Nurses Attitudes towards Euthanasia - Research Paper Example

Nurses’ Attitudes towards Euthanasia Ethical Issues in Nursing “Death is a certainty for everyone and making the end of someone’s life a dignified end is the nurse’s responsibility and their ethical and moral obligation” - AP Clark, 2010. Every profession is fraught with tensions, struggles, conflicts, and Issues whether ethical, moral, technical, or otherwise. Nursing is no exception to this rule. In fact, it is usually argued that, “Nursing literature is rife with stories of conflict” (Moland, 2006). Nurses have to deal with many Issues daily, ranging from inadequate healthcare, inefficient administration, distressed families, and uncooperative patients. Several ethical Issues arise in this profession because it deals with matters of life and death such as “the treatment of dying patients, dealing with Issues of abortion, euthanasia, and physical or chemical restraints” (Moyer, 2011). Nurses must deal with these problems keeping in mind the legal and professional implications of making any decision. A nurse must constantly combine “ethical reasoning and clinical judgment” (Nelson. 2006). Medicine and advances in science and technology have led to an improvement in the quality of life and have resulted in the prolongation of the lifespan of an average person. This is turn leads us to one of the biggest ethical debates that nurses face and that is in respect to withdrawal of care leading to a patient’s death or euthanasia. In Belgium and the Netherlands, laws declare that euthanasia is legal “under carefully delineated circumstances” and the Belgian euthanasia act defines it as the “administration of lethal drugs at the explicit request of the patient with the explicit intention of shortening the patient’s life” (Berghes, Casterle, & Gastmans, 2005). Nurses are involved in end of life care and its withdrawal or administration of lethal drugs internationally and so their position in this ethical debate is very important and brings them into the front stage. End of life care poses ethical dilemmas for nurses because it is hard for them to witness suffering and they have the urge to end it. In addition, there are inadequate resources like few hospital beds in the Intensive Care Unit, different value judgments and the moral distress in ending a person’s life despite their request for the nurse to do so (Oberle, Hughes, 2001). This debate has ethical, cultural, religious, moral, and legal nuances that add to the nurses’ distress. The key element in this debate is the fact that autonomy is very important as stated in the Belgian euthanasia act too. The patients have a right to live their lives and to command certain actions about their own health. Most nurses would agree that withdrawal of care or administration of certain drugs to end someone’s life could be justified ethically by arguing for the simple idea of autonomy that means “the right of the patient to decide” and “patient’s own request” in this regard (Berghes, Casterle, & Gastmans, 2005). Although nurses usually agree that each individual situation is different and difficult, they also recognize that their patients’ legal rights and their ethical bindings do matter the most. Nurses usually structure their behavior and attitudes according to their patients’ wishes but this in no way means that their decision making process is easier because their own ethical dilemmas are hard to let go of (Berghes, Casterle, & Gastmans, 2005). Not only do nurses have to keep in mind their patients’ wishes but have to take into account their own rights as caretakers, the rights of doctors, the decision of the patients’ families etc (Berghes, Casterle, & Gastmans, 2005). Autonomy is important though, because if a patient is in pain and does not want to remain so, he/she must have a right to ask professional help in ending the pain especially if death is imminent anyway. If this is true then Ms. Robaczynski could be considered a killer because in this case Mr. Gessner had not expressed any overt wish to forgo treatment and so we can assume that he wanted it to go on. Even if he did not, the fact that he has not expressed the desire to be disconnected from the respirator means that the nurse had no right to do so. Nurses’ idea of “good” is based more on the caring part of the relationship between them and the patients and not in bioethics. Nurses usually place emphasis on “patient dignity, comfort, and wishes” rather than their legal rights and technical aspects. This makes it hard for them to witness people in pain and the quality of life of their patients is very important to them. This helps them overcome the ethical dilemma that withdrawal of care ensues. If their patients are in such discomfort and agony, they feel that on the patients’ explicit wishes, withdrawal of care or euthanasia would in fact be justified (Oberle, Hughes, 2001). However, it is notes that most nurses do not want to make this huge decision or shoulder the responsibility of ending someone’s life and felt that this decision would be redundant if the patients’ kin did not agree to it (Berghes, Casterle, & Gastmans, 2005). Nurses face moral distress because they have to administer someone else’s decisions whether or not they agree completely and since they carry out the act, they cannot distance themselves from it even if they try. Once euthanasia has taken place, nurses “lived that decision more intimately than the physicians” (Berghes, Casterle, & Gastmans, 2005). The fact that nurses feel the pain of the patients can be used to somewhat justify Ms. Robaczynski’s actions because she stated in the case that she felt no pulse or blood pressure and did not know what to do. In this situation, it is easy for nurses to get flustered and so we can sympathize with her. The biggest problem in making an end-of-life decision is whose values should have an upper hand: the patient’s, the family’s, the physician’s or the nurse’s. This situation gets even worse when patients cannot speak for themselves e.g. if they are paralyzed or in a coma. In this situation, it is hard to gauge who should have a say in ending the patient’s life. It is obvious that “what the patient wants” matters but sometimes the different parties have different opinions about what the patient would have wanted and this poses a lot of value-laden questions and ethical dilemmas (Oberle & Hughes, 2001). It is expected that the family of the patient would make an informed decision but there were concerns that they “sometimes acted in their own best interests rather than those of the patient” (Oberle & Hughes, 2001). This is because they are already “dealing with the physical, financial, and psychological demands their loved ones illness has on them” and so cannot make coherent decisions (Paganini, 2010). Moreover, they might not be able to understand the medical and technical aspect of things that only a doctor would understand. The Canadian Nurses Association position statement says that if a person is incapable of making end-of-life decisions, nurses “must comply with specific legislation related to substitute decision-making in their jurisdiction” (CNA, 2008). If Mr. Gessner had no expressed any desire for withdrawal of treatment and Ms. Robaczynski had to make the decision, this situation would have been different if she had consulted his family and relatives. To make such a decision on her own was against the laws and so she can be called a criminal. Some nurses believe that acceptance of euthanasia would lead to a deterioration in the relationship of caregivers and patients and would harm society. There should be clear policies with guidelines so that society’s fear of death, inadequate medical care, and distrust of nurses could be remedied (Berghes, Casterle, & Gastmans, 2005). Clear legal policies and guidelines would help this issue and provide some sort of relief to the nurses’ ethical Issues as well as guaranteeing that they are legally correct in supporting euthanasia. It is important for these guidelines to be clear and precise though or else they can cause even more Issues e.g. Dutch nurses said that euthanasia is “dealt with in a technical, business like, and unnatural way because of fears of not following the guidelines correctly” (Berghes, Casterle, & Gastmans, 2005). If guidelines were not clear or precise nurses would be constantly scared of engaging in some illegal activity unknowingly. Nurses should be aware of the “specific legislation” regarding end of life care and they should know that these decisions of withdrawing or withholding treatment involve not just their patients but also the families, the healthcare team, the ethicists etc (CNA, 2008). If the legislation were clear and precise, Ms. Robaczynski would have known what to do and would not have landed in this situation. When there are no clear laws, there are grey areas. Some nurses face ethical dilemmas regarding end-of-life care and euthanasia because of religious reasons. Catholic nurses, for examples, were against the idea of euthanasia compared to other faiths and felt as if these decisions were best left to God (Berghes, Casterle, & Gastmans, 2005). It is important for nurses to keep in mind the religious and cultural nuances of the debate that surrounds death and euthanasia and it is good if they not only keep in mind their patients’ ideas but their families’ too (CNA, 2008). However, nurses have to contextualize the issue to be professional and ethical at the same time. They should not let their own beliefs guide lives of others. Ms. Robaczynski made the mistake of letting her own beliefs get in the way of her judgment, this makes her unprofessional, and she could be held responsible for the patient’s death. Another ethical issue that nurses worry about is the situation in which they know that a treatment administered by the doctor is either causing unnecessary pain to the patient or prolonging death. This issue can be solved adequately if nursing managers make sure that nurses can voice their opinions, concerns and Issues without being threatened (Elchos, 2010). A model for ethical problem solving has the acronym DECIDE which stands for “define the problem, ethical review, consider option, investigate ethical outcomes, decide on a plan, and evaluate results” (Elchos, 2010). This provides nurses with a structure to follow in solving their ethical Issues and encourages them to speak up. Most individuals want a smooth end-of-life period in which they can retain as much of their autonomy as possible and have a peaceful death that is free from pain and discomfort and nurses usually try to see that they can ensure that even if it means withdrawing treatment at one point. Palliative care is the provision of care to relieve the suffering of patients and to improve not just the quality of living but of dying too (CNA, 2008). Nurses should have adequate palliative training care so that euthanasia is not even an issue that they have to deal with. Nurses believed that it is easier to give patients care in palliative settings than in hospital settings (Berghes, Casterle, & Gastmans, 2005). Ethical dilemmas surrounding end-of-life laws that exist and those that should exist all put the nurse’s position into perspective and highlight the kind of daily stress that is part of the job. The code of ethics that nurses follow is often very vague and does not address the unique situation that they face with certain patients especially when they demand withdrawal of treatment or administration of lethal drugs and in these situations they have to come up with their own solutions and decisions ((Erdil, 2009). Nurses should have clear guidelines, more palliative training, and better emotional control to deal with a serious issue such as euthanasia. Since they are responsible for dealing with the patients and providing comfort, care, and personal treatment, they usually face the most ethical dilemmas in the face of dying patients, disease and euthanasia but these Issues can be remedied through legal measures, training, and guidelines. If Ms. Robaczynski had clear guidelines and had proper training, she would have been smart and would have dealt with this situation better. She could be considered a criminal for taking Mr. Gessner off the respirator because he did not wish for any such action but she felt like he had passed away. If Mr.Gessner had used his autonomy to express the desire for the forgoing of treatment or if the laws were clear, Ms. Robaczynski would never have been blamed for this situation. References Berghes, M., Casterlé, B. D., & Gastmans, C. (2005). The complexity of nurses’ attitudes towards euthanasia: a review of the literature. Journal of Medical Ethics. Vol. 31, No. 8, pp. 441-446. CNA. (2008). Providing Nursing Care at the End of Life. Canadian Nurses Association. Elchos, S. (2010). Is this ethical? You decide. Nursing Critical Care. Vol. 5, No. 4, pp. 45-47. Erdil, F., & Korkmaz, F. (2009). Ethical problems observed by student nurses. Nursing Ethics. Vol. 16, No. 5, pp. 589-598. Moyer, M. V. (2001). Nursing Ethics and End of Life Care. Retrieved on April 15, 2013: http://mattmoyer.weebly.com/ethical-issues-in-nursing.html Nelson, S. (2006). The Complexities of Care. ILR Press. Oberle, K., Hughes, D. (2001). “Doctors’ and nurses’ perceptions of ethical problems in end-of-life decisions”. Journal of Advanced Nursing. Vol. 33, No. 6, pp.707-715. Paganini, M. (2010). Nurses' autonomy and end-of-life decision-making. Nursing Ethics. Vol. 17, No. 3, pp. 285-287. Read More