Should Euthanasia and Physician-Assisted Suicide be Legalized - Essay Example

? Should Euthanasia and Physician Assisted Suicide be Legalized? July Should Euthanasia and Physician Assisted Suicide be Legalized? Abstract Euthanasia and physician assisted suicide are burning issues across the globe. They are illegal in many jurisdictions but data shows that physicians still conduct these procedures. This paper reviewed existing literature on the controversy as to the practices and identified the need for legalization of physically assisted death within the context of the involved ethical concerns and public utility. Introduction The role of nursing (though previously restricted to caring for in patients and currently diversified to include coordination of care and critical thinking towards health care solutions in the society) is to ensure well being of members of the society. Therefore, nurses are the principle caregivers, communicators, advisers, and can change agents in health care provision with focus on patients’ interests. Euthanasia and physician assisted deaths have emerged as contemporary controversial issues that support and contradict the role of nursing. Euthanasia defines a physician’s direct involvement in terminating patient’s life and involves actions like injecting lethal drugs to facilitate death, while physician assisted suicide involves an indirect role, such as consultancy or provision of a lethal substance for a patient’s use towards a faster death. The irony of a nurse’s involvement in euthanasia and physically assisted suicide (contrary to the traditionally perceived role of facilitating well being and relieving patients of pain together with moral and legal concerns over people’s lives) has raised the debate on whether euthanasia and physically assisted suicide should be legalized. This paper explores existing literature to develop the position that euthanasia and physically assisted suicide could and should be legalized. Arguments Supporting Legalization of Euthanasia and Physically Assisted Suicide Terminal illnesses and their associated endless pains are the fundamental factors to the debate on euthanasia and physician assisted suicide. The diseases are incurable and the level of pain that the patients suffer, especially as they approach death, is extreme and sometimes beyond ordinary painkillers. The patients, their relatives and close associates, and even their care givers may face the dilemma of relieving the pain or letting the patient suffer the pain awaiting natural death and the right to make such decisions are reflective of ethical and legal considerations. Martin, Mauron, and Hurst argue that core to the debate on euthanasia and physician assisted suicide is consideration of the wider scope of medical ethics, even beyond issues of patients’ deaths (2011). The authors argue that caregivers have many roles that supersede healing and that some forms of assisted deaths may be necessary and justified. A consideration of some medical practices that have been legalized despite their moral contentions and non-healing objectives is the first basis for exploring the euthanasia and physician assisted suicide debate. Application of contraceptive pills that control unwanted pregnancies is a non-healing act but is considered legal and ethical and similarity in application of contraceptives and those of euthanasia and physician assisted suicide means that they should be accorded a similar treatment regarding the healing argument. The core objective of contraceptive application is to respect people’s right to determine their appropriate time for having children and implies the need for respect of people’s autonomy in other matters. Termination of life through physicians’ assistance falls within such categories of personal decisions, especially if the patient makes the primary reason (Martin, Mauron, and Hurst, 2011). Legal and moral considerations over “preventive medical measures and palliative care” are other reasons that support legalization of euthanasia and physician assisted suicide (Martin, Mauron, and Hurst, 2011, p. 56). The two scopes of care lack healing objective but have never been controversial. They are further legal and this undermines the controversy of physician-assisted deaths based on lack of healing objective. In addition to the healing perspective, ethical and legal issues in care provisions identify the need for assisted deaths. Legal provisions and medical ethics require care providers to respect patients’ autonomy with a consequence that a patient’s decision should be final. Retaining illegality of euthanasia and physician assisted suicide therefore induces legal dilemma because the law is contradictory. It offers patients the right to ask for physicians’ help in life termination and at the same time prohibit physicians from respecting patients’ rights. This identifies weakness in law, and one of the solutions is to legalize euthanasia and physician assisted suicide for consistent laws. The law also safeguards personal values and beliefs such as cultural practices and religious views that may promote voluntary end of life. Such views however, remain contrary to the same law and a physician’s refusal to help a patient in terminating life would contravene legal provisions for respect of personal values. Studies have further identified social needs for euthanasia and physician assisted suicide in the relationship between patients and their physicians following decisions to assist or not to assist patients in their death decisions. While compliance with patients’ needs for aided deaths does not have adverse effects on the relationship, refusing to help patients die would mean isolating them upon realization that their conditions are beyond caregivers’ potentials. Such a perspective among patients and their relatives is however likely to inflict more pain on them and care givers’ compliance with request for assisted deaths is therefore moral, based on utilitarian ethics (Martin, Mauron, and Hurst, 2011). Lachman supports the ethical principle of autonomy as one of the fundamental issues to the controversy around euthanasia and physician assisted suicide. The author, in evaluating the scope of assisted suicide, explains that the United States upholds the doctrine and therefore protects patients’ rights to personal decisions and this leaves physicians with the moral duty to determine their positions on patients’ right to die, whether to accept or reject. A deeper controversy on the issue has also been experienced within government arms with legislators and the judiciary holding conflicting views. The United States Supreme in the year 1997 declared assisted death illegal by its decision that people do not have a right to die. Some states in the United States then enacted laws to counter the supreme courts’ decision and the judiciary upheld such laws that are constructed to the best interest of patients and the society. Oregon’s Death with Dignity Act is an example. According to the act, a patient must be informed of the scope of assisted death and must offer voluntary concept, a provision that not only identifies autonomy but focuses on patient’s interest in assisted death. The act also avoids possible misuse of autonomy in its provision that assisted death is only legal within a patient’s last six months of life. Two physicians must ascertain the time limit and a patient must submit both oral and written requests into assisted death. Morality in the act’s provision is further established by a requirement that a patient waits for at least two weeks after making a request for assisted death because the time allows for reconsideration, absolute autonomy, and assurance of the patient’s conviction. The law also prohibits coercion into assisted deaths and requires counseling for patients who seek physician assisted deaths and even though it illegalizes euthanasia, its clear guidelines that establishes morality and legality of physician assisted deaths shows that euthanasia can similarly be regulated to observe morality and respect rights of involved stakeholders. Legalization of assisted deaths in Oregon also means that similar laws can be enacted in other geographical jurisdictions to end an ethical dilemma in question (Lachman, 2010). Trends in a number of assisted deaths under the Oregon laws and the number of patients that requests for the service also suggests sanity in the practice because a significant proportion of the patients change their minds in relation of assisted death. While the number of patients who request for the service has increased with significant consistency following the legislation, the number that ends up with assisted death has not increased with a similar trend but has oscillated with constant and decreasing figures and shows that legalization of physician assisted deaths does not promote arbitrary decisions into assisted death. Inference to euthanasia therefore suggests its moral application with care to ensure patients’ rights and interest before application (Lachman, 2010). An independent review of euthanasia and patient assisted suicide in Spain also supports the need to legalize the acts. Though the practices are illegal in the country, they are practiced and a significant percentage of nurses reported experience with either euthanasia or physician assisted death with higher cases of physician-assisted deaths. Patients request for life termination and even with the legal provision in the country, nurses believe that physicians in Spain practice euthanasia and physically assisted suicide. A majority of nurse in the country also support legalization of the practices and are willing to help patients end their lives in their desirable ways. The results identify three important facts that should be considered in the debate on legalization of euthanasia and physician assisted suicide in Spain and other countries. The care needs are being met despite the current laws that make them illegal and this has far-reaching consequences such as unprofessionalism in service delivery. It also means that the law is not effective in controlling euthanasia and physician assisted deaths and legalization with clear guidelines, like in Oregon, would be better. Another important issue for consideration is nurses’ experience with patients’ conditions as they approach death and their informed opinion of the best approach to helping the patients. Nurses’ willingness to help patients in their need for assisted death also support validity of such needs that legalization of assisted would meet (Velazquez, Lorda and Piqueras, 2012). Hoseinni narrows down the dilemma to within care provision, from which other concerns such as legal and ethical issues emanates. Traditional care practice among Greek nurses required an oath that care providers should not offer or recommend a dangerous drug to a person, even on request. American Medical Association has opposed the use of euthanasia and physician assisted suicide on the same basis. The association, in reference to an activist’s advocacy for the assisted deaths, termed the activist as an agent of death and a threat to the society. The legal fraternity joined in the opposition and the activists broadcast of a taped assisted death led to legal proceedings in which the court found him guilty of murder. The society’s opinion on the action however welcomed the act, expressing support for assisted suicide. A survey of opinions from members of the society, following the broadcast, identified almost a two-third majority in support of assisted suicide with merely half opposing it and the society being the foundation of ethics suggest that the act is moral. While about 46 percent of interviewed people believed that such actions deserve a murder charge or a lesser charge, about 40 percent expressed the opinion that no charge should be imposed on physicians who helped people in their dying process. The American Medical Association’s position on the issue also focuses on the profession’s image instead of ethical values and professionals have criticized this basis because the scope of the assisted deaths is social. Professionals in care services also reports high probability of receiving requests for assisted suicide and that a significant percentage of the request leads to assisted deaths (Hosseini, 2012). The core of the Hosseini’s argument for assisted suicide is the doctrine of autonomy, especially when the involved patient is an adult with decision-making rights. Their legal rights should extend to health decision and they should be allowed to chose when they want to die and how they want to die when their deaths are eminent. Further, the decision to end one’s own life does not infringe any other person’s life and should therefore be considered legal. Justice, another ethical principle, requires equality in treatment but making assisted suicide illegal offers different treatment to patients because the law recognizes rights of people with terminal complications to decline treatment in order to accelerate their deaths. Refusing treatment is however not effective in facilitating death under all terminal illnesses and legal provision offers a disadvantage to those patients in who refused treatment cannot facilitate faster death. A fair treatment would be to allow for alternatives such as euthanasia or physician assisted deaths. Another ethical support for termination of a patient’s life through physician’s assistance is the doctrine of non-malfeasance that requires mitigation of harm such as pain. Patients with terminal complications however suffer from extreme levels of pain that only death can relieve and non-malfeasance would support such mitigation approach. Illegalizing euthanasia and physician assisted suicide also limits people’s liberty (Hosseini, 2012). An empirical study of Belgian religious minorities identifies mixed opinions on end of life practices. Conducted among elderly women, the research by Backe, Wils and Broeckaert reported a liberal perception on assisted death with respect for patients’ autonomy (2011). Nurses’ attitudes towards assisted deaths also depend on their religious perspectives, which can regulate the acts and supports the need for uniform laws from legalization on assisted deaths. Beliefs that prohibit arbitrary end of life will for example regulate the practice among physicians and render legislation useless. Illegalization of the end of life practices, against a physician’s religious belief is however contrary to legal provisions for respect of religious beliefs and practices (Gielen, Branden and Broeckaert, 2009). A review of literature on international perspective identifies the global need for legislative awareness on patients’ need for assisted suicide (Hendry, Pasterfield, Lewis, Carter, Hodgson and Wilkinson, 2013). Canadians’ opinions on euthanasia and assisted suicide are similar to globally reported perspectives. Majority of Canadians support assisted death and this establishes validity of a postulate that people support assisted suicide to meet patients’ needs. Two thirds of Canadians, according a survey in the year 2010, supports the life ending practices with an almost unanimous support for legalization of euthanasia and physician assisted suicide. Canadian physicians also support and are willing to participate in assisted end of life practices (Schuklenk, Delden, Downie, McLean and Weinstock, 2011). Arguments against legalization of euthanasia and physically assisted suicide Husseini, in his exploration of morality and legal aspects of physician assisted suicide, gives many reasons for opposing care provider’s roles in ending life of patients. Core to the argument is the sanctity of life among traditional views that may oppose unnatural deaths. There are also fears of abuse of duty by physicians to end patient’s life without valid reasons. This could be due to negligence or a patient’s need to die when conditions do not warrant premature death. Husseini further argues that physician assisted deaths may not meet the definition of non-malfeasance doctrine because the society should be able to develop alternative strategies to reducing patients’ pain. Traditional ethical values in health care, which American Medical Association supports, also argue against assisted deaths because of integrity reasons. Legalization of euthanasia and physically assisted suicide may also lead to unnecessary end of life due to mistakes in patient diagnosis (Hosseini, 2012). Effects of religious belief on people’s opinions against assisted end of life are also significant, as faithful people believe that the power and decision to end life belongs to the God only (Backe, Wils and Broeckaert, 2011). Conclusion Nurses’ roles include the need to ensure well being of members of the society through relieving pain and taking care of patients. Terminal illnesses and their associated pains that are uncontrollable identify a dilemma on the best way to deal with patients in such conditions and while assisted death at patients’ request is an alternative, it remains illegal and opposed by some regulatory bodies. Different opinions have been raised with ethical issues such as patients’ autonomy, integrity, non-malfeasance and traditional and religious issues to support legalization and use of euthanasia and physician assisted suicide. Public opinion also indicates the need to legalize the care practices to the best interest of patients and provisions of Oregon’s act that legalized physician assisted deaths indicates that the practices can be conducted with absolute care. There are, however, opinions that support the current state in which assisted death is illegal. They are integrity and value issues. The reasons for legalization of assisted deaths are however, more significant, are valid, and can remedy some of the reasons against legalization. This paper therefore argues that euthanasia and physician assisted suicide should be legalized to the best welfare of the terminally ill patients and the society. References Backe, G., Wils, J. and Broeckaert, B. (2011). ‘We are (not) the master of our body’: Elderly Jewish women’s attitudes towards euthanasia and assisted suicide. Ethnicity and Health (16.3), 259-278. Gielen, J., Branden, S. and Broeckaert, B. (2009). Religion and nurses’ attitudes to euthanasia and physician assisted suicide. Nursing Ethics. (16.3), 303-316. Hendry, M., Pasterfield, D., Lewis, R., Carter, B., Hodgson, D. and Wilkinson, C. (2013). Why do we want the right to die? A systematic review of the international literature on the views of patients, careres and the public on assisted dying. Palliative Medicine (27.1), 13-26. Hosseini, H. (2012). Ethics, the illegality of physician assisted suicide in the United States, and the role and ordeal of Dr. Jack Kevorkian before his death. Review of European Studies (4.5), 203-209. Lachman, V. (2010). Physician-assisted suicide: Compassionate liberation or murder? MEDSURG Nursing 19(2): 121-125. Martin, A., Mauron, A. and Hurst, S. (2011). 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