Sedation verses Euthanasia
The ethical principle of non-malefiecense is the duty to do no harm. This is promoted by doing three interventions. First intervention is avoiding deliberate harm, risk of harm that occurs during the performance of nursing actions. The second intervention is considering the degree of risk permissible. The third intervention is determining whether the use of technological advances provides benefits that outweigh the risks.
The ethical principle of beneficence is the doing or active promotion of good. This is done by providing health benefits to the patients, balancing the benefits and risks of harm, and considering how a patient can be best helped. The ethical principle of Justice is the promotion of equity or fairness in every situation a nurse encounters. The two nursing implications that promote justice are ensuring fair allocation of resources, and determining the order in which clients should be treated. ("Ethical Principles," January 2011, p. screen)

There are several nursing ethical arguments on Euthanasia. Those that are against mercy killing have the ethical arguments that euthanasia might not be promoting the patient’s best interest, accepting that it means acknowledging that some people are more important than others, weakening the society’s respect for the holiness of life, and arguing that if voluntary euthanasia were to become legal nationwide, then most probably involuntary euthanasia will be committed at a higher level. The ethical arguments for those in favor of euthanasia are people having a right to die, euthanasia causing no harm to others and the state, therefore people having no right to interfere with someone’s own decisions, once euthanasia can be legal and regulated by the state, then involuntary euthanasia can be monitored and prevented therefore allowing a terminally ill person to die, will free, alleviating the family of any financial burdens that the terminal illness may cause. ("Ethical Issues: Euthanasia," January 2011, p. screen)
Family members and caregivers should be educated about the implications of sedation and care associated with it. The patient typically loses their protective mechanisms with increased levels of sedation. Oral intake becomes a risk factor for aspiration. The patient should be provided with lubrication and moisture to oral mucous membranes in order to avoid dry moth and corneal irritation. Most family members or caregivers can be taught basic care and comfort measures. This offer is meaningful to the family members and aids in carrying out the wishes of the patient who wants to die at home. Family should also be informed of medication comfort measures to be taken and the patient’s likely hood of being in a deep sedated state towards the end of life. The family must be in acordance with the road to deep sedation as the illness overcomes the patient and death is near. Families of terminally ill patients play a valuable role as caregivers and must serve as formal and informal proxy decision makers.
Euthanasia is the intentional ending of life, by way of practice, in order to relieve pain and suffering quickly. It is considered to be a criminal homicide that is prosecutable by law in all but 3 states (Washington, Oregon, and Montana). (Wreen, 1988)
These ethical principles have provided a foundation for the nursing practice. They are defined as a basis for nurse’s decisions on consideration of consequences and of universal moral principles when making clinical judgments. The most fundamental of these principles is respect of person. According to the American Nurses Association, the most fundamental principle of professional behavior is the respect for persons. The principle not only applies to the clinical settings but to all life’s situations. The principle emphasizes that all people should treat one another as a worthy individual. In nursing practice, it is important that this principle should be simplified. Therefore, respect for persons generally means respecting a patient’s autonomy. The primary and basic ethical principles are respect for autonym, no maleficence, beneficence, and justice. Respecting a patient’s rights, values and choices are synonymous to respecting a person’s autonomy. A method that promotes and respects a person’s autonomy is an informed consent. A patient and family must be offered enough information and options to make up their mind free of coercion or external and internal influences in order for a patient and family to make an autonomous decision and action. ("Ethical Principles," January 2011, p. screen)
It is important for health care professionals to discover with families any reservations associated with the period of passing and any tradition or spiritual ceremonies that may be significant to them. Such ceremonies might include a specific way to place the body. The Islamic patient must have the head of the patient facing Mecca at the time of death. The orthodox religions practice mandates same-sex caregivers or family members wash the body. When loss occurs, manifestations of grief by those beside differ greatly, dictated in part by tradition and in part by their planning for the death. The family should be consulted with if they would like a Chaplain to be contacted for bereavement. One the family is ready the nurse is there to assist with making any important phone calls for the family which may include calling an estranged family member, or even the funeral home.( Higo,2012).
Several patients dread uncontrolled pain during the last days of life, while communicating apprehensions that opioid use may speed up death. The family and healthcare professional may likewise share this fear and should be openly discussed amongst all involved. Experience suggests that most patients can attain pain relief through the final hours of life and that very high does of opioids are rarely needed. Awareness may diminish throughout this time and swallowing becomes tough, practioners should anticipate substitutions to the oral route. Sublingual medications are the preferred route when the patient is no longer able to swallow.
Palliative care nursing focuses on comprehensive physical, emotional, psychological, and spiritual care of the terminally ill person and their families. It includes the administration and monitoring of medication, recognizing refractory symptoms, advising the healthcare team of those symptoms, affording psychosocial support and education to the patient and family, as well as identifying specific cultural needs in relation to dying and death. (Lawson, 2012)
The nurse’s role is vital in assessing and monitoring the patient receiving palliative sedation. The aim is to provide comfort and symptom control. For example, the assessment changes from merely monitoring respiratiory depression, to looking for signs of respiratory distress and hunger for air. The nurse must be advanced in assessing for nonverbal cues that are indicative of ongoing pain, unrelieved symptoms, or severity of suffering. These symptoms can be observed by way of facial expressions, body movements, or agitation. Consciousness should be monitored by way of eyelash reflex. A stroke across the eyelash, while closed, should cause a diminished flicker or reflex. Lack of response to the test indicates deep sedation, indicating a change in dose administration It is important that the palliative care nurse be will trained in these assessment tools to avoid crossing the line of sedation into the realm of euthanasia. (Lawson, 2012)
In conclusion, palliative sedation relieves the patient from suffering when a cure for their illness is not possible. As caregivers, we must look to provide support and meet the needs of the dying patient as well as their family. It is also important that we are aware of changes in the patient’s condition so that their needs are met throughout the dying process to facilitate ease and comfort, as well as ensuring that the adequate staff and resources are available to meet the needs of the dying patient. Be aware of cultural considerations and adequate family support, as this will also enhance quality of life that is associated with death at home. (Fields,2007).
As with euthanasia, it is important to be aware of all laws that are set into place whether they are the laws of society or faith-based laws. The patient who seeks end of life care should understand that the dying process is a deliberate process and not hasty. The healthcare provider should look for cues that may indicate possible euthanasia. Provide the patient and family with adequate information to make a decision regarding the decision for end of care life and ensure that the patient is not being forced to take sedative medication to end their life whether it’s in relation to their current illness, to relieve the family of burden or at the doctor’s request. In these instances, it is important to advocate for the patient and ensure that they are being treated with respect and that their rights are not being violated. In the end, the patient should die with comfort and dignity at their own will and not at the will of others. (Rady,2012)

References
Ethical Arguments of Euthanasia. (January 2011). Retrieved from www.nursingcrib.com
Ethical Principles. (January 2011). Retrieved from www.nursingcrib.com
Lawson, M. (2012, May 28). Palliative Sedation: Role of the Nurse. Clinical Journal of Oncology Nursing, 15(6). Retrieved from http://www.medscape.com/viewarticle/758639_4
Wreen, M. (1988). The Definition of Euthanasia. Philosophy and phenomenological research, 48, 637-640. Retrieved from http://dx.doi.org/10.2307/2108012
Rady, M., & Verheijde, J. (2012). Distress from voluntary refusal of food and fluids to hasten death: what is the role of continuous deep sedation?. Journal Of Medical Ethics, 38(8), 510-512.
J Med Ethics 2012;38:510-512 doi:10.1136/medethics-2011-100278
Fields, L. (2007). DNR does not mean no care... do not resuscitate. Journal Of Neuroscience Nursing, 39(5), 294-296.
Higo, M. (2012). Surviving Death-Anxieties in Liquid Modern Times: Examining Zygmunt Bauman's Cultural Theory of Death and Dying. Omega: Journal Of Death & Dying, 65(3), 221-238.
Chater, K., & Tsai, C. (2008). Palliative care in a multicultural society: a challenge for western ethics. Australian Journal Of Advanced Nursing, 26(2), 95-100.
Oberle, K., & Allen, M. (2006). Ethical considerations for nurses in clinical trials. Nursing Ethics, 13(2), 180-186. doi:10.1191/0969733006ne836oa