Ethical and Legal Implications of End-of-life Care - Research Paper Example

Abstract End-of-life care for the critically or terminally ill patients has acquired abundant debates from around the globe for several decades. The main premise lies from its legal, ethical, and cultural implications taking into account that culture and religious beliefs vary from every state and country that is why the acceptance of end-of-life practices differs. Voluntary euthanasia and assisted suicide had been legalized in several secular countries since 1996 (Nitschke, 2012) while in most countries, only the practice of withdrawing or withholding of treatment and rendering palliative care to the terminally ill are accepted as legal. This paper explores on the ethical and legal implications of end-of-life care taking into account the legalization of voluntary euthanasia and assisted suicide in some countries. Issues relating to this practices’ moral acceptability and the opposing opinions from the religious sect were also discussed. Whether these end-of-life practices are aimed to alleviate the patient from suffering and pain or if this is a gateway for opportunistic individuals to legalize murder and suicide is still a debate. Ethical and Legal Implications of End-of-life Care Terminal illness devours one person’s entire life into a world filled with suffering and pain physically, mentally, emotionally, and spiritually. It consumes not only the person himself but also his family members, friends, and everyone that surrounds them. Some abating conditions become too overwhelming for this people to handle that preference for ending one’s life becomes their crucial option. This is the case of a fifty-seven year old British man named Tony Nicklinson who suffers from locked-in syndrome for seven year. He was a victim of cardiovascular accident and became quadriplegic since then. His only means of communication was through blinking and nodding while letters are electronically prompted for him. With all these agony, he and his family – wife and two daughters – plead the court of London to allow him of assisted suicide so that his physician spared from potential lawsuit on murder (Cowell, 2012). This scenario is not the first of its kind, since 1996, an end-of-life practice called voluntary euthanasia has been made legal in the Northern Territory of Australia and was followed by legalization of such practice and assisted suicide in Netherlands and Switzerland together with American state like Oregon. Yet, it is still on a debate among several countries and states particularly from those with greater religious affiliations and cultural principles (Nitschke, 2012). The secondary option for these countries is honoring of advance directives as legally binding. Advance directives are a person’s written will stating his desires or wishes on the extent of care that will be given to him once faced in terminal or critical illness. This may include withholding or withdrawing usage of medical technologies to prolong one’s life such as medications, intravenous fluids, nutrition, machine-assisted ventilation, etc. When made by a patient with ample decision-making capacity and is put into writing, this is considered legal and ethically acceptable to fulfill the patient’s final will (Meisel, Snyder, & Quill, 2000). Advance directive has been practiced for quite some time yet the worry of patient satisfaction and its pairing costs are still on discussion. Despite the time of its existence, its practice and execution are still on the challenging stage that researchers and health care providers are conceptualizing ideas and ways to policy changes in order to meet this problem (Molloy, et al., 2000). A study by Mezey, Leitman, Mitty, Bottrell, and Ramsey (2000) states, that completion and execution of advance directives are highly influenced by level of education together with factors such as race, language spoken and income. With this, it could be concluded that a policy change must take effect concerning the legal documents involved and that it must meet the level of literacy of the patient. This could be achieved through early education of advance directives by healthcare providers to improve the rate of execution and completion of the will. Sudore, et al. (2007) redesigned an advance directive to meet the literacy level of selected English and Spanish speaking respondents who attained fifth grade level up to twelfth grade. They concluded that this redesigned advance directive was rated more acceptable and useful to gain higher completion rates. This study generally supports the proposal of increasing the awareness of the community regarding advance directives among both the terminally or critically ill and those who are not. This will therefore garner increased completion and execution of a will which will probably result to a better end-of-life care for all. But where does the mercy in killing stops and murder starts? That is the fearsome query of the lawmakers whenever this issue is dealt. It has been evident in infirmaries especially those which cares from the terminally ill how great the anguish of these patients and their families have. A study made by Gunten, Ferris and Emanuel (2000) suggested the usage of a seven-step communication tool as guide in facilitation of palliative end-of-life care to the patients and their families. They further discuss the moral justification and relevance of rendering palliative care to alleviate the pain of the patient on their dying days. For them, good communication is the key to prepare the patient and their families to the imminent demise. Meisel, et al. (2000) elaborated on legality of using anesthetics in assuaging pain from the ill and even if this results to death, its double blade effect is still acceptable for the main goal is to give the patient a peaceful and painless death. Nicklinson’s plea was granted by the court of London as the judge accepted their argument that assisted suicide has been a necessity for the person no longer has dignity and privacy in his life and that it is in consideration for his right to respect for private life. Nevertheless, his wife said that the patient did this not to take away his life instantaneous but just to know that he has an option if the time comes that he could not take his suffering anymore (Cowell, 2012). In the end, the principal rule must remain and that is the preservation of this gift acquired from God – life. As Henry (n.d.) stated in his commentary for Genesis 9:4-7, “Man must not take away his own life. Our lives are God's, and we must only give them up when he pleases. If we in any way hasten our own death, we are accountable to God for it.” Works Cited Cowell, A. (2012, March 12). Stroke Victim Wins Right to Seek Legal Euthanasia. The New York Times. Retrieved from http://www.nytimes.com Gunten, C., Ferris, F., & Emanuel, L. (2000). Ensuring Competency in End-of-Life Care Communication and Relational Skills. The Journal of the American Medical Association, 284(23), 3051-3057. doi:10.1001/jama.284.23.3051 Henry, M. (n.d.). Concise Commentary on the Bible. Retrieved June 16, 2012, from Biblos website, http://mhc.biblecommenter.com Meisel, A., Snyder, L., & Quill, T. (2000). Seven Legal Barriers to End-of-Life Care: Myths, Realities, and Grains of Truth. The Journal of the American Medical Association, 284(19), 2495-2501. doi:10.1001/jama.284.19.2495 Mezey, M., Leitman, R., Mitty, E., Bottrell, M., and Ramsey, G. (2000). Why hospital patients do and do not execute an advance directive. Nursing Outlook, 48(4), 165-171. Molloy, W. et al., (2000). Systematic Implementation of an Advance Directive Program in Nursing Homes. The Journal of the American Medical Association, 283(11):1437-1444. doi:10.1001/jama.283.11.1437 Nitschke, P. (2012, April 10). The Role of Religion in the U.S. The New York Times. Retrieved from http://www.nytimes.com Sudore, R., et al. (2007). An advance directive redesigned to meet the literacy level of most adults: A randomized trial. Patient Education and Counseling Journal, 68(1), 165-195. Read More