Ethical Dilemma Debate_ Assisted Suicide

7/23/2019 Ethical Dilemma Debate_ Assisted Suicide

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NURS 362 - FALL 2015

Group Members: Elizabeth, Charleen, Tomi, Darren & Young-jin

ETHICAL DILEMMA DEBAT

Topic: A Nurse’s Ro Assisted Suicide



Would you participat

Assisted Suicide?



How can an ethical nurse, dedicat

healing, participate in an act that pu

ends a patient’s life?



“Goodbye to all my dear friends and family that I love. To

day I have chosen to pass away with dignity in the face o

terminal illness, this terrible brain cancer that has taken

from me … but would have taken so much more.”

Brittany Maynard, as promised, ends her li

DX: Stage 4 Malignant Brain tumor→ Terminally ill



SYNOPSIS OF THE ISSUthe issue

The ethical dilemma of assisted suicide revolves ar

conflict between the patient’s right to autonomy

nurse’s ethical duty to the principles of benefice

nonmaleficence.



The American Nurses Association (ANA) believes that the nurse should not

assisted suicide. Such an act is in violation of the Code for Nurses with Interpret

(Code for Nurses) and the ethical traditions of the profession.

Nurses, individually and collectively, have an obligation to provide compre

compassionate end-of-life care which includes the promotion of comfort and t

and at times, forgoing life-sustaining treatments

At times, it may be difficult to find a balance between the preservation of

facilitation of a dignified death. Nurses need to recognize their own feelings (f

and the effect these agonizing tensions may have on a nurse. They may consid

hastening a patient's death as a humane and compassionate response, yet t

goals and values of the profession mitigate against it.

SYNOPSIS OF THE ISSUthe issue (continued)



SYNOPSIS OF THE ISSUethical principles violated with assisted suicide...

LEAST HARM● The profession of nursing is built upon the Hippocratic tradition "do no harm" and aopposition to killing another human being.

● The ethical framework of the profession as explained through the Code for Nurses exdeliberately terminating the life of any human being.

BENEFICENCE● By "doing good" is it found in the practice of medicine where the health of an individual is b

treatment from a physician or nurse.

● This principle is also related to the principle of utility, which states that we should attempt largest ratio of good over evil possible in the world.

○ The theory of Utility supports what is best for most people. The value of the act is determiwith the main emphasis on the outcome or consequences. This theory examines what creathappiness for the most people.



ETHICAL ANALYSISethical principles supporting assisted suicide

AUTONOMY/ADVOCACY● The principle of respect for a person and his/her decisions even th

decisions may create risks to his/her health.

● Patients have right to die or choose the methods of their death.

BENEFICENCE

● The principle of promoting goodness, kindness, and charity.

● Assisted suicide will help patients end suffering from excruciating pa

dignity.



SYNOPSIS OF THE ISSUcourses of action alternative to Assisted Suicide

● Nurses can become active, aggressive patient advocates fo

palliative care – even if the end result is a shorter life.○ Careful assessment and optimal symptom control and supportive care, the suffering of mos

threatening illnesses could be reduced sufficiently to eliminate their desire for hastened de

● Hospice, a philosophy of care that provides support for the

while allowing death with dignity.○ assist with medications

● Nurses must remain dedicated to caring for patients and de

promoting maximum health, even in the midst of a termina



There is a continuum of end-of-life choices that encompasses a broad spectrum of interv

but are not limited to:

-alleviation of suffering-adequate pain control-do-not-resuscitate orders-withdrawing/withholding artificially provided nutrition and hydration-requests for assisted suicide

Throughout this continuum nurses can respond to patients with compassion, faithfuln Yet, nurses must understand the subtleties and distinctions of these issues in order t

reasonable and ethically permissible manner.

SYNOPSIS OF THE ISSUcourses of action supporting Assisted Suicide



ETHICAL ANALYSISOther Complications

Pros Cons

Reduction of health care costs Family’s financial & emotional incsee patient to die

Family members better prepared foraccepting patient’s death

Potential creation of perverse incfor insurance providers

The save of vital organs. Patient’s wishhonored

Ambivalence in determining the dlife left and the level of suffering



ETHICAL ANALYSISRelevant Values

Christy O’Donnell is a 46-year-old single mother from Santa Clara, CA

diagnosed with a stage 4 lung cancer and have struggled with excrucia

to her intolerance to morphine. Her fight for the right to die has been b

national attention since a lawsuit was filed in July 2015 in CA by Comp

Choice, a nonprofit aid-in-dying group, for her and two other terminal

In her Youtube video, she stated, “The most fear I have is that my daug

me lying dead when she comes home.”

This month, the Gov. in CA, Jerry Brown, signed the “End of Life Optio

transforming Dr.-prescribed suicide into a medical treatment in CA.



ETHICAL ANALYSISRights

Patient Self-Determination Act of 1990. Patients have the right to:

● Participate in their own healthcare decisions

● Accept or refuse medical treatment

● Make advance health care directives

Self-Determination at End-of-Life, the “right-to-die”

Nurses serve as patient advocates and should respect the wishes of th

without bias



ETHICAL ANALYSISlaws

● PAS is legal in five U.S. states - mandated by state law in Oregon, Verm

Washington and California and by court ruling in Montana.● In Oregon, since the enactment in 1997, 895 patients have been assis

of 2015.

● California approved the bill in October, 2015.

● Around the world, Netherlands, Germany, Switzerland, Belgium, & Ja

●

Hawaii almost enacted legalization of Assisted Suicide similar to Oreg

Pt eligibility:

● 18 yrs or older

● Capable of making and communicating health care decision for own and mentally co

● Must have a terminal illness as well as a prognosis of six months or less to live.



ETHICAL ANALYSISlaws

Physician protocol:

● If physician determines that the pt’s judgment is impaired, the pt mus

for a psychological examination.

● The physician must inform the pt of alternative, including palliative ca

pain management options.

Pt request timeline:

● First oral request to physician

● 15 day waiting period

● Second oral request to physician

● Written request to physician



Oregon Nurses Association assisted suicide guidelines



ETHICAL DECISION MAKIprocess

According to Cherry & Jacob, “theories provide a cognitive plan for co

ethical issues; principles offer guiding truths on which to base the ethi

ETHICAL DECISION MAKING MODEL

1. Identify the ethical issues and

problems.2. Identify and analyze available

alternatives for action.

3. Select one alternative.

4. Justify the selection.



ETHICAL DECISION MAKING

1. Identify the ethical issues and problems.

How can a nurse dedicated in healing, participate in an act that purposely ends a patient’s life? Should physician as

allowed?

2. Identify & analyze available alternatives for action. (Questions to think about

- What are the possibilities for action, and how do the different affected parties (patient, family, MD, and nur

problem?

- What ethical principles are needed for each alternative?

- What is needed for each alternative, and what are their implications for future action?

- Are there any additional ethical problems that the alternatives raise?

On one hand there is the patient’s rights to autonomy and on the other hand the nurse’s ethical duty to the principles of nonm

and beneficence (doing good).

Found in the code of ethics for nurses from the ANA: “nursing care is directed toward meeting the comprehensive needs of pa

across the continuum of care. This is particularly vital in the care of patients and families at the end-of-life to prevent and reliev

symptoms and suffering that are commonly associated with dying...Nurses may not act with the sole intent of ending a patient’

action may be motivated by compassion, respect for patient autonomy and quality of life considerations”




3. Selective one alternative.

Together the decision maker’s and profession’s v

of others to come up with a purposeful and reaso

- According to ANA, there is palative sedatio

intent of palliative and hospice care is to re

suffering through effective symptom mana

to enhance the patient’s quality of life and s

and families in the dying process”.

- Palliative sedation is the controlled and mo

non-opioid medications intended to lower t

of consciousness to the extent necessary, fo

unendurable symptoms



ETHICAL DECISION MAKI4. Justify the selection.

Here the rational justification for which the decision was based is shared to justify the dec

Questions to assess the pt’s request for dying:

1. What reason does the patient give for the request?

2. Does the patient view suicide as the only option?

3. What is the social, cultural, and religious context?

These questions assist nurses in better understanding the meaning of these requests and h

with the emotional suffering that may accompany this burden.




REFERENCES



REFERENCESAmerican Nurses Association (2015). Short Definitions of Ethical Principles and Theories Familiar words, what do they mean?

//www.nursingworld.org/MainMenuCategories/EthicsStandards/Resources/Ethics-Definitions.pdf

American Nursing Association (2015). ANA Position Statement: Assisted Suicide. Retrieved from http://www.nursingworld.

org/mainmenucategories/ethicsstandards/ethics-position-statements/prtetsuic14456.html

American Public Health Association (2008). Patients’ rights to self-determination at the end of life. Retrieved from

https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/29/13/28/patients-righ

the-end-of-life

Anderson, Ryan T. (2015). Always care, never kill: how physician-assisted suicide endangers the weak, corrupts medicine, c

and violates human dignity and equality. Retrieved from http://report.heritage.org/bg3004

Cherry, B. (2014). Contemporary nursing: Issues, trends, & management (6th ed.). St. Louis, Mo.: Elsevier.

CNN. (2015). Physician-assisted suicide fast facts. Retrieved from www.cnn.com/2014/11/26/us/physician-assisted-suicide-f

Death with Dignity National Center. (2015). Death with dignity around the U.S. Retrieved from www.deathwithdignity.org/adv

Dyer, Dale E. (1999). Assisted Suicide. Retrieved from http://www.juns.nursing.arizona.edu/Dyer.htm

REFERENCES

http://www.juns.nursing.arizona.edu/Dyer.htm


http://www.cnn.com/2014/11/26/us/physician-assisted-suicide-fast-facts/


https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/29/13/28/patients-rights-to-self-determination-at-the-end-of-life

http://www.nursingworld.org/mainmenucategories/ethicsstandards/ethics-position-statements/prtetsuic14456.html

http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Resources/Ethics-Definitions.pdf


http://www.deathwithdignity.org/advocates/national


http://report.heritage.org/bg3004





http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Resources/Ethics-Definitions.pdf



Ersek, M. (2004). The continuing challenge of assisted death. Journal of Hospice and Palliative Nursing. Retreived from http://wwcom/viewarticle/468566_5

Euthanasia, Assisted Suicide, and Aid in Dying. (2013, April 24). Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements/Euthanasia-Assisted-Suicide-and-Aid-in-Dying.pdf

Lachman, Vicki. (March/April, 2010). Medsurg nursing. Physician-assisted suicide: Compassionate liberation or murder? Vol.19/Nonursingworld.org/MaintainCategories/EthicsStandards/End-of-Life/Physician

Slosar, J. (2004, February). Ethical Decisions in Health Care. Retrieved from https://www.chausa.org/publications/health-profebruary-2004/ethical-decisions-in-health-care

Tucker, Kathryn (2014). End‐of ‐life law and policy in hawaii aid in dying. Retrieved from https://www.compassionandchoices.orLaw-and-Policy-in-Hawaii-Aid-in-Dying.pdf

University of Washington School of Medicine. (2013). Physician aid-in-dying. Retrieved from https://depts.washington.edu/bi

REFERENCES

http://www.nursingworld.org/MaintainCategories/EthicsStandards/End-of-Life/Physician

https://depts.washington.edu/bioethx/topics/pad.html

https://www.compassionandchoices.org/userfiles/End-of-Life-Law-and-Policy-in-Hawaii-Aid-in-Dying.pdf

https://www.compassionandchoices.org/userfiles/End-of-Life-Law-and-Policy-in-Hawaii-Aid-in-Dying.pdf

http://www.nursingworld.org/MaintainCategories/EthicsStandards/End-of-Life/Physician

http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements/Euthanasia-Assisted-Suicide-and-Aid-in-Dying.pdf

http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements/Euthanasia-Assisted-Suicide-and-Aid-in-Dying.pdf

http://www.medscape.com/viewarticle/468566_5

http://www.medscape.com/viewarticle/468566_5

Ethical Dilemma Debate_ Assisted Suicide

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