Assisted Suicide

Yusuf J. Shalah

HSA 515
Dr. James Coon

1. Explain how the Patient Bill of Rights applies to the situation. With regards to this situation, the Patient’s Bill of Rights was established to contribute to more effective patient care, and to ensure that care is considerate and respectful, and more importantly, to ensure a health care ethic that extends that respect to a patient’s role in decision-making about treatment choices and other aspects of their care. “These rights can be exercised on the patient’s behalf by a designated surrogate or proxy decision maker if the patient if the patient lacks decision making capacity, is legally incompetent or is a minor.”(Aha, 1993) Mrs. Jones, in our scenario, is a patient evidently suffering from a terminal illness possibly in its latter stages, or possibly a fresh diagnosis. In either situation, from the information provided Mrs. Jones has made no declaration, or request, agreement to receiving an extra dose of a narcotic which could potentially end her life. Thus, Nancy nurses’ decision to administer this extra dose is not only capable of killing her, but is also premeditated. There is no consideration to her wishes, those of her family, and a blatant disregard of any other health professionals involved. If you are to be justified in helping someone to die (assisted suicide), the person you are going to ‘help’ must have made it clear that they want to be killed. “A unilateral decision that is in someone else’s best interests that they stop living cannot provide acceptable grounds for killing them, if it did, murder would cease to be a crime.” (Palmer, 2010) Yet, in our scenario, that is actually the case, the decision made by Nancy Nurse that Mrs. Jones’ life was one not worth living….and as far as she was concerned and thus, would take it upon herself to end it. I cannot say that Nancy Nurse, in this situation, did not act out of sympathy and compassion, or that she believed that she was doing what Mrs. Jones wanted. But the central issue, which is that the law must not license the killing of people by health professionals, family, or friends simply because they ‘think the individual will be better off dead.’ To avoid confusion, it is important to b clear about what we mean by the term ‘euthanasia’. Etymologically, it means “good death”. In terms of it’s relevancy to the Patient Bill of Rights, it could very well mean any medical act intended to end a patient’s life at his or her persistent, carefully considered and voluntary request in order to relieve unbearable suffering. Voluntary and active provided for in the patient bill of rights, which spells out guidelines relating to the achievement of these rights such as; to be truthfully and comprehensively informed about one’s condition; to consult other Doctors; not to be treated against one’s will, protected from undue pressure; to have one’s wishes as to specific treatment taken into account as far as possible; and to have one’s right to life respected.

2. Identify and explain at least three ethical considerations.
Assisted suicide raises a number of ethical considerations for nurses. It can be difficult for today’s nurses to determine which course of action is most ethical when it comes to matters of patient autonomy, quality of life, and the medical definition of death. No other issue raises more ethical or practical questions about the role of the nurse in treating patients than assisted suicide. The three ethical issues raised by the concept of assisted suicide include patient autonomy, quality of life, and what it means to act in the patient’s best interest. It is important to think about what we mean by “patient autonomy” and what limits can and should be placed upon it? Does patient autonomy include a “right to die”? It is well accepted, that a patient has a right to reject medical treatment even when the patient’s Dr. or nurse believes the treatment is in his or her best interest. In such a case, withholding treatment at the patient’s request is not considered “assisted suicide” but rather a gesture of respect towards the dignity and free-will of the patient. However, according to most medical boards, the duty to provide care to a patient does not encompass a duty to comply with a patient’s request to be put to death, nor does it provide for a nurse or other healthcare professional, like Nancy Nurse in our scenario, to take it upon themselves to hasten a patient’s death, no matter how hopeless the patient’s condition appears or how intense the patient’s pain. In order to honor a patient’s autonomy, nurses and other medical professionals must be sure that a patient’s choices are informed and not a product of pressure or coercion. An important consideration is quality of life. At what point does life cease to have “quality”? And, who should decide how much “quality’ a particular patient’s life has? It is within a nurse’s ethical prerogative to administer palliative are that may incidently hasten death, he or she is forbidden under the Code of Ethics from “acting with sole intent of ending a patient’s life even though such action may be motivated by compassion, respect for a patient’s autonomy and motivated by compassion, respect for a patient’s autonomy and quality of life considerations. (American Nurses Association Code of Ethics, 2001)

3. Identify and explain t least three legal considerations.
As long as notions of life-taking without consent are simplistically thought to be only associated with some degree of malicious intent, it can be considered insulting to suggest that non-voluntary euthanasia might be practical if voluntary euthanasia were legally permitted. Especially if such a suggestion thought to reflect adversely on doctors, while they are often enticed on other grounds, are not generally thought to be unprincipled or malicious. But when the actual motivation for non-voluntary euthanasia, in its practitioner’s estimation, is that it is an act of kindness, the risk to the lives of some of the more vulnerable in society then becomes more apparent.”(Pijnenborg, Delden, Looman, 1993) First, throughout the United States, it remains illegal under most circumstances for a medical professional, whether physician or nurse, to assist in the suicide of a patient, even if the patient has a terminal illness, is suffering pain, and specifically requests the assistance. A nurse who participates in an assisted suicide can face severe legal consequences, including prosecution for murder. Secondly, today, many courts make no distinction between palliative care that hastens death and action taken for the purpose of actively ending a patient’s life. Thus, it is chance for nurses and other health professionals to face adverse legal consequences when they act in accordance with their ethical obligations to ease the suffering of the terminally ill. Third consideration involves informed consent. Informed is defined as a legal requirement to disclose information to a patient about his condition, a patient’s options, and the probable consequences of his decisions about them. Consent can be a voluntary agreement, require sufficient mentality to make intelligent choices about an action proposed by another person in relation to medication or treatment procedures. In our scenario, Nurse Nancy was not concerned with consent informed or otherwise. Her only interest lied in relieving the patient from her debilitating condition, which she felt no input from the patient was necessary. 4. Identify and explain at least 3 business considerations.
The hospital’s reputation will be affected which may cause a reduction in revenue because patients will not feel safe and will be concerned about patient autonomy and decision making powers. A hospital owes a legal duty directly to the patient and this duty is not delegable to the medical staff or other personnel. They are obligated to act within the best interest of the client. Another consideration is that a certain service is not given or that someone performed a service or treatment in a way that did not meet the standard of care that in accordance with his or her training. Another business consideration, involves a nurse not performing a duty or procedure in a manner that meets the reasonable standard of care and the patient is in a position to suffer harm or even death as a result of her action. The law requires healthcare providers disclose all risk and hazards associated with medical procedures that could influence reasonable people to consent to procedures. Ensuring that healthcare providers uphold the informed consent principle is also important in avoiding liability and malpractice claims. “If a hospital is to protect itself from liability for treatment without consent, the hospital must at minimum have policies and procedures relating to documentation of consent.” (Showalter, 2007) A final business consideration involves the hospital providing a base of understanding and respecting the right and responsibility of patients, their families, and; respecting the role of patients in decision making about treatment choices and other care. All of these activities should be conducting with the values and dignity of patients. 5. Explain what the manager should do in the situation and why?
As a manager, I would have to look at the situation in light of the actual facts. Thus, one must ascertain the actual behavior that Nancy Nurse is promising. Assisted suicide/euthanasia, which is defined as, “the deliberate act undertaken by one person with the intention of ending the life of another person in order to relieve that person’s suffering where that act is the cause of death”. (Senate of Canada, 1995). In this case, non-voluntary euthanasia is done without the knowledge or the wishes of the patient. Therefore, Nancy Nurse is contemplating what is actually considered murder or homicide. Every day, nurses or doctors use quality of life arguments to decide why they should or should not pursue a treatment or a remedy in a different case. It is much easier and cheaper to do nothing for a patient, than to carefully palliate a condition providing adequate pain control and comfort measures without shortening the life of a patient. True compassion leads to sharing another’s pain; it does not kill the person whose suffering we cannot bear. Moreover, the act of euthanasia appears all the more perverse if it is carried out by those who by virtue of their specific profession, as Nurse Nancy in our scenario; are suppose to care for the sick person even in the most painful stages or circumstances. I would say her actions speak homicide, not just malpractice or negligence. She intentionally wants to cause death to a patient, betraying the trust of her patient, her family, and betraying the noble mission of the profession “to cure if possible, always to care.” She would have broken away from the ethical standards set by the Hippocratic Oath. Nancy Nurse must be reported and confronted before her plan is put into action. It would be my responsibility and duty in this position, given the situation.

References 1. Showalter, J. S. (2007) The Law of Healthcare Administration. (5th Ed.) Chicago: Health Administration Press. 2. aha.org/resource/pbillofrights.html 3. telegraph.com.uk/commentk0627h/mercy killing without consent 4.