Ethics in Hospice Care - Essay Example

Ethics in Hospice Care: Total Sedation and Euthanasia Ezechiel Dominique Loyola Ethics in Hospice Care: Total Sedation and Euthanasia Introduction The use ethics in the hospitals has been a major concern. The presence of care practices such as sedation and euthanasia in the hospital have spanned various views and reasoning especially where ethics is concerned. Hospice care providers deal with many potential ethical dilemmas on a daily bases. Manyhospice care practices are in the gray area of ethical acceptance by society. It is not clear why some practices are acceptable while others are rejected. For instance, total sedation is acceptable while euthanasia is frown upon. Despite advances in pain and symptom management, sometimes pain and other symptoms are unmanageable.  In such cases, the hospice care team may use total sedation to relief suffering from uncontrolled symptoms. Total sedation may be referred to as palliative or terminal sedation. This involves using of sedatives to bring about a level of comfort in a terminally ill patient that is facing unrelieved pain or suffering. Most health care professional does not consider total sedation as euthanasia. The use of total sedation to relief suffering is an ethically acceptable intervention, especially in the face of imminent death (Fine, 2001, p. 81).  I proposed to include euthanasia as a permitted option when caring for terminally ill patients with intractable suffering. Euthanasia is a deliberate act undertaken by one person with the intention of ending life of another person to relieve that persons suffering and where the act is the cause of death (Gupta, Bhatnagar, & Mishra, 2006, p. 1). In other words, itis the act of ending the life of a patient due to severe suffering by the patient (Fine, 2001), which may end the suffering faster than total sedation. Euthanasia can be voluntary or involuntary, both raises ethical controversies. In voluntary euthanasia, physicians get informed consent from the patient. Physician assisted suicide is a huge ethical issue in the United States (Friend, 2011). The legality of the actions is another issue of concern that contributes to increased ethical dilemmas. It is currently legal in some states. For example, Oregon, USA has legalized only physician-assisted suicide in 1997 (Gupta et al., 2006, p. 1). However, euthanasia is mostly illegal in the United States. Principles such as autonomy (self-determined) invoked as justifications for this potentially controversial end of life (EOL) care practice (Keown, 2004, p. 621). Autonomy comes from the Greek words “authos” (self) and “nomos” (rule or law) and originally referred to the right of self-governance in the city-state (Friend, 2011, p. 110). Patient’s autonomy is very important when making moral decisions. This involves taking into consideration the wishes of the patient and the family. Patients should be allowed to include euthanasia in the advance directives. The scope of this proposal is allowing euthanasia only for terminally ill patients with refractory suffering. In this case, there will not be much different between euthanasia and total sedation. The patients will eventually die if either total sedation or euthanasia is selected. The only small potential different between the two forms of suffering control is that the patient might die faster if euthanasia is selected. The possibility of “slow euthanasia” exists during total sedations (Douglas, Kerridge, & Ankeny, 2008, p. 388). Analgesics and sedatives hasten death (Douglas et al., 2008, p. 388). In total sedation patient will most likely die slowly and in euthanasia, patients will most likely die faster. The time it takes for the patient to die may be the reason society accepts total sedation and reject euthanasia. Patient will eventually die under both EOL practices while relieve suffering. The intention of the prescriber of the sedation medications raise as an important factor for differentiates between total sedation and euthanasia. According to a standard view, the administration of analgesics and sedatives consider euthanasia when the drugs are given with an intention to hasten death (Douglas et al., 2008, p. 388).The intention is obviously to relief suffering from emotional and physical symptoms, but that does not remove the prescriber’s knowledge that these drugs can also suppress respirations ultimately cause death. If the intention is not to hasten death, then it is accepted. I disagree with this view, the result of what actual happened after total sedation are more important than the intention of doctor when prescribed the medications. Douglas and others found a remarkable ambiguity and uncertainty regarding intentions of doctors who prescribed analgesics and sedatives for terminally ill patients(Douglas et al., 2008, p. 388). In the same study, some doctors report a grey area between palliation and euthanasia (Douglas et al., 2008, p. 388). None of the doctors in Douglas’ study was consistent in distinguishing between a foreseen death and an intended death (Douglas et al., 2008, p. 388). They doctors know that these patients will die faster because of total sedation. The hospice care team decided that it is better to end suffered than allow the patients to live few hours or days longer. In euthanasia, prescribers’ intention is to hasten death and death will happen very fast. The doctors behavior are very similar to that of society as a whole, a slow euthanasia may be more psychologically acceptable to doctors than active voluntary euthanasia by bolus injection, partly because the former would usually only result in a small loss of time for patients already very close to death(Douglas et al., 2008, p. 388). Total sedation and euthanasia are clearly ethical concerns for hospice care, especially when dealing with terminally ill patients with intractable suffering. Healthcare operates under codes of ethics and legal provisions that regulate issues such as total sedation and euthanasia. Medical professionals who provide hospice care require to practice under ethical standards and regulations. In case of euthanasia, it is considered assisted suicide (Friend, 2011), which is mostly illegal in the United States. For example, if total sedation is labeled slow euthanasia, then many medical professional will be hesitating to participate in such care. Hospice professionals use total sedation to relieve suffering in terminally ill patients; however, ethical concerns come up on the total sedation as slow euthanasia. Some health care professional already believes that total sedation is a type of euthanasia. Euthanasia should be allowed under the same guideline and practices of total sedation, which to only be allowed for terminally ill patients with refractory suffering. By so doing it will avoid unnecessary suffering of patients when dying. The issue of euthanasia is complicated because there are arguments for and against in society. Health care professionals need to work with families to ensure that they identify and resolve most difficult ethical with euthanasia. For example, terminally ill patients may have specific wishes in their advance directives to end their lives if they experience intractable suffering, whichmight raise ethical dilemmas to health care professionals who have a duty to do no warm. This makes the ethical issues that arise from the topic of euthanasia to be complicated. Therefore requires deep understanding of issues such as professional ethical codes of conduct, ethical theories, and wishes of the family among other issues that may influence decision-making. The ethical issues in healthcare today are complex in a way that practitioners cannot make decisions by themselves. If a patient will inevitably die in a short period, it is ethical for physicians to reduce any unnecessary form of suffering (Keown, 2004). Both sedation and euthanasia can be available to patients and families. The slow euthanasia in the case of total sedation is psychologically accepted. May be some patients might require a faster end then a slow of suffering. In medical practice, there are ethical norms that need to be followed. The question whether patients should have the option to ask assistance to end their lives raises ethical debates on how humane or moral that is. In this case, the benefit is said to be to the patient who requests for death. However, physicians have a moral responsibility to treat and keep the patient alive until they are no longer able (Keown, 2004). This changes the moral responsibility of medical practitioners by making them to end lives. There are various arguments that have been raised that discourage the killing of people even if they are terminally ill. The different points of views are vital to enable people comprehend the moral perspective. These arguments are for and against euthanasia which have been revealed from an ethical and moral perspective of the ordinary individuals. Ordinarily, the medics have a moral obligation to relief suffering and pain in the patients while keeping them alive and healthy. There is the formation of a catch 22 because total sedation usage in itself may lead to death. Total sedation is an accepted strategy of controlling suffering in medical care. The trouble is that total with sedation has gradually been considered as a form of euthanasia (Keown, 2004).In a case, where the patient is having refractory suffering and faces imminent death, decision making on whether to use total sedation becomes easier once there is consent from the patients.Normally,The consent of a patient whose conscience tell him that there will be death soon has made many patients to consider the total sedation. According to the psychologists the patients are usually fast to make the decisions when they have undergone long term suffering and pain. They often think that they should “rest “instead of suffering. The medical practices have code of ethics which have played a pivotal role in solving the dilemma. The complexity of ethical issue of total sedation and euthanasia becoming a challenge.It has proved difficult to differentiate what is good and what is not. Codes of ethics for professionals differentiate good and bad conduct and show the implication of both good and bad actions. However good or bad has been viewed by different people in diversity. Therefore some are not happy with how others have perceived bad and good. For the code of ethics to be successful,there need to be a union of diverse views and perceptions among different and relevant parties so as to make binding agreement. The application of the code of ethics involves showing and defining best practice and operations in health care to maximize performance in an ethical manner. Codes of ethics have rules and guidelines in place that have to be followed, for example, by physicians while dealing with terminally ill patients. Various hospitals have different policies on how to deal with issues of total sedation and euthanasia (Math and Chaturvedi, 2012). The policies and rules should be made with a community that is ready to reconcile and agree on the ideas for the sake of binding agreement with zero conflict. These policies, rules and guidelines relating to ethical conduct are vital in creating of ethical health care practice. However, the complexity of medical procedures makes this a challenge. The understanding on how to deal with this dilemma is essential for the medical practitioners for it will help deal with this problem. I addition the trainings on ethical decision making is important for it will to enable them deal with ethical dilemmas in diversity. The code of ethics will require that the community does good and not evil. Most people are of the idea of doing well to others and not letting them suffer.Therefore,they are not strong believers of suffering. They often consider not to have pain. According to much euthanasia will do them well in case of terminal illness as they have the perception that that is doing well to the people. On the other hand those with strong religious faith who are against euthanasia will believe that nothing is impossible before God and that no disease is hard for him to heal. Therefore they will not subject themselves to this doctrine which is unethical to them. The people say that euthanasia is immoral.Normaly; there would be the violation of moral laws or norms for something to be immoral. “Their argument of anti-euthanasia proponents is that euthanasia is immoral because life must be preserved and protected. The preservation of life is, however, subject to the self-determined choice of the person and not the choice of the physician. For an example, murder infringes on a person’s right to life by taking away the element of choice in the persons death. No infringement is done when it is the person who chooses how to die. For a physician to deny the person his right to die when under intense pain and suffering is effectively forcing them to live a life without what they believe is their dignity, a life of suffering and eventual death . While the intentions may be good, no person has the right to demand of another person to live a life of suffering, in fact, that is immoral and unethical as it denies their right to choose. Euthanasia will facilitate the choice making it in fact the compassionate choice and sympathetic to that person’s dignity. Those that argue to preserve life despite the patient being terminally ill and in extreme pain are usually not the patients themselves and therefore removed from the consequences of the decision.” (Kevorkian, 2014) It is ethical to undertake euthanasia because it does not harm others. “Normaly, euthanasia as a choice infringes on no such fundamental rights. Death by its nature is a private affair. Assisted suicide will involve direct harm and the termination of life only to the individual who has requested it. One cannot request euthanasia for another “competent” person. If this is the case, it will then be a question of murder instead. The process of euthanasia does not restrict or infringe on anyone’s fundamental rights and therefore does no harm.” (Kevorkian, 2014)The patient has the moral obligation to choose for his life and this is ethical. The modern society has emerged with diverse views on ethical behaviors. Therefore the society as a whole has to be involved fully for the ethical problems to be solved because they require sound decision making. Ethical theories are models used in ethical considerations in deciding if total sedation is good or evil. Diverse ethical theories have various approaches of explaining the concepts of effective human conduct that contributes to moral decision making. The problems that concern ethics are exclusive depending on the problem and the individuals involved in the ethical problem. The theories have strengths and weaknesses in dealing with ethical problems depending on the nature of application. These spans from the models of decision making.Ordinarily, the strength are that the ethical theories not only focus on the problem, but they focus on individuals relating to the problem. The weakness is that the choice of ethical model to use occurs due to motivations of belief that is in alignment with the principles of the theory. The ethical troubles arise due to lack of grounds to make effective decisions. The decisions whether the act of sedation is right or wrong depend on the ethical approach used. Normally, the medical profession involves a significantly high number of emerging issues in the society that relate to the aspect of ethics and morals. The insinuation of both ethical issues and issue of diversification on the field of health care is that they contribute to changes in the nature of professional training. The society has kept on changing, therefore, the field of health care from a social perspective is not resistant to emerging issues as society changes. The societal views will always encourage the perpetration of good values and condemn evil. This is coupled by the respect of the decision that has been made by the patient. Many critics argue that the doctors have a legal obligation to keep the patient alive and allow them the freedom to choose whether to die or not. (Math and Chaturvedi, 2012). On the other hand total sedation and euthanasia is important as it reduces the suffering of patient who is close to death. The physical pain and psychological pain is solved by the euthanasia.Normaly such people will constrain their own or lovers finances and eventually die living behind a family full of debts. This is why they prefer to die rather than to afflict pain to their beloved. There have been differences on whether total sedation should be used while dealing with physical symptoms or in dealing with psychosocial suffering. The speeding up death by physicians is an ethical issue of concern in health care and has created a dilemma on whether to mitigate suffering or not. This is because mitigation of pain using sedatives will lead to death in most cases and therefore proving that sedation is a form of euthanasia. There has been a challenge in understanding whether sedation was meant to hasten death or to control the patient’s suffering especially when a patient dies (Math and Chaturvedi, 2012). The total sedation and euthanasia are usually properly regulated by law. “The critics of euthanasia often cite the horror stories of patients being euthanized without consent or for unethical or impure reasons. Normally, the euthanasia will not lack its fair share of horror stories and because of the gravity of its practice, it does need to be regulated. However, this is not reason enough to say that it cannot be properly regulated. Developed nations like the Netherlands have legalized euthanasia and have had only minor problems from its legalization. Any law or system can be abused, but that law and system can always be refined to prevent such abuse from happening. In the same way, it is possible to properly and effectively regulate euthanasia as various first world countries have done. More so because the process of euthanasia itself as it is being argued here, requires competent consent from the patient. It is important to consider the protection of both the physicians as well as the patients. The critical element in the regulation of euthanasia will be determining the line between what is considered to be euthanasia and what is considered to be murder and this is ethical in the health care.” (Kevorkian, 2014) The diversity of ethical principles has shown various arguments for and against total sedation. This include the bioethical principles which show us how to deal with the ethical issues and are commonly used in the explaining total sedation include, beneficence, autonomy, and the doctrine of double effect (Keown, 2004). The personal values of the autonomous patient according to the autonomy principle will give him or her a free will to make care decisions whether to die or not. The principle of autonomy shows that a person has the right to make health care decisions in accordance to their personal values. John Hardwig stated that patients have a duty to die if their lives cause hardship for their families (Hardwig, 1997) of which I strongly believe in.  I do not believe that family hardship is a good reason to have a duty to die.  The duty to die should only decide solely by the person who decides to die.  If the family is unable to provide care for the ill person, the State should be responsible to provide that care and remove this burden on the family. According to Hardwig every person should have the opportunity to make a decision whether they have a duty to die and approach family and friend only after you have made up your mind, to say good-bye (Hardwig, 1997).  This will enable the family members to converse and agree on the decision of the patient so as to grand the patient will. On the same note, each person has a right to a good death, therefore a good death must not be denied to those who want it. “Nobody thinks of their death and desires it to be extremely painful. Rational human beings desire a good, dignified end to an ideally long and fruitful life. Circumstance, like luck, may not always be in your favor. It may not even be a terminal disease, which is so frequently used in pro-euthanasia arguments. It can be as savage as a freak accident or as simple as falling down the stairs to put you in a world of excruciating pain which is not wished by anyone.” (Kevorkian, 2014) The duty to die should be a duty by itself, which should protect the person’s autonomy On the other hand the bioethical principle of beneficence in health care states that medical practitioners need to provide care that will promote the wellbeing of patients (Keown, 2004). This is done through the observation of the persons decisions.”Every person has a right to die and a right to live. The decision to die in case of a terminal illness is in the hands of the patient. Ordinarily, since we can determine the course of our lives by our own will, we have the right to live our lives and determine our own course. Naturally it follows that the same self-determining capacity we have as human beings also gives us the fundamental right to determine how we die. It is also important to consider that the right to life has no say over the right to die. The right to live and the right to die are two separate, although related rights. They are also mutually exclusive in the sense that the right to live concerns itself only with self-determined life and ends with the right to die. The right to die on the other hand begins where life ends in death. While you live, you exercise your right to life; when your life ends, you exercise your right to die. It is important to consider that we refer to self-determined or natural death and not death resulting from someone directly removing from you your life, thereby restricting your right to live. If such significant weight in this sense is given to our right to live, should we not also give equal weight to our right to die.” (Kevorkian, 2014) Normaly,the intention of sedation is to reduce pain in the patient while euthanasia claims lives. The differences of whether the person has the right to end life may not be ethical but are legal. (Math and Chaturvedi, 2012). The therapic interventension are usually used in patients that are dying in health cares. The diseases they cannot be cured or those that cause extreme pain and that will lead to death are often hard to deal with. Sedation wills of use if the patients have unresponsive pain to medication interventions. This includes agitated delirium,dyspnea and psychological stress. The medical doctor has the ethical obligation to provide information about the effects of the medical procedures they conduct on their patients (Keown, 2004). This is to enable the patient make unsound decision that may be regretted by their beloved. There are also collection of unethical issues that accrue the total sedation and euthanasia. This rises due to the differences in the duty of the sedation. This brings ethical issues because both the health givers need to ensure that the patients receive benefits of pain reduction without being harmed. It will be unethical for a doctor to give wrong information concerning the patient health because he may consider sedation on a healthy body. This will become suicidal and unethical.Normaly,total sedation reduces pain and suffering of patients while causing harm of speeding up death. On the other hand, euthanasia is used in cases where the patient has unmanageable diseases (Keown, 2004).The two need to be allowed as options for care of patients.However,there are critics who believe that God is the only being who can take life view this as unethical. Conclusion In conclusion it can be observed that the paper has examined the total sedation and euthanasia as critical ethical issues in healthcare. There are provisions given of ethical support of total sedation in cases where patients face inevitable death and have unmanageable suffering. As it has been seen the critics are of the idea that both euthanasia and total sedation have the intention of ending life which is not the case. The life will only be terminated through the consent of the patient since he or she has the right to life. The thesis in this case has clearly revealed that there the is need to allow euthanasia and total sedation while especially when tackling the patient with terminal illness with a solely aim of reducing pain and also save on the finances for the beloved. Ordinarily when a terminal ill patient is on the bed, there is little that the doctor will do as the patient waits for his or her death. If the patient consent not to be allowed to live then it is ethical to do it for he will be saved from pain. References Douglas, C., Kerridge, I., & Ankeny, R. (2008). Managing intentions: the end-of-life administration of analgesics and sedatives, and the possibility of slow euthanasia. Bioethics, 22, 388-396. Fine, P. (2001). Total sedation in end-of-life care: clinical considerations. Journal of Hospice & Palliative Nursing, 3(3), 81-87. Friend, M. (2011). Physician-Assisted Suicide: Death with Dignity? Journal of Nursing, 14(3-4), 110-116. Gielen, J., Van den Branden, S., Van Iersel, T., &Broeckaert, B. (2012). Flemish palliative-care nurses attitudes to palliative sedation: a quantitative study. Nursing Ethics, 19(5), 692-704. Gupta, D., Bhatnagar, S., & Mishra, S. (2006). Euthanasia: issues implied within. Internet Journal Of Pain, Symptom Control & Palliative Care,4(2). Hardwig, J. (1997). Is there a duty to die? Hastings Center Report, 27(2), 34-42 Keown, J. (2004). Euthanasia, Ethics and Public Policy: An Argument against Legalization. Ethics: An International Journal Of Social, Political, And Legal Philosophy, 114(3), 621-623. Kevorkian, J. (2014). Reasons Euthanasia Should Be Legal Everywhere. Retrieved 2015, fro m http://www.listland.com/top-10-reasons-euthanasia-should-be-legal-everywhere/ Math, S. B., &Chaturvedi, S. K. (2012). Euthanasia: right to life vs right to die. The Indian Journal Of Medical Research, 136(6), 899-902. Indian J Med Res 136, December 2012; pp 899-902 Read More