The Application and Use of Euthanasia - Case Study Example

Legally Significant Events In the first case scenario, some of the legally significant events include the facts that Mrs. Jordan had taken the time out to write an advanced care directive which clearly stipulated that her wish was that no life sustaining medical treatment (LSMT) should be offered to her in the event that she happens to contract a terminal illness. Janet, the nurse communicated this to the attending Intesivist, Dr. Johnson who sought to disobey the directive based on the belief that she would get better. This is in spite of the insistence by the family that the directive be followed. Refusal to follow the directive is legally considered to amount to assault and battery under common law. There are also chances of civil liability ensuing (Guido, G. 2009). Though The Human Rights Act 1998 identifies a right to life in Article 2. A court ruling, NHS Trust A v M: NHS Trust B v H [2001, affirmed that the patient’s right to willingly refuse treatment, and whether it was in the patient’s ‘best interests’ to forgo treatment were the two key factors determine whether treatment will be foregone. The patient’s right to intentionally refuse treatment, was recognized as being both legal and not the same as suicide, this was despite the fact that the refusal would ultimately lead to the patient’s death (Chiarella 2006). Legality of Janet’s Actions Janet’s actions can be termed as being illegal because, according to NHS guidelines on the discontinuation of (LSMT), in occasion a disagreement amongst the team members, the team should sit down and consider the basis of the disagreement and try to obtain an opinion from a medical professional who happens to be working in a discipline that is the same as the disagreeing member. This was clearly not followed in the case of Dr. Johnson’s disagreement with the other attending nurses (Guido, G. 2009). Janet the nurse did not consult with all the staff included in the patient’s care when she made the decision to discontinue the supply of Mrs. Jordan’s noradrenaline. This was in direct contravention of a checklist used in the ruling by Dame Elizabeth Butler-Sloss in Case: Re B (an adult: refusal of medical treatment) [2002] 2 All ER 449. One of the requirements in the checklist was that there must be adequate consultation between all the staff involved before a decision is made (McIlwraith &Madden 2006). Ethical Features Mrs. Jordan was undergoing palliative chemotherapy, for pancreatic adenocarcinoma that was in its advanced stage and there were not chances that she would recover. Her quality of life was severely hampered and her family understood this and wanted the Life Sustaining Medical Treatment to be discontinued. Their intentions are seen to be inline with the doctrine of double effect (Chirella 2006) Ethicality of Janet’s Actions Janet’s actions can be viewed as being ethical as supported by a court ruling, Re Conroy [1985] that upheld that a patient declining life-sustaining treatment could not be viewed as an attempt to commit suicide. The action merely allows a disease to follow its natural course. If the patient dies, it could not be termed as a self-inflicted injury but it would be considered to be the result of the underlying disease. She was not responsible for the death (Charella 2006). Legally significant Events in the Alternate Version of the Case Scenario In the second Scenario, there was sufficient consultation between the medical staff attending to Mrs. Jordan and her family before Janet was instructed to withdraw the LSMT. Hence this is perfectly legal in accordance with the Ministry of Health Guidelines (Ministry of Health). The medical professionals and members of the family were also in agreement as opposed to the first scenario where their views were divergent. Dr. Jackson also complied with Mrs. Jordan’s Advanced Care Directive which clearly stated that she did not want to receive LSMT. This is in compliance with the law as opposed to the first scenario where he clearly disregarded the law (Smallman, Chapman and Burnard 1993). Ethical significant Features Different from the first Scenario Janet only stopped the LSMT of Mrs. Jordan upon instruction from the attending Intevist Dr. Johnson (Smallman, Chapman and Burnard 1993 Is Janet’s Conduct Ethically Appropriate in This Version? Janet’s conduct can be termed as being ethically appropriate in this scenario since all the relevant legal channels were followed and she did stop the Life Sustaining Medical Treatment on her own accord, without any consultations as she did in the first scenario. Her intentions were also in line with the doctrine of double effect since her intentions were clearly aimed at stopping the suffering that Mrs. Jordan was going through as a result of the terminal cancer she had developed (McIlwraith &Madden 2006). The Application and Use of Euthanasia What does Euthanasia Mean in Practice? Euthanasia is defined as giving patient drugs with the sole intent of causing the death of the patient. This is achieved through the use of lethal injections and giving of poisonous oral medication. It should be differentiated from Aid in dying (AID) which is defined as where someone else actively assists a patient to take his own life and Physician Assisted Suicide (PAS) where the physician only provides the medication to be used to commit suicide but does not actively administer them. The patient does this by himself. According to studies conducted by Sanchia, Aranda and Margaret O’conner in 1994, 77% of the respondents who were nurses claimed that they had received direct requests for the administration of Euthanasia with ninety one percent of the nurses believing that the patient’s request for euthanasia to be rational. Of the nurses who had received the request, 16% had complied with the request without receiving any directive from a doctor to do so. 13% of these nurses reported that they had helped patients to commit suicide on more than three occasions (McIlwraith &Madden 2006). Would legalizing of Euthanasia be significantly different from Current Acceptable Practices involved in Ending of Patient’s Lives? The current practice of using Advance Care Directives to create, Do-not-attempt-resuscitation (DNAR) orders to be used in stopping resuscitation in the event of heart failure, or prevent the administration of Life Sustaining Medical Treatment (LSMT), is not that much different from euthanasia. In that at the end of it all, the patient ends up dying, irrespective of the Legality of it all. According to the results of the survey, fifty percent of the respondents in the survey favored a change in the laws that would allow doctors to take active measures to willingly terminate the life of a patient in some cases. Irrespective of this, according to the study, nurses were found to be less willing to be involved in the active administration of euthanasia if the laws were changed to make it legal to administer euthanasia. Only 40% of the nurses answered that they would willingly participate in the procedure as compared to 35% who declared that they would not be willing. 8% of the nurses interviewed in the survey chose of their own volition, not to respond to that particular question. Most of those interviewed indicated that they were strongly of the belief that if euthanasia was legalized, it would only be necessary for administration to a small minority of the patients (Melia. 1989). The Advocacy of Janet for her Patient According to Melia, K.M., advocacy can be referred to as protecting the rights of an individual but its use in the medical field normally pertains to providing information and support to patients. After offering appropriate advice to their patients, nurses allow the patients to independently make the necessary decisions as pertains to their health care and there after defend and abide by the patient’s right to make those decisions. Relationship between Nursing and Accountability Nurses are normally the ones who end up spending the most time with patients. As a result of this, a patient is more likely to develop a trusting relationship with the nurse. The nurse is in this case can be morally accountable to the patient as a result of the relationship that is shared between the two of them (Melia 2006). The Ethical importance of Advocacy as pertaining to accountability. The nurses natural role of performing tasks for a patient which the patient would normally have been able to do for themselves were it not for the illness or affliction that are facing is clearly suggestion of advocacy on the part of the nurse. A nurse who identifies what she deems as a patient’s rights to certain action or course of treatment is morally obliged to try and ensure that the patient gets the treatment. This is in line with her role of being the patient’s advocate (Melia 2006). The Advocacy of Janet’s Conduct Janet’s conduct can be viewed as advocacy since she had good intentions and was just trying to ensure that her patient obtained her wishes. This is despite the fact that Dr. Jackson was clearly opposing the Advance Care Directive where Mrs. Jordan had clearly stated her wish not to receive any Life Sustaining Medical Treatment (LSMT) in the event of a terminal illness. Hence her actions though illegal, may be justified (Melia 2006) Nurses and the Writing of NFR Orders Studies have shown that the nursing staffs in a hospital are frequently the ones who make the initial request for the creation of NFR policies within their respective hospitals. This is as a result of the fact that NFR have for a long time been quite problematic to nurses and a cause of a lot of frustration and conflict. Most nursing literature on the matter constantly focus the problem on physicians who only give the nurses verbal orders, write orders for competent patients without consulting the patient, fail to honor patient’s wishes not to be resuscitated and fail to communicate with the nursing staff concerning the orders they write. The Pros of Nurses having Authority Regarding NFR Orders Due to the nature of their work that requires frequent and prolonged interaction with their patients, nurses are the ones who are normally hear from a patient, their request to have an NFR order. It therefore makes good sense to have nurses after appropriate consultation with the attending physician and other appropriate persons, to write the NFR order and its relevant justification in the patient’s progress notes (Smallman, Chapman and Burnard 1993). By their deliberate inaction, it is usually the nurses who carry out NFR orders irregardless of who writes the DNR order. It is common for physicians to write NFR orders without first having consulted with the attending nurse or the patient and justifying it in the progress notes. This often creates a situation where nurses are confronted with NFR orders that have no supporting information (Chinn 1986). The nurses being authorized to write NFR orders is consistent with the definition of nursing that has been set forth by the American Nurses’ Association. The association defines nursing as “The diagnosis and treatment of human responses to actual or potential health problems (Chinn 1986). The Cons of having Nurses Write NFR orders By law, the writing of NFR orders is mostly a physician’s function and cannot be delegated to nurse, though in some places, the law does not say that writing NFR orders is not a nursing function (Curtis and Benjamin 1992). It can also be argued that writing of NFR orders is rightly a physician’s function since the patients decision will heavily be based upon the medical judgment that the patient receives from the physician concerning the irreversibility of the disease. Another common view point is that the task of writing NFR orders should fall upon the physician since it is the physician who eventually has to discuss the question about writing an NFR with the patient (Smallman, Chapman and Burnard 1993). Accountability in Relation to the Writing of NFR orders If nurses are authorized to write NFR orders, it would help make them more accountable to their patients as this would reduce the instances of doctors illegally defying a patient’s orders as is evidenced in the first case scenario. Nurses would have more say and in some instances control over the course of action as regarding a patient’s NFR order (Melia 2006). Bibliography: Charella, M. 2006. Policy in end-of -life care: education, ethics, practice and research. London: Quay Books. Chinn, P.L. 1986. Ethical issues in nursing. Maryland. Maryland. Aspen Systems Corp. Curtis, J and Benjamin, M. 1992. Ethics in nursing. New York. Oxford University Press. Guido, G. 2009. Legal and ethical issues in nursing. London. Pearson. McIlwraith, J.&Madden,B.2006. Health care and the law. Pyrmont.Thomson Melia, K.M. 1989. Whose side are you on? In Everyday nursing ethics.London: Bailliere Tindall. Smallman, S., Chapman, C and Burnard, P. 1993. Professional and ethical issues in nursing. Edinburgh. Tindall. Read More