End of Life Issues: Euthanasia - Essay Example

End of Life Issues: Euthanasia Oladele Yusuf HCMN 441 Prof. M. Alt May 4, End of Life Issues: Euthanasia Introduction The controversial issue surrounding end of life decisions have continued to spur debates worldwide. There have been legal, ethical and moral concerns brought forth by parties arguing for its legalization and immediately countered by those who see it as a violation of the professional codes of conduct. The World Health Organization (WHO) (2000) confirmed their position on the subject, to wit: “in recent years euthanasia and assisted suicide have become issues that may confront the physician. Active euthanasia is illegal in almost all jurisdictions, and assisted suicide is enmeshed in moral, ethical and philosophical controversy" (p. 9). In the United States, only four out of the 50 states have been reported to have clear provisions for euthanasia in their judicial system (Naik, 2011). This is indicative of the skewed argument against euthanasia as evidenced by the predominance of states explicitly prohibiting assisted suicide or euthanasia (Legal Status of Assisted Suicide/Euthanasia in the United States, n.d.). One’s personal contention is towards prohibiting euthanasia as an end of life decision for patients. Statistics on Assisted Suicide Practice The Johns Hopkins University and Bruce Leff (2007) discussed ethics at end of life scenarios, particularly euthanasia where three diverse interventions were explained: active, passive and assisted. Goel (2008) likewise expanded the categories to include involuntary euthanasia. The grid presented as “Legal Status of Assisted Suicide/Euthanasia in the United States” presented highlights of states’ statutes, past legislation and ballot initiatives, as well as court cases. From the 50 states, a total of 10 states indicated that they have no law which specifically prohibits assisted suicide; while one state (Montana) clearly stipulated that it is legalized, to wit: “under a Montana Supreme Court ruling on 12/31/09 which created a consent defense for physicians who comply with a terminally ill patients request for physician-assisted suicide” (Legal Status of Assisted Suicide/Euthanasia in the United States, n.d., p. 5). The states that have no existing laws on assisted suicide are: Alabama, District of Columbia, Idaho, Massachusetts, North Carolina, Ohio, Utah, Vermont, West Virginia, and Wyoming. In an article written by Hermsen and ten Have (2002), the authors have analyzed the extent of research conducted on the subject of euthanasia in palliative care journals and the results revealed that since 1984 up to 1999, a total of 75 euthanasia studies were published (Hermsen & teh Have, 2002, p. 519). From these reviews of literature, the authors identified that of the 75 articles, 12 signified favorable attitude towards euthanasia; while 28 disclosed unfavorable attitudes; a total of 35 was neutral on the subject. Arguments For and Against Euthanasia The controversial nature of euthanasia was emphasized by Goel (2008) as he identified that aside from the ethical, legal and moral issues, the definition itself contributes to its’ contestability. As averred, “at the extreme ends of disagreement, advocates say euthanasia, also known as physician aid in dying, or physician assisted suicide, is a merciful method of death. At the other end are opponents of euthanasia, who may consider this method as a form of murder” (Goel, 2008, p. 230). Another study that proposed further examination of defining passive euthanasia was Garrard and Wilkinson (2005) whose findings indicate the validity of health care practitioners in examining the rationales for potential implementation, as warranted. The Wisconsin Right to Life emphasized that supporters of euthanasia argue that “the right of a competent patient to make medical treatment decisions should include the right to request and receive death by lethal injection” (2011, par. 1). This contention was further expounded by the findings revealed by Hermsen & teh Have (2002) who indicated that autonomy of the patient, compassion and the fallibility of palliative care are valid grounds to legal the patients’ decision to end their lives, as requested. On the contrary, arguments against euthanasia emphasize that “once you open the door for killing of patients for one reason, it is nearly impossible to limit the “right” to that one circumstance” (Wisconsin Right to Life: Euthanasia, 2011, par. 24). As contented from the results of the study conducted by Hermsen & teh Have (2002), the authors disclosed that valid arguments have significantly indicated that there is no place for euthanasia in the provision of palliative care to the respect for human life; that dying is a natural part of life; and that the issue of euthanasia diverts attention from the capacities of providign palliative care. The arguments towards its support were countered through emphasizing the concepts of the slippery slope argument (“legalizing euthanasia or permitting euthanasia to be a component of good care for terminally ill patients will definitely lead to abuse, such as involuntary euthanasia (especially of the elderly, the handicapped, and chronically ill patients) or murder” (Hermsen & teh Have, 2002, p. 523)) and by indicating that legalizing it would label contemporary culture as a culture of death. Conclusion One’s personal contention favors the prohibition of legalization of euthanasia for the same reasons that advocates of palliative care have disclosed. I strongly believe that patients who are faced with debilitating or chronic illnesses have other options to alleviate pain and suffering other than resorting to ending one’s life. As a strong promoter of preservation of life and in steadfast faith in God, I am convinced that the ethical, legal and moral issues confounding euthanasia (slippery slope argument and a violation to the right to live) would not be resolved by legalizing it; as health care practitioners could address end of life issues through effective palliative care interventions. Abstract of Major Findings The essay that analyzed the moral, ethical and legal implications of euthanasia as an end of life issue emphasized that majority of health care practitioners, organizations, and groups still value life and the benefits of resorting to palliative care. As emphasize, the once euthanasia is legalized, it would open the doors for potential abuse in defining the boundaries for deciding on assisting passive euthanasia as deemed needed or appropriate. Aside from resolving who would be authorized to establish legality of the decision (the medical practitioner, the family members, or the patient), there are also issues to adherence to professional codes of ethics as medical practitioners are supposed to do everything within their means to prolong the life of their patients. Three Questions Noted 1. If patients are not anymore coherent or mentally capable to decide, who should decide on issues regarding passive euthanasia, if legalized? 2. To what extent would doctors be not held liable if and when euthanasia is legalized? 3. Wouldn’t the promotion of euthanasia be significantly contrary to the ethical principles of beneficence, justice and nonmaleficence? Annotated Bibliographies Garrard, E., & Wilkinson, S. (2005). Passive Euthanasia. Journal of Medical Ethics, Vol. 31, 64– 68. The authors discussed the moral issues of passive euthanasia in the palliative care setting particularly evaluating the alleged contradiction in terminology. By expounding on three arguments, such as the wrongness of the term passive euthanasia; the claim that it is not euthanasia since it does not cause the demise of the patient; and further examining the alleged bad consequences of the term, the findings revealed that a greater understanding of the term passive euthanasia would provide ample information and confidence of its applicability in the health care setting. As indicated, there is a crucial need for health care practitioners to distinguish that ‘‘euthanasia reasons’’ for withdrawing or withholding life prolonging treatment are carefully distinguished from other reasons” (Garrard & Wilkinson, 2005, p. 64) Goel, V. (2008). Euthanasia – A dignified end of life! International NGO Journal, Vol. 3, No. 12, 224-231. A discussion on the meaning of euthanasia, the different classifications, misgivings and as distinguished from Medical Termination of Pregnancy (MTP) was presented in the article. The present legal positions in various states and countries globally, were likewise discussed. The findings of the author indicated that euthanasia can be resorted as a dignified way for end of life scenarios. Hermsen, M., & teh Have, H. (2002). Euthanasia in Palliative Care Journals. Journal of Pain and Symptom Management, Vol. 23, No. 6, 517-525. The authors discussed the moral issues of euthanasia in the palliative care setting by examining the review of related literature from 1984 to 1999; by determining the attitudes towards this practice; by expounding on the uses and definitions of crucial terms on euthanasia through the articles reviewed; and finally, on the arguments for and against the place of euthanasia in palliative care. Legal Status of Assisted Suicide/Euthanasia in the United States. (n.d.). Retrieved May 1, 2012, from nightingalealliance.org: http://www.nightingalealliance.org/pdf/state_grid.pdf The grid presented highlights of states’ statutes, past legislation and ballot initiatives, as well as court cases. From the 50 states, a total of 10 states indicated that they have no law which specifically prohibits assisted suicide; while one state (Montana) clearly stipulated that it is legalized, to wit: “under a Montana Supreme Court ruling on 12/31/09 which created a consent defense for physicians who comply with a terminally ill patients request for physician-assisted suicide” (Legal Status of Assisted Suicide/Euthanasia in the United States, n.d., p. 5). The states that have no existing laws on assisted suicide are: Alabama, District of Columbia, Idaho, Massachusetts, North Carolina, Ohio, Utah, Vermont, West Virginia, and Wyoming. Naik, A. (2011, Septembe 27). Euthanasia Laws. Retrieved May 1, 2012, from http://www.buzzle.com/articles/euthanasia-laws.html The author provided a brief overview of euthanasia and progressed to stipulating countries all over the world that practice it and those that render it illegal. From among those identified as having legalized euthanasia are: the Netherlands, Belgium, Albania, Luxembourg. The author continued to provide a brief overview of euthanasia in the United States that indicated through the Death With Dignity (DWD) Act of 1994 which stipulates that “people who are terminally ill, with no chances of survival whatsoever, can ask the doctor for lethal medication” (Naik, 2011, par. 5), some states were able to justify its implementation. The Johns Hopkins University and Bruce Leff. (2007). Ethical Issues in Health Care for Older Persons. Retrieved 21 February 2012, from The author, Leff (2007) proffered pertinent issues relative to ethical issues that older persons face within the health care setting. The initially presented the basic principles of ethical decision making focusing on autonomy, beneficence, justice and nonmaleficence. Other mini-case scenarios were presented; together with an identification of significant points concerning the concept of advance directives. Then, ethics at end of life situations, particularly, euthanasia were expounded, detailing the three interventions: active, passive and assisted. Other ethical issues that were discussed were research ethics and health care rationing. The information presented from this discourse in beneficial in the current research through the credibility posed by the author as an associate professor of the John Hopkins University and thereby has been exposed and directly involved in addressing ethical issues faced by older patients at the end of life stage. Wisconsin Right to Life. (2011). Euthanasia. Retrieved 21 February 2012, from The discourse presented balanced arguments detailing the legality of the issues; considering this as an option for patients in pain; and other reasons for promoting and using euthanasia. The article likewise identified the groups opposing the legalization of euthanasia and assisted suicide as coming from both medical and disability rights groups. The contents of the article are thereby useful for the current research in terms of providing a balanced discourse and presenting updated statistics given the current status of its publication (2011). Other valid and authoritative sites were likewise provided for more information on the subject, as deemed necessary. World Health Organization (WHO). (2000). Preventing Suicide: A Resource for General Physicians. Retrieved May 1, 2012, from http://www.who.int/mental_health/media/en/56.pdf The article presented pertinent issues relating to suicide, particularly due to mental disorder, physical disorders and sociodemographic factors. Concurrently, it also highlighted high risks for suicidal behavior, including management of suicidal patients and determining the need to refer to specialist care. In summary, the contents provided steps in suicide prevention. The subject of euthanasia was noted in terms of its controversial nature and its outright illegality if active euthanasia is implemented. References Garrard, E., & Wilkinson, S. (2005). Passive Euthanasia. Journal of Medical Ethics, Vol. 31, 64–68. Goel, V. (2008). Euthanasia – A dignified end of life! International NGO Journal, Vol. , No. 12, 224-231. Hermsen, M., & teh Have, H. (2002). Euthanasia in Palliative Care Journals. Journal of Pain and Symptom Management, Vol. 23, No. 6, 517-525. Legal Status of Assisted Suicide/Euthanasia in the United States. (n.d.). Retrieved May 1, 2012, from nightingalealliance.org: http://www.nightingalealliance.org/pdf/state_grid.pdf Naik, A. (2011, Septembe 27). Euthanasia Laws. Retrieved May 1, 2012, from http://www.buzzle.com/articles/euthanasia-laws.html The Johns Hopkins University and Bruce Leff. (2007). Ethical Issues in Health Care for Older Persons. Retrieved 21 February 2012, from Wisconsin Right to Life. (2011). Euthanasia. Retrieved 21 February 2012, from World Health Organization (WHO). (2000). Preventing Suicide: A Resource for General Physicians. Retrieved May 1, 2012, from http://www.who.int/mental_health/media/en/56.pdf Read More