For and against the Legalization of Euthanasia - Dissertation Example

 For and against the Legalization of Euthanasia Abstract Health ethical issues related to the ‘right to live’ and the ‘right to die’ are two different concept that health care professionals should be familiar with in order to avoid facing legal problems. Considering the different ideas behind these issues, this study will not only differentiate active euthanasia from passive euthanasia but also discuss advance directives concerning its double effect. Introduction Life and death are two significant parts of the life cycle. Genetic views strongly believe that life starts at fertilization stage whereas embryological views argue that life begins at the point of gestation (Gilbert, 2011; Blazer & Zimmer, 2005, pp. 1 – 20). As compared to genetic and embryological views, some people argue that life begins at birth (ibid). Regardless of how life starts, health care professionals are trained to conserve human lives by alleviating their suffering whenever they are terminally ill. As much as possible, medical care professionals should prolong the lives of the patients unless there is an advance order stating that the patient instructed a “do not resuscitate” (DNR) decision together with the patient’s signature (Salmasy, Sood, & Ury, 2008). Death is the end part of the life cycle which nobody can avoid. Aside from a combination of pain, depression, and psychological disturbances, the fact that the economic cost of medical intervention for terminally ill patients is very expensive for most people with average income increases the number of cases wherein a terminally ill patient would seek for medical assistance to end their lives at the soonest possible time. Euthanasia is all about “intentional killing of a dependent human being, by act or omission, for the patient’s alleged legal benefits” (Ciabal, 2003, p. 129). As a way to preserve the human dignity of a terminally ill patient who is already near death, euthanasia or mercy killing is made intentionally in order to lessen the pain and emotional burden a terminally ill patient is experiencing. Totally different from wanting to kill another person, euthanasia is considered as “good death” since this option allows a terminally ill patient to live the last few minutes of their lives more comfortable (ibid). Focusing on ethical cases whereby terminally ill patients are seeking for euthanasia, this report will discuss whether or not a terminally ill patient has the right to refuse medical treatment. In reference to the sanctity of life and quality of life perspective, this report will discuss why life should be prioritized more than death. As part of going through the main discussion, whether or not the patients have the right to request for an ineffective medical treatment will be answered together with the clinicians’ obligations to meet the patients’ request. After discussing the significance of advance directives in terminating the lives of terminally ill patients, some barriers that could prevent the patients from writing an advance directive will be identified and tackled in details. The Right of a Terminally Ill Patient to Refuse Medical Treatment Under the informed consent guidelines, the doctors and nurses should properly inform the patients about the main purpose, advantages, and disadvantages of each prescribed drug and other medical care intervention such as the use of life-sustaining treatment like tube feeding devices, mechanical breathing ventilation and dialysis machines, and/or diagnosing devices like x-ray and CT scan (Kaufmann & Ruhli, 2010; Ganzini et al., 2003). On top of this, each medical care professional is also required to respect and observe the patient’s autonomy by allowing them to make their personal decision when it comes to selecting the care and medical treatment they prefer (Walker, 2009; Stirrat & Gill, 2005). Given that each patient has the right to accept or not to accept medical treatment that is proposed by the medical care professionals (Department of Health, 2001a), a terminally ill patient will should always be given the right to refuse medical treatment. In general, there are two common types of euthanasia. Specifically the active or direct euthanasia is referring to the medical care professionals decision to procure the patient’s death with the purpose of eliminating their pain whereas the passive of indirect euthanasia happens when the medical care professionals does not necessarily mean ending the life of the patient but also seeks to alleviate their pain and sufferings by purposely shortening the dying patient’s lives (Ciabal, 2003, p. 131). In general, receiving artificial nutrition and hydration is necessary to prolong the life of a terminally ill patient. A patient who is at the end-stage of his life can choose to avoid tube feeding and dextrose. As long as the medical care professionals has carefully explained the health consequences of the patient’s choice of starvation, the medical care professionals should respect the final decision made by the patient (Ganzini et al., 2003). When it comes to this matter, respecting the patient’s decision with regards to the patient’s right to refuse treatment does not totally mean that the medical care professionals are violating the health care ethics related to non-maleficence, beneficence and justice. In case a terminally ill patient is unconscious or is not in the right position to make important treatment and care decision at the time wherein the medical care professionals should immediately perform specific care and treatment, the group of medical care professionals should carefully observe the health care ethics related to non-maleficence, beneficence and justice (Schwartz, Preece, & Hendry, 2002, p. 168). In line with this, non-maleficence means that the medical care professionals should never perform actions that can injure the patient either emotionally or physically whereas the law of beneficence means that medical care professional should only do actions that will promote the well-being of the terminally ill patients (De Roubaix, 2010; Schwartz, Preece, & Hendry, 2002, p. 168; Omonzejele, 2005; Gillon, 1994). With regards to justice, the medical care professionals should always be fair not only to the terminally ill patients but also to their family members and love ones (Omonzejele, 2005; Schwartz, Preece, & Hendry, 2002, p. 168). Decisions Made When the Terminally Ill Patients Request for a Futile or Ineffective Medical Care and Treatment Intervention Physiologic futility is referring to a situation wherein the patients’ preferred care and treatment is ineffective in a physiological sense (Davis, 2008; Jecker, 2007). It means that even though the medical care practitioners would grant the patient’s request for a specific treatment, that particular treatment will be ineffective in terms of curing the patient’s physiological complaints. Considering that a study shows that the provision of cardiopulmonary resuscitation (CPR) in a terminally ill patient with metastatic cancer is only 1% effective in terms of reviving the patients who are going through a cardiac arrest, the medical care professionals need not consider performing CPR especially when they know that this particular medical care and treatment option could do further harm to the patient (Day, 2009). Even though the patients’ autonomy suggest that the medical care practitioners should respect the rights of the patients to decide and request for their preferred treatment and care, the medical care professionals have zero obligations or duty to submit with the patient’s request given that the patient’s preferred treatment and care is futile or ineffective (Weijer et al., 1998). Specifically the patient’s right to request for a futile or ineffective medical treatment is often subject to a lot of controversy particularly when it comes to the issue on autonomy wherein the patient is given the right to choose their preferred care and medical treatment. Although the concept of autonomy gives the patient the right to choose their preferred care and treatment, the medical care professionals should also consider other health care ethics such as those that are related to non-maleficence, beneficence and justice. According to Goldsmith & Karotkin (2003, p. 85), there are some cases wherein the patients and the patients’ family members would request or obliged the physicians to administer some life-prolonging treatments and medical intervention to prolong the life of the patients. Considering the ethics behind non-maleficence, beneficence and justice, the medical care professionals should at anytime consider the patients’ autonomy as irrelevant especially in cases wherein the requested care and treatment intervention could not lead to any further positive effects towards the existing health condition of the patients who are terminally ill. Instead of totally disregarding the patients’ autonomy, the medical care professionals should respect the ethics behind informed consent. In line with this, the medical care professionals should explain in details why the medical health care team decided not to give way to the patients’ suggested futile or ineffective medical treatment procedures. By clearly explaining to the terminally ill patient and the patient’s family members the reason for refusing to grant the patient’s request, it would be easier for them to accept the physician’s decision without the need to feel bad that the patient or the patient’s family members’ request has been ignored or refused. Aside from making a fair and sound decision to all, the medical care professionals should at all time base their final decision not to cause further harm or detriment to the health of the terminally ill patient. Why Life should be prioritized more than Death With regards to the ethical argument as to whether or not euthanasia should be accepted in medical practices and health care, health ethics behind sanctity of life and quality of life is often considered in the legal basis when making this important decision (Major, 2011). Considering that human life is sacred and has dignity, sanctity of life strongly promotes the need to preserve life. It means that life should be “cherished, affirmed, respected, enhanced, and promoted” (Ciabal, 2003, p. 18). Quality of life is referring to the act of reducing pain and symptoms that could gradually damage the health quality of a terminally ill patient (Cohen-Almagor & Shmueli, 2000). Through the use of life-sustaining devices and health care treatments, it is possible to increase the patients’ comfort and dignity not only on the part of the terminally ill patient but also the patients’ family members (Jonsen, Siegler, & Winslade, 2002, p. 105). In reference to the sanctity of life, the lives of the terminally ill patients are valuable. Since the life of a dying patient is considered sacred, it is considered unethical to view euthanasia or the act of mercy killing to improve the quality of life of the patient. Despite the fact that euthanasia or mercy killing should be considered as unethical and immoral, Kuhse (1987) argued that offering medical assistance to hasten the death of a terminally ill patient is different from killing the patient in the sense that the medical care professionals are only improving the patients’ quality of life by helping them alleviate their pain. Advance Directives in Terminally Ill Patients Advance directive is referring to the living will or personal directive made by the patient while he is still capable of making decisions with regards to his or her preferred care or medical intervention at the time the patient is close to death. As part of the advance directive, the patient’s decision as to whether or not he wanted to instruct the medical care professionals not the revive him or do not resuscitate (DNR) is clearly stated in writing together with the patient’s signature and date when he signed the contract. In most cases, advance directive provides the terminally ill patients with two major options with regards to their health care and treatment. First, the patient is given the option to discontinue or withheld the use of any forms of life-saving intervention in order to hasten the death of the patient (Day, 2009). In line with this, the first option aims to deliver comfortable life as the terminally ill patient reaches their end of life. Regardless of the patients’ quality of life, the second option gives the terminally ill patient the option to allow the medical care professionals to perform all medical procedures and intervention that can effectively prolong their lives (ibid). Barriers that may prevent the Patients from Writing an Advance Directive There are many barriers that could clearly explain why a dying patient was not given the opportunity to come up with an advance directive. First, the failure of the medical care professionals to explain the importance of advance directive to the patient days or months before the terminally ill patient is dying is one of the most common factors that prevents dying patients from writing an advance directive. Likewise, it is also possible on the part of the health care professionals to neglect the human rights of patient to make their own decision regarding their preferred medical care and treatment intervention. In this case, it is clear that the medical care professionals have already violated the patient’s autonomy. In some cases, terminally ill patients who are not capable of making their own decision could sometimes become a reason why the patient did not receive the benefit of an advance directive. Considering the case wherein the patient is no longer capable of deciding for their own treatment and care, it is the patient’s immediate family members or loved one who are given the opportunity to discuss with the medical care professionals about the possible options that a dying patient could have in an advance directive. Other special case wherein the patient is deprived of writing an advance directive is when a dying patient was immediately rushed to the emergency room because of an accident or heart failure. If this is the case, the medical care professionals need not observe informed consent or autonomy. Instead, this group of health care professionals needs to revive the patient’s life by all means. In other words, the medical care team has the option to do only actions that will promote the life of the dying patient. Failure to observe health ethical considerations or the universally accepted operating procedure when it comes to the delivery of the patient’s care and treatment is one of the common ground wherein the health care professionals would end up facing future legal actions mostly because the patient’s family members and/or love ones decided to file legal complaints against the health care team who were assigned to deliver care and treatment to their dying love ones. To avoid facing legal challenges, the group of health care professionals should carefully observe the rules behind the health ethics especially before deciding whether or not to participate in the patient’s decision to perform euthanasia. Discussion There are some people who consider the practice of euthanasia as humane simply because the act of hastening the lives of a dying patient would lessen the need for them to suffer from pain and emotional burden. Based on the quality of life perspective, euthanasia is not automatically considered immoral depending on the motives and circumstances in which euthanasia took place. When it comes to human rights, it is argued that every person has the right to live. For this reason, it is assumed that each person would prefer life more than death. Unfortunately, not all dying person who are already close to dying would still want to live their lives in physical pain and distress. This is more likely the primary concern of most dying patients and medical care professionals who are pro-euthanasia. Because of the pro-euthanasia’s decision and beliefs that a dying person should die with dignity free from the physical health consequences of their illnesses, there is an increasing number of people who are supporting the idea of euthanasia. Freeing a dying person from pain is not only the main reason why a terminally ill patient would write an advance directive that clearly state “DNR” instruction. Since there are many people throughout the United Kingdom who are only earning less than minimum income, hastening the death of their loved ones is often considered a solution in terms of minimizing the financial problems. Contrary to the beliefs of pro-euthanasia, the religious sector is against the promotion of either active or passive euthanasia for the reason that nobody has the right to end the life of any person except God. Considering this point-of-view, euthanasia whether active or passive is considered unethical in the field of medicine. Medical care practitioners are aware of the fact that they should respect the patients’ autonomy at all times. However, the case of a terminally ill patient who is already dying is more complicated. Instead of solely depending on the concept of patient’s autonomy, the medical care professionals should equally consider other ethical arguments related to maleficence, beneficence and justice. Conclusion When it comes to the ethical issue behind euthanasia, positive arguments strongly believe that legalizing euthanasia is the best way to preserve the human dignity of a terminally ill patient who is already dying. According to Ciabal (2003, p. 130), “to die with dignity means that one should make decision to die in case dying is a better option that going through distressing life caused by the incurable illness”. It means that through mercy killing, it is possible for a dying patient to have the opportunity to die peacefully and with dignity. Aside from speeding up the death of a dying person, negative statement suggests that the act of euthanasia destroys human dignity for the reason that medical intervention or non-intervention is used not to allow a dying person to experience pain and suffering. Euthanasia in health ethics is a very serious topic that each health care professional should not take lightly. Although there are some medical care professionals who would willingly participate in the process of euthanasia, the fact that an active euthanasia is similar to intentional killing automatically make this practice immoral. It is also not a good decision to make euthanasia legal because medical care professionals such as in the case of the doctors would only be tempted not to do their best in terms of preserving the lives of the patients. In other words, making euthanasia legal would only make intentional killing a universally accepted norm which clearly violates the role and responsibility of the health care professionals which is to preserve the life of the people. *** End *** References Blazer, S., & Zimmer, E. (2005). The Embryo: Scientific Discovery and Medical Ethics. Basel: Karger. Ciabal, L. (2003). Ethics for health professionals. C&E Publishing Inc. Cohen-Almagor, R., & Shmueli, M. (2000). Can Life Be Evaluated? 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