Should Nurses and Physicians Assist Patients Who Want to End their Lives?

Physician-assisted death (PAD) is an issue that has been in the public dialogue since the 1990s, and until this century, it is still an issue whose consensus has not been reached in the public domain. Various ethical questions surrounding the rights of terminally ill patients to end their lives have been raised and become prominent in numerous ethical health related literatures (Shara, Robert, Conroy, & Gardner, 2014). In the United States, PAD was illegalized by the Supreme Court ruling of 1997 which stated that individuals have no constitutional and fundamental right to physician-assisted suicide. Nevertheless, PAD is a legal activity today in a few of the States which includes the state of Oregon, and Colorado. Physician-assisted death (PAD) is defined as the lethal medication given by physicians to end the lives of terminally ill patients particularly under extreme pain and sufferings (Timothy, 2015). In some studies, PAD is described as an activity that involves a medical doctors counseling, and/or giving a remedy of a deadly drug to a terminally ill patient so that he or she can take his or her own life (Dresser, 2017).  Various prior literatures have reported that despite being illegalized, PAD was supported by large percentage of the United States citizens in 1997 but some relevant traditional institutions such as the United States Medical Association, and the United States medical ethics literature condemned it. Over the past decades, various significant assertions against and for PAD have remained outstandingly the same since the late 19th century (Gill, 2015). Most of the recent studies done on PAD have mainly been centered on the attitude of physicians towards PAD. While the findings of some of these studies support and recommends the legalization of PAD in the United States and across the world, the findings of other studies does not support its legalization(Tal et al.2013).

Although PAD opponents maintains that it is morally wrong for a physician or a nurse to take part in assisting terminally ill patients end their lives, but PAD has been argued to have extreme  benefits to the terminally ill patients as well as the physicians or nurses taking part in the act. One of the obvious benefits of ending the life of a terminally ill patient in extreme pain is that it ends the individual suffering. According to a study by Shara et al. 2014, one of the major roles of physicians in caring for terminally ill or dying patients is to reduce their sufferings. In situations where a patient is extremely suffering and healing is not possible, reduction of the suffering is the next course of action. Nevertheless, the duty to reduce suffering by the physician has some limitation of respect particularly if the patient is capable; the physician should reduce the suffering only by means that the patient permits (Incardona & Bean, 2016). Apart from termination of a patient’s sufferings and pain, PAD can potentially give patients with untreatable illness psychological comfort (Incardona & Bean, 2016). Based on the cancer statistics from the National Cancer Institute, in an estimate, over 1 million Americans were diagnosed with cancer in 2017. Over a half of this estimate died of cancer in the same year (NIH, 2018). Deaths resulting from cancerous diseases mostly occur under extreme pain and suffering since nearly all cancerous diseases have no medication or cure. If PAD is legalized, patients diagnosed with untreatable illness such as cancer will have psychological comfort knowing that there is an alternative way to die without undergoing extreme pain and sufferings (Incardona & Bean, 2016). Lastly, legalizing PAD gives terminally ill patients right to autonomy. In other words, this means that patients have the right to supervise their own destiny objectives particularly in terms of the manner and timing of their deaths (Gill, 2015).

Should Nurses and Physicians Assist Patients Who Want to End their Lives?
Should Nurses and Physicians Assist Patients Who Want to End their Lives?

Even though PAD has various benefits especially to the terminally ill patients, which if comprehensively examined, can qualify its legalization, but it has also various detrimental and harmful aspects particularly to the physicians or nurses as well as to the medical profession at large. Among the various harmful aspects of PAD, some of the critically harmful aspects include deflation of the medical profession integrity, leads to psychological distress and fretfulness to the family members of the deceased patients, and intimidation of terminally ill patients to consider using PAD against their desires (Timothy, 2015). To begin with, PAD can potentially demoralize the medical profession by dispiriting physicians to perform their duties of promoting health and reducing suffering to the dying patients. According to the findings a study by Tal et al. 2013 on the attitude of physicians towards PAD, most physicians were found to have a feeling of regret once they perform the act of PAD even with the consent of the patient. While some physicians can comfortably live with no regrets of having performed PAD and can perform it again under the same situation, a significant percentage have been found to regret performing PAD.  Although regrets does not indicate any harm to the medical profession, but the studies suggests that such feelings can have adverse psychological effects on the physician which can possibly interfere with their duty performance as physicians (Gill, 2015). Even though there is no empirical study that has been done on the effects  of PAD decisions on the family members left behind , but  the impact of PAD decisions goes beyond the individual patient but extend to the family  members that remains behind after the patient is dead (Gill, 2015).

From my personal point of view, PAD should be legalized to be practiced in the medical field. However, this should be practiced under restricted ethical guidelines to guide physicians oh how to manage such situations. One significant component of such guidelines is when a physician should consider agreeing to perform a PAD (Timothy, 2015).  For instance, PAD can only occur when the patient is competent enough and has the decision making capacity to make the decision of ending his or her life. Additionally, PAD should only be considered when all the other treatments have failed or ineffective (Dresser, 2017). Before considering PAD, a patient should have explored all the other alternatives, PAD should only come into consideration once all the other alternatives are explored but found to be ineffective (Gill, 2015). It is not essentially morally wrong to perform PAD under these conditions since it is possible to ethically restrict the practice of PAD to individuals that are only competent and capable enough to make decisions concerning ending their lives.

In this paper, it has been shown that regardless of the detrimental aspects of PAD, it is possible that nurses and physicians can practice PAD particularly under ethical and moral grounds. The beneficial aspects of PAD are mainly advantageous to the terminally ill patients, and therefore in situations where a patient is competent enough and have the capability to freely without any influence from the caregiver, request to for an assistance to end his or her life given that there is no any other alternative to reduce his or her pain and sufferings, should be granted his or her request. Hence in conclusion, nurses and physicians should assist patients who want to end their lives.

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