Euthanasia and Ethical Implications Thereof Euthanasia according to the medical dictionary is the act or practice of killing hopelessly sick or injured individuals in a relatively painless way for reasons of mercy and/or allowing said person to die by taking less than complete medical measures to prolong life. This type of act is also known as mercy killing or assisted suicide. Individuals who have reached the point when they feel they have no other options have often chosen to look into euthanasia as a way out. Families who see their loved one suffering have approached heath care professionals to act on their behalf and end the pain by euthanizing them. Each instance creates an ethical dilemma for the individual, the health care provider, the family, and other loved ones.
Nursing Obligations
According to the American Nurses Association (ANA), Nurses are not expected to participate in active euthanasia, as this violates the nurses’ code of ethics. As nurses we have the obligation to provide timely, humane, comprehensive, and compassionate end-of-life care (ANA, 1985). The code for nurses affirms that respect for persons “extends to all who require the services of the nurse for the promotion of health, the prevention of illness, the restoration of health, the alleviation of suffering and provision of supportive care of the dying. The nurse does not act deliberately to terminate life of any person” (ANA, 1985).
However, ANA recognizes the patients’ right to self-determination, every patient has the legal and moral right to make decision of what will be done with their own person, including the choice of no treatment, to accept, refuse or terminate treatment without deceit, undue influence, duress, coercion or penalty and to be given necessary support throughout the decision-making of treatment process (ANA, Code of Ethics. Pg. 4). Looking at two scenarios presented in our case study, the patient has every right to make decision of what he wants and this autonomy should be respected.
The obligation of the nurse has been to promote, preserve and protect human life and this role has never changed. The nurse participation in active euthanasia does not refute this obligation. The nurse is expected to provide proper and ethically justified end-of-life care which includes promotion of comfort and alleviation of suffering, adequate pain control, and sometimes foregoing life sustaining treatment.
Applied Laws
Both the Dax Cowart and Terri Schiavo cases dealt with various laws and principles that were highly controversial due to their ethical consequences. In Cowart’s case, the ethical principle of patients’ right to autonomy is notably disregarded. Although healthcare providers’ stated that Cowart had full decision-making capability, they upheld the consent of his mother who was not even his selected legal guardian. Furthermore, he underwent a copious amount of pain throughout the burn recovery process. Respect for autonomy indicates that patients have the right to self-determination in most scenarios. Cowart not only suffered during the recovery stages but his voice was also considerably ignored despite the numerous times he vocally refused to carry on with treatments. Likewise, in the debatable cases of Schiavo, many local and national branches of government were greatly involved in the matter. After her husband requested a change in law, the Florida legislature approved the removal of feeding tubes when patients were in a permanent vegetative state (PVS), or any other terminal illness (Bishop, 2008, pg. 544). Judge George Greer of a Florida circuit court ordered to remove her feeding tube but was invalidated with the Governor of Florida, Jeb Bush’s, passing of Terri’s Law. Many claimed that the law eliminated Schiavo’s right to privacy and confidentiality. Congress passed the highly criticized Palm Sunday Compromise which allowed her parents to bring the case to federal courts. However, the Supreme Court did not end up granting certiorari and the case was not reviewed. Overall, after her death, various bills were passed in many states that prohibited the removal of feeding tubes without prior written consent from incompetent patients. These two cases brought awareness for patients’ right and autonomy into national consideration.
Obvious Stakeholders
The Terri Schiavo case presented itself essentially as a black and white issue which turned out to be not so black and white. “Evidence suggests that recovery from PVS after 3 months in nontraumatic brain injury is rare and recovery after 12 months in traumatic brain injury is seldom encountered” (Racine, Amaram, Seidler, Karczewska, & Illes, 2008, p. 1031). This led to the decision to withhold feedings as per her wishes by her husband Michael Schiavo. There were the obvious stakeholders in this public tug-o-war which were her aforementioned husband and opposing him, Terri’s mother and father, Robert and Mary Schindler.
Not So Obvious Stakeholders It is arguably important for the reader to know that Terri suffered from bulimia and this fact had contributed to her health issue. People suffering from bulimia could benefit from Terri’s story and possibly improve their conditions. The activists that stood outside the hospital and the courts also had a stake in this matter. As conditions worsened Florida’s sixth circuit courts were involved and had a stake to make the right decision. The Supreme Court said that “the administration of artificial nutrition and hydration without consent is and intrusion of personal liberty” (Casarett, Kapo, & Kaplan, 2005, p. 2607). Pro-Choice and Pro-Life activists were up in arms about this issue and would argue ad nausea about this issue. Even major public figures such as Ralph Nader, Rev. Jesse Jackson, and republican senator Jose Serrano made statements to save Terri’s life. The Catholic Church became involved with pleas from Pope Jean Paul II to spare Terri’s life. Lastly this made the American public a stakeholder in the sense that living wills are now a part of our everyday considerations when entering a hospital.
Summary of Values, Morals, and Norms
The opinions of society are viewed in many ways. Each individual has their own social value, moral upholding, and general norms. In the nursing practice it really is not much different. Nurses are just part of the human race that happens to look after other’s well-being. Nurses must put aside their own beliefs daily to act in best interest of their patients and abide by their wishes to the best of their ability while making sure they are safe and well cared for.
In the matter of euthanasia, the ethical implications can come at very high moral consideration for anyone in the health care practice. Euthanasia is a Greek work which means a “good death” (vanBogart, Biko & Ogunbanjo, 2010). When we look at cases such as the Dax Cowart, here is a man who repeatedly begged to die whether it was by being shot by a ranger, killed by paramedics, his own failed suicide of throwing himself down stairs at the hospital, or hoping to die from sepsis of his own burn infections, this man did not want treatment but was given it against his will (vanBogart, Biko & Ogunbanjo, 2010). While euthanasia may be looked upon as morally wrong, it can be seen as morally wrong to repeatedly treat someone against their will. There is also the case of Terri Schiavo, a young woman who had suffered from respiratory arrest, cardiac arrest, was in a coma for 10 weeks, was being keep alive only by tools of modern medicine, had no living will, and after three years was diagnosed as being in PVS. Her husband, who was in control of her health matters, was in a long legal battle with her parents to end medical interventions and let her die naturally (Bioethics, 2010). While no one knows honestly what they would do in this situation unless they are actually faced with it head-on, it seems morally just to let someone go who has no quality of life.
By definition, ethical behavior is the moral principles or values based on concepts of good or bad (Bioethics, 2010). Taking this into consideration, everyone acting on behalf of the patients in two aforementioned cases was in fact acting in an ethical fashion. The actions were value based and in good intention. There was no malice at any time intended for either Dax or Terri. This now presents the question, is euthanasia right or wrong? That still remains to be seen. As individuals we still have our own opinions and views on topics such as these.

Conclusion The cases of Dax and Terri are truly representative of the various outcomes of tragic circumstances and the ethical indications presented. In both cases, there were various conspicuous stakeholders and more ambiguous components. Moreover, as nurses, many morals and values are tested during end-of-life cases. Our obligations will indicate our behavior towards practices of euthanasia. However, all situations are highly different in stakeholders, individuals, and overall values so we must assess each case appropriately.

References
American Nurses Association (1985). Code for Nurses with Interpretive Statements. Kansas City, MO: The Author.
American Nurses Association; code of ethics retrieved from http://nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/EthicsStandard/CodeofEthics.aspx
Bioethics, euthanasia, and physician-assisted suicide. (2010). Chapter 5. Jones and Bartlett Publishers. Retrieved from http://www.jblearning.com/samples/0763743267/43267_CH05_Pass1.pdf
Bishop, J. (2008). Biopolitics, terri schiavo, and the sovereign subject of death. Journal of Medicine & Philosophy, 33(6), 538-557.
Casarett, D., Kapo, J., & Kaplan, A. (2005, December 15). Appropriate use of artificial nutrition and hydration - fundamental principles and recommendations. The New England Journal of Medicine, 353, 2607 - 2612. Retrieved from http://www.hadassah-med.com/media/1884450/sounding_board-1.pdf
Racine, E., Amaram, R., Seidler, M., Karczewska, M., & Illes, J. (2008, September 23). Media coverage of the persistent vegetative state and end-of-life decision making. Neurology, 71, 1027 - 1032. http://dx.doi.org/10.1212/01.wnl.0000320507.64683.ee van Bogart, D. K., Biko, S., & Ogunbanjo, G. A. (2010). Assistance in dying: Dax's case and other reflections on this issue. S.A. Family Practice (Supplement 1), 52(6), S19-S23. Retrieved from http://www.che.org/members/ethics/docs/2666/Dax Cowart.pdf