitate analysis. One may consider doing passive or active euthanasia, and would act upon an action that can do little harm to an individual. Nonetheless, the intensity of such action cannot be judged whether passive or active alone, but euthanasia as the word alone connotes that it is wrong, and can never be considered as morally acceptable (Kappel, 2001). Therefore, a nurse must adhere to the truth that the practice of euthanasia can never be legal even in places where it is declared as legal (Kappel, 2001). C. Medical Ethics and Euthanasia It is the primary duty of a nurse to save lives rather than end it. It is also the function of the society to safeguard the right of an individual to die with dignity. In the religious point of view, churches are against euthanasia since they believe that God, as the creator of mankind, has the sole right to get back the life of man. In the practice of medicine, euthanasia is considered senseless since our primary duty is to save lives, not end it. With modernization of medical practise, a greater chance of a medical recovery of a client is not unlikely because of the possibility of mistaken diagnosis. D. Information Dissemination and Euthanasia A nurse must learn what euthanasia is all about so that she will be able to properly disseminate information that relates to it to his or her client. Through this way, euthanasia can be well explained to the client and their immediate family. Additionally, a nurse is obliged to explain to the immediate family each detail of the case of the client. This includes the procedure that has to be performed and its sequelae. Any refusal of any procedures must be well - documented by the nurse so that any legal action can be avoided in case something happens to the patient in the future. In this case, the client went into coma, and subsequently had a cardiac arrest and the wife decided to say no to any further treatment. It is visibly clear that the client in his will specified to be treated only through ordinary means; otherwise, any other forms of treatment will be declined dutifully. On the other end, it must be explained to the immediate family members that had it not on its first attempt to place the client on ventilator, the client could have succumbed to death. Any form of treatment tendered to the client must be thoroughly explained by the healthcare provider to the immediate family of the patient to avoid misunderstanding that may lead to any form of legal actions. XI. Belief on Euthanasia Looking back at the history of euthanasia, one can see a frightening future for the reason that floodgates of euthanasia are now opened not only in Europe but other states in the US as well (Schadenberg, 2008). Euthanasia is not all about terminal illness or unexpected disability, but it is more about compassion or “ending suffering” (Schadenberg, 2008). However, we must bear in mind that it is not morally and ethically right to choose how we have to end up our walk in this life. Everything lies in the hand of our Creator. Hence, nurses must define their moral and ethical belief towards euthanasia as well as their personal belief towards it. Whether or not it is in tuned and in line with our advocacy to save lives, this belief must be reinforced in their practise. XII. References: American Life League (2005) Euthanasia. Available at: http://www.all.org/article.php?id=10189 (Accessed: 14 November 2009) Arizona Right to Life (2007). Euthanasia. Available at: http://www.arizonarighttolife.org/userfiles/File/Euthanasia.pdf (Accessed: 14 November 2009). Brent, N. (2001). Nurses and the Law.2nd Edition. Philadelphia: Saunders (An imprint of Elsevier). Euthanasia (2009). History of Euthanasia. Available at: http://www.euthanasia.com/historyeuthanasia.html (Accessed: 13 November 2009). Kappel, K. (2001). The Morality of Euthanasia. Available at: http://www.staff.hum.ku.dk/kappel/tekster/pdf/The%20morality%20of%20euthanasia.pdf (Accessed: 15 November 2009). Kozier, B., Erb G., Berman, A., and Snyder, S. (2004) Fundamentals of Nursing, seventh Edition. New Jersey: Pearson Education, Inc. LeBaron, G. (1999). The Ethics of Euthanasia. Available at: http://www.quantonics.com/The_Ethics_of_Euthanasia_By_Garn_LeBaron.html (Accessed: 15 November 2009). Med Help (2009). Suicide and Suicidal Behaviour. Available at: http://www.medhelp.org/medical-information/show/1115/Suicide-and-suicidal-behavior (Accessed: 13 November 2009). Schadenberg, A. (2008). Troubling Trends on Euthanasia in Europe. Available at: http://www.theinterim.com/2008/june/15euthanasia.html (Accessed: 15 November 2009). Read More