PICOTQuestion: How accessible are resources (O) for terminally illpatients (P) who choose Physician-Assisted Suicide (I) to be able toestablish how/when they die (T) in Europe compared to the UnitedStates (C)?
Overthe years, arguments over the right to die with the help of a doctorat the time and manner people choose have intensified across theworld. Some of the arguments include diversified perspectivesregarding states such as Colombia in the United States and others inEurope allowing some form of physician-assisted death. However, draftbills, ballot initiatives and court cases continue to progress inmore countries across the world. For instance, the Canadian SupremeCourt recently eradicated a ban on assisting patients in dying. Theircourse of action motivated other nations in Europe such as Germanyand Britain to incorporate physician-assisted death. Nevertheless,these works fill critics with dismay as some argue thatphysician-assisted death is moral and absolute. The critics againstsuch actions believe that the deliberate ending of an individual’slife violates the right to life because it is sacred and theendurance of suffering confers its dignity. On the other hand,supporters of physician-assisted death argue that it entails theinitial step in instances where vulnerable patients feel threatenedor where premature death becomes a cheap alternative to palliativecare.
Theessence of the present study involves determining the availability ofresources for terminally ill patients who choose Physician-assistedsuicide to establish how and when they die. It also aims atidentifying the factors that lead to the use of physician-assistedsuicide as well as its significance to nursing and patient care.These will be followed closely by the history behind the interventionstrategy and how it took place. Besides, the paper will alsodetermine how physician-assisted suicide affects legal and ethicalissues in nursing. Most of these factors will incorporate acomprehensive comparison between the actions carried out in Europeand the United States.
Thephrase physician-assisted suicide describes the act in which medicalpractitioners provide competent, terminally ill patients withprescriptions including a lethal dose of medication based on therequests of the patient. However, these medicines occur through thepatient’s intention to use in terminating their lives orcontrolling the timing of their death. Most importantly, the practiceof physician-assisted suicide emanated from ancient Greece where thegovernment gave hemlock to those who needed it. For instance, WilliamShakespeare illustrated a memory of the Roman practice in his work“Julius Caesar” through depicting Brutus running into the swordheld by Strato. These incidents are followed closely by opposition tothe physician-assisted suicide practice where more than half of thethirty-seven states in the United States prohibited the act in 1868.They also indicate the essence of assisted suicide as a way ofpreserving one’s honor in the ancient days.
Contrastingly,over the past few decades assisted suicide has been viewed as aresponse to the progress of modern medicine as new and expensivemedical technologies have been developed with the aim of prolonginglife. However, these technologies also extend the dying processleading people to question whether modern medicine coerces patientsto live in avoidable pain when there exists no possibility of cure(Rymowicz and Joshi, 2016). Nevertheless, passive euthanasia orrather the disconnection of a respirator or removing a feeding tubehas become an acceptable solution to such a dilemma. On the otherhand, active euthanasia which describes an overdose of pills or alethal injection of morphine remain controversial. Physician-assistedsuicide employs the broad definition as a type of active euthanasiain which doctors provide the means of death by prescribing a lethaldose of drugs based on the responsibility of the patient forperforming the final act (Rymowicz and Joshi, 2016).
Inthe United States, the phrase physician-assisted suicide describesthe practice authorized under the Washington, Oregon and VermontDeath with Dignity Acts which reflects the requirement the eligiblepeople must be competent to make decisions and possess a limited lifeexpectancy of about six months or less. It also elaborates the factthat physicians provide assistance to patients who may otherwise dieor those who seek help to control the timing and circumstances oftheir death in the face of end-of-life suffering deemed intolerable(Rymowicz and Joshi, 2016). Although the phrase evades the mentalhealth connotations associated with the word suicide, critics of thepractice suggest that it could include other practices that areclearly outside the legal bounds of the three states’ death withdignity Acts (Rymowicz and Joshi, 2016). For instance, patients whoreceive assistance in ingesting the medication would constituteeuthanasia. Most of these practices employ the phrase physician aidin dying with the aim of reflecting a legal action under theWashington Death with Dignity Act. Besides, the phrasephysician-assisted suicide was rejected by the Oregon Department ofPublic Health as well as other entities responsible for maintainingproviding health care services in the United States. The rejection ofthe phrase contributed towards the adoption of the term physicianaid-in-dying applied in Oregon, Washington as well as Vermont Deathwith Dignity laws (Rymowicz and Joshi, 2016).
Mostimportantly, these laws indicate the difference between the use ofeuthanasia and physician aid-in-dying which entails disparity in theadministrator of the medication that will end the patient’s life(Finlay and George, 2010). In physician aid-in-dying, the patientshould administer the medications themselves or seek assistance froma doctor based on their decision on whether and when to ingest theprescribed dose. On the other hand, euthanasia occurs when a thirdparty administers medication or acts directly to end the patient’slife. Nevertheless, euthanasia is illegal in all the states inAmerica (Finlay and George, 2010).
InEurope, the issue of physician-assisted suicide brings aboutcontroversial perspectives based on legal and ethical factors. Forinstance, the European Court of Human Rights encountered an issue ofvoluntary euthanasia where a patient suffered from motor neurondisease which affected the control of her muscle activity. Theeffects included the inability to speak, walk, breathe and swallowand in its terminal phase, the illness contributed towards thepatient becoming paralyzed and later died of suffocation (Gamondi etal. 2013). The death of the patient occurred as a result of thedifficulties in breathing, but the patient’s intellect and capacityto make decisions remained unimpaired throughout the illness. Thesefactors drove the patient towards requesting the intervention of theDirector of Public Prosecutions to pardon her husband as opposed toprosecuting him in case he assisted her in committing suicide(Gamondi et al. 2013). However, the UK authorities denied her theundertaking which drove the husband to seek approval before theEuropean Court. Some of the claims that the refusal violated includedviolation of the right to life which also includes the right toterminate an individual’s life, human dignity, the right toprivacy, just to mention but a few. The Court thus held that theincident did not violate any of these rights and hence rejected thepetition (Gamondi et al. 2013).
Legally,the event brings about an interpretation as the collision of twonon-quantifiable human rights which entail the right to life and theright to human dignity. On the ethical perspective, the incidentbrings about a different question regarding the limits of stateintervention to protect individuals from their self-harming conducts.Nevertheless, paternalism in Europe refers to the coerciveintervention to the Behaviour of a person with the aim of preventingthem from causing harm to themselves (Gamondi et al. 2013). Theincident described above portrays an elaborate instance ofpaternalism as it involved the intervention of professionals as wellas family members in taking any medical stands regarding ending thepatient’s life. However, there exist disparities in the variousforms of euthanasia used in Europe. The variations involve voluntary,involuntary and non-voluntary forms euthanasia. Involuntaryeuthanasia focuses on the subject against the patient’s will ordisregards their consent. It also qualifies as murder as it ends apatient’s life without their approval or consent irrespective ofthe criticality of their health situation (Gamondi et al. 2013). Onthe other hand, non-voluntary euthanasia involves mental incompetenceof the patient in making informed decisions. Passive euthanasiafocuses on the refusal of medical treatment by terminally illpatients while active voluntary euthanasia means a physician’sdirect contribution towards the patient’s death based on theirrequest.
Mostimportantly, physician-assisted suicide in Europe differs from activeeuthanasia in that the patient provides the final link in the causalchain while the doctor helps in carrying out the process. Theprohibition of voluntary euthanasia, as well as physician, assistedsuicide qualify as paternalism since in other instances they do notinterfere with the patient’s autonomy. The incident mentioned abovemay be eligible as a request for assisted suicide or even voluntaryeuthanasia (Georges et al. 2007). However, the qualification dependson who performed the suicide or murder act. Therefore, theprohibition of the UK authorities qualifies paternalism based ondistinctions such as it is an indirect, harm-preventive, coercive andpassive form. Besides, Europe provides different models forjustifying socialism where the first entails deontological ethics.This approach gives socialism an absolute priority to autonomy overother considerations. It also focuses on the kind of paternalisticinterferences that violate sovereignty as some range from weak tostrong (Georges et al. 2007). Hard paternalism propagates forcoercion to protect competent adults against their deliberateself-harming decisions. For instance, the criminal prohibition ofdrug use or active voluntary euthanasia as well as the obligation tofasten seat belts while driving. Contrastingly, soft paternalismfacilitates protection from self-regarding corrupt conduct especiallyin cases where the conduct entails substantial non-voluntary aspects(Georges et al. 2007).
Effectsto Legal and Ethical Issues in Nursing
Theuse of physician-assisted suicide brings about questions regardingethical and unethical practices of killing people with/withoutconsent or good cause. These issues may be coupled with whether itgives life its value and meaning. However, one of the most importanttopics it seeks to answer includes physician-assisted suicide, or theuse of euthanasia are acceptable practices within the ethics ofChristian people (Nelson, 2015). Some arguments focus on biblicalcodes that state that when the murder occurred, blood retributionentailed the legal right and moral duty of the victim’s next ofkin. Nevertheless, technology did not exist then and interventionssuch as antibiotics, blood transfusions, organ transplants, were notinvented yet. Evolution throughout the years and advancement intechnology contributed towards stimulation of body organs but thedetermination of the time of death may not be possible (Nelson,2015). The biblical values collide with technological and medicalexpertise available today thus rendering the conclusions of the pastinoperative for the future.
Additionally,critics argue that medical interventions such as physician-assistedsuicide or even the use of euthanasia contradict the natural causesprovided by biblical perspectives. Legally, they claim that suchpractices violate the right to life-based on the ethical element ofvaluing the lives of each. On the other hand, supporters of thepractice indicate that it provides an alternative strategy that endsthe lives of people suffering from terminal illnesses. The issuesregarding the value of life entail societal beliefs among people whouse the Bible as a reference in critiquing modern elements.Therefore, physician-assisted suicide, paternalism, as well assimilar medical interventions motivated by genuine benevolence,indicate the virtue of care (Nelson, 2015). These factors occurthrough the virtue of caring that makes people autonomous, and sincemedical practitioners carry out their services based on the provisionof attention, they follow ethical and legal requirements in makingdecisions regarding the welfare of their patients.
Importanceof the topic to Nursing and Patient Care
Physician-AssistedSuicide or paternalism, as described in other parts of the world,provides an elaborate point of discussion in the nursing professionas it evaluates their involvement in decisions made by patients andtheir relatives. Nevertheless, these phrases bring about an essentialelement in healing where they are expected to guide patients indecision making especially in instances where terminal illnessesrender their lifespan minimal. Similarly, physician-assisted suicideallows medical practitioners to portray empathy in theresponsibilities as they place themselves in the shoes of the subject(Nelson, 2015). This ensures that the subject of such practicesreceives specific attention as well as engrossment into their health.These elements facilitate in relieving the burden and pain from thepatient as well as the relatives who have endured emotion, financialand psychological torture. Therefore, suicide moderated by thephysicians with the consent of patients and their family membersserves as a means to an end that reduces the suffering throughintentional death. Contrastingly, such activities may to some extentviolate social norms related to health care especially in the socialexpectation put on the patient to devote themselves entirely torecovery. It also violates social expectations on doctors of curingand avoiding harm to the patients (Nelson, 2015).
Theselection of this topic entailed the evaluation of the ethical andlegal issues surrounding the physician-assisted suicide practice indifferent parts of the world. It also aimed at creating anunderstanding of the factors involved in conducting such practicesbased on the legal and ethical considerations held in the UnitedStates and Europe (Nelson, 2015). These factors brought about therevelation of other key elements required when participating inphysician-assisted suicide. For instance, in Europe, determination ofthese factors contributed towards understanding other practices thatmay be regarded as illegal and immoral. Nevertheless, the topicfacilitates in the depiction of the importance of nurses and othermedical practitioners in making decision regarding the life of aterminally ill patient.
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Gamondi, C.,Pott, M., & Payne, S. (2013). Families` experienceswith patients who died after assisted suicide: a retrospectiveinterview study in southern Switzerland. Annalsof Oncology, 24(6),1639-1644. doi:10.1093/annonc/mdt033
Georges, J.,Onwuteaka-Philipsen, B. D., Muller, M. T., Vander Wal, G., Van der Heide, A., & Van der Maas, P. J.(2007). Relatives` Perspective on the Terminally Ill Patients WhoDied after Euthanasia or Physician-Assisted Suicide: A RetrospectiveCross-Sectional Interview Study in the Netherlands. DeathStudies, 31(1),1-15. Doi: 10.1080/07481180600985041
Nelson, B.(2015). In right-to-die debate, a new focus on practicality: As lawslegalizing physician-assisted suicide gain ground, physiciansconsider conscientious objection, training, oversight, and access toend-of-life care. CancerCytopathology, 123(7),385-386. doi:10.1002/cncy.21579
Rymowicz, R.,& Joshi, P. (2016). Statistical Analysis Suggests SomeSuicidal Adults Choose in Oregon. TheAmerican Journal of Geriatric Psychiatry, 24(3),S94-S95. doi:10.1016/j.jagp.2016.01.094