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Euthanasia and Healthcare Ethics:
An Ethical Dilemma
Dawn Pisturino
Abstract
Healthcare
ethics deal with life and death situations which involve every member of the
healthcare team. But the patient is at
the heart of healthcare ethics, and the rights, safety, and well-being of the
patient must come first in all healthcare decisions. It is not up to healthcare personnel to
decide who will live and who will die.
Euthanasia and Healthcare Ethics:
An Ethical Dilemma
Every discipline has a code of ethics to
follow when it comes to making ethical decisions, and healthcare is no
exception. Ethics in healthcare is so
important, in fact, that most organizations have a process through which tough
ethical decisions, such as end-of-life decisions, can be made.
The Hippocratic Oath
and Modern Healthcare Ethics
The origin of healthcare ethics dates
back to the Hippocratic School of 200 B.C. (Geppert & Roberts, 2008). Hippocrates devised the Oath of the
Hippocratic School, which includes confidentiality, nonmaleficence, and
beneficence (Geppert & Roberts, 2008).
Since then, technology has forced changes in healthcare ethics, adding
principles of autonomy, respect for persons, compassion, privacy, and honesty
(Geppert & Roberts, 2008). Most of
these principles can be applied to end-of-life issues.
The End-of-Life
Debate
The end-of-life debate
has been fueled by the preponderance of chronic disease in modern society,
quality of life issues, and the soaring cost of healthcare. In most countries around the world,
euthanasia and patient-assisted suicide are illegal. Hippocrates himself said, “I will neither
give a deadly drug to anybody if asked for it, nor will I make a suggestion to
this effect” (Doukas, 1995).
Dr. Jack Kevorkian
In 1999, Dr. Jack Kevorkian
was found guilty of second-degree murder by a Michigan jury in the death of
Thomas Youk (Charatan, 1999). Dr.
Kevorkian had administered a lethal dose of
medication
to Youk, who was suffering from ALS (amyotrophic lateral sclerosis). He could not prove that Youk had asked him to
end his life.
The Hemlock Society, a proponent of
physician-assisted suicide, condemned the verdict (Charatan, 1999). But many organizations devoted to disability
rights applauded Dr. Kevorkian’s conviction, claiming that euthanasia is a
threat to people with disabilities (Charatan, 1999). The American Medical Association issued a
statement by Dr. Nancy W. Dickey, who was president at the time: “Patients in
America can be relieved that the guilty verdict against Dr. Jack Kevorkian
helps protect them from those who would take their lives prematurely”
(Charatan, 1999).
John Roberts, North American editor of
the British Medical Journal, labeled
Dr. Jack Kevorkian “a medical hero.” He
considered Kevorkian an honest man who was acting according to his personal
moral principles (Roberts & Kjellstrand, 1996). Still, most physicians want to be perceived
by the public as healers – not death dealers (Doukas, 1995).
Dutch Euthanasia Act
In 2002, the
Netherlands passed the Dutch Euthanasia Act, sparking a world-wide debate on
end-of-life issues (Van der Heide, 2007).
Euthanasia, as defined in the
Netherlands, is “death resulting from medication that is administered by a
physician with the explicit request of the patient” (Van der Heide, 2007). In physician-assisted suicide, the physician
prescribes the medication and the patient administers it himself, leading to
death. In both cases, the physician is
legally protected by the Dutch Euthanasia Act for ending life “at the request
of a patient who was suffering unbearably without hope of relief” (Van der Heide, 2007).
Before making a decision, physicians are
required to discuss euthanasia and physician-assisted suicide with the
terminally-ill patient and his relatives.
If there is any question about the ethical nature of the decision,
physicians may discuss the matter with colleagues. In 2005, in the Netherlands, 73.9% of all
patient-requested deaths were the result of neuromuscular relaxants or
barbituates; 16.2% were the result of opioids (Van der Heide, 2007).
Ethical Dilemma Case
Example
Physicians are not the
only healthcare workers faced with ethical dilemmas. Nurses also find themselves in situations
where they must apply ethical principles.
The Charge Nurse at a local hospital
wanted to open up a patient bed in order to admit a patient from the emergency
room. She asked this author – the
patient’s nurse – to give a dose of intravenous morphine to a patient who was
dying of end-stage kidney disease.
Legally, the patient was a “Do Not Resuscitate.” The family was at the bedside.
“Ethical dilemmas often provoke powerful
emotions and strong personal opinions; however, emotions and opinions alone are
not a satisfactory way of resolving ethical dilemmas” (Lo, 2013). Faced with an ethical dilemma of tantamount
importance, this nurse had only a short time in which to make the right
decision.
The first thing to consider was the law and the legal ramifications of any decision made in this situation (Pojman
& Fieser, 2017). How would the
decision affect the Charge Nurse and the patient’s nurse? Would we be held legally liable if the
patient died after receiving an extra dose of morphine? Would we lose our nursing licenses? Would the family sue? Would we lose our jobs? Euthanasia in Arizona is against the law.
Secondly, would the patient want to be
given an extra dose of morphine? A “Do
Not Resuscitate” status merely indicates that the patient does not want to be
revived if the heart stops beating or respirations cease. It is not a request for euthanasia. Would it violate the patient’s personal or
religious beliefs to administer an extra dose of morphine? Would it violate her core ethics? Would it take away her right of self-determination and autonomy (Pojman & Fieser,
2017)?
Thirdly, to go into the patient’s room
and administer an injection of morphine without just cause would violate the culture and ethics of the hospital,
the doctor, and most of the nursing staff (Pojman & Fieser, 2017). It would look suspicious to the family. They would question what this nurse was
doing. It would place this nurse in an
uncomfortable situation.
The ethical dilemma posed here is this:
should the patient’s nurse do what the Charge Nurse requested or refuse? In order to make a rational and ethical
decision, the patient’s nurse must first analyze the situation. According to Pojman and Fieser, “most ethical
analysis falls into one or more of the following domains: (1) action, (2)
consequences, (3) character traits, and (4) motives.”
Action
Giving the patient an extra dose of
morphine would be the right action if the patient was in pain and wanted the
medication. It would be the right action
if the patient seemed uncomfortable and the patient’s family requested it. It would not be an obligatory act if it was
too soon to give the medication or if the patient did not need it at that
time. It would be considered an optional
act, based on the nurse’s professional judgment and opinion. On the other hand, it would be a wrong
action to give the morphine if the patient did not need it or the patient’s
family did not want it given. If
euthanasia were legal and the physician was at the bedside and requested the
patient’s nurse to draw up the medication, it would be considered a
supererogatory act if the physician administered it to the patient. He would be ending the patient’s
suffering. The nurse would be involved
in a legal and compassionate act.
Consequences
If the patient was in pain and needed
the medication, giving the morphine would be the right action because it eased
the patient’s pain. If the patient died
as a result, there would be no legal or professional consequences because there
is no way to predict if that particular injection will cause the patient to
stop breathing. The morphine was given
according to medical guidelines ordered by the physician. If the patient was not in pain and the extra
injection of morphine caused the patient to stop breathing, it could raise
ethical and legal issues for the nurse who administered the medication. Those issues would most likely be raised by
the family, if they were concerned.
Character Traits
The Charge Nurse was more concerned
about opening up a patient bed than respecting the rights of the patient who
was dying. It seems callous, malevolent,
and unfeeling. The patient’s nurse must
examine her own feelings and attitudes and decide if the Charge Nurse was right
or wrong in her request.
Motive
The motive of the
Charge Nurse was clearly to give in to pressure from the emergency room to
admit a patient. She showed no concern
whatsoever for the patient who was dying.
She had no respect for the patient’s rights and autonomy – or for the
patient’s family.
The nurse’s motive should be to protect the rights and safety of her patient. She is the patient’s advocate. If she gives in to pressure from the Charge Nurse,
she will fail in her duty to her patient.
Even if she believes that euthanasia is a moral act, neither she nor the
physician has informed consent from the patient or the family.
What Happened
The patient’s nurse
evaluated the motives of the Charge Nurse, felt disgusted, and went into the
patient’s room to check on her condition.
She was resting quietly with her eyes closed, and the nurse saw no
evidence of pain or discomfort. When the
nurse asked the patient’s family if they wanted the patient to receive a
morphine injection for pain, they agreed with the nurse that the patient was
resting quietly and did not need it.
Relieved, the patient’s nurse reported all of this to the Charge Nurse. As a parting shot she added, “And I’m not Dr.
Kevorkian!”
Conclusion
Patients and their
families have the final say in what happens to terminally-ill patients. It is not up to healthcare personnel to make
decisions about end-of-life care for a patient.
This will be particularly true if euthanasia and patient-assisted
suicide ever become legal on a widespread scale. The medical community, in line with its own
ethical principles, must respect the right of self-determination and autonomy
of terminally-ill patients.
References
Charatan,
Fred. (1999). Dr. Kevorkian found guilty of second degree murder. British medical
journal,
318(7189), 962. Retrieved from
Doukas,
D.J., Waterhouse, D., Gorenflo, D.W., Seid, J. (1995). Attitudes and behaviors
on
physician-assisted death: A study of
Michigan oncologists. Journal of Clinical
Oncology,
13(5), 1055-1061
Geppert,
M.A., & Roberts, L.W. (Ed.) (2008). Book
of ethics. Center City, MN: Hazelden
Foundation
Lo,
Bernard. (2013). Resolving ethical
dilemmas: A guide for clinicians. Philadelphia, PA:
Lippincott, Williams and Wilkins
Pojman,
L.P., & Fieser, J. (2017). Ethics:
Discovering right and wrong. Boston, MA:
Cengage Learning
Roberts,
J., & Kjellstrand, C. (1996). Jack Kevorkian: a medical hero. BMJ: British
Medical Journal,
312(7044), 1434
Van
der Heide, A., Onwuteaka-Philipsen, B.D., Rurup, M.L., Buitina, H.M., van
Delden, J.M.,
Hanssen-de Wolf, J.E., . . . van der
Wal, G. (2007). End-of-life practices in the Netherlands
under the euthanasia act. New England Journal of Medicine, 356
(19), 1957-1965.
Dawn Pisturino
April 2017
Ethics 151
Mohave Community College
Kingman, Arizona
Copyright 2017 Dawn Pisturino. All Rights Reserved.
(The formatting for this paper did not come out quite right online. My apologies.)
