Ethics of Euthanasia in Nursing

Introduction

The reflection on nursing ethics helps nursing professionals develop cognitive perception of any activity to assess it to be moral or unethical. In this reflection, I am going to reflect on euthanasia to determine its ethical importance. The euthanasia is referred to mercy killing in which an individual who is suffering painfully from any incapacitating disorder or incurable disease is allowed to die by withdrawing life support or treatment (Emanuel et al. 2016). In this purpose, Gibb's reflective cycle is to be used. The importance of using Gibb’s reflective cycle is that it allows individual to develop systematic analysis and thinking of the experiences they faced to determine what is right or wrong in the condition (Li et al., 2020). Thus, using this reflective model I would be able to evaluate my feelings and perception regarding the issue of euthanasia to understand the extent to which I consider it to be ethically important. The benefit of using Gibb’s cycle compared to other reflective model is that it allows overtime developing accurate and balanced judgement (Saunders et al., 2018). Thus, it is to be used in reflecting the ethical context of euthanasia to accurately judge its moral importance overtime. Moreover, the reflection would also allow discussing importance of use of contemporary NHS policies and guideline in delivering care in respect to euthanasia. Further, reflection is to be used to highlight the research methods use and way evidence-based practice, along with healthcare dissertation help, is to be used in euthanasia to deliver high quality care to patients.

Gibb’s Reflective cycle

The Gibb’s Reflective cycle contains six steps which are as follows and they are to be abided in discussing the ethical importance of euthanasia.

Description:

During my placement in the cancer ward, I was allocated to care for a patient named M with terminal brain cancer who was experiencing deliberating headache for nearly a year. She was found to undergo chemotherapy for brief amount of time but expressed no improvement in her heath. In the last six months, the patient reported that instead of progressive care her condition has worsened and wish to die through euthanasia. Moreover, the health professionals have mentioned she has no more than 6 months left to live. However, the family members are seen to be against her thought of euthanasia as they feel there is still hope for her to recover and there is no need to end her life. In Britain, the UK, the clinical governance considers euthanasia to be illegal and therefore the hospital authorities along with others did not support her thought (Inbadas et al. 2017). (Refer to Appendix 1)

During her care, I was intensely bothered by the pain perceived by her which is beyond limits as at times she was seen to cry in painful headache and had sleepless nights. On the basis of the condition, I tried to determine the ethical context of euthanasia and consider it to be an ethical act. However, health professionals are not convinced of the explanation and avoided to consider euthanasia to be an ethical act. This is because health professional considers euthanasia to inappropriately end the life of patients without offering them effective care (Kalal, 2018). I tried to identify NHS policies and guidance to determine the ethical aspect of euthanasia for M. However, in Britain, I failed to identify any NHS policies to support M’s preference to die through euthanasia. I develop electronic research regarding euthanasia to gather evidence, which led me to collect certain evidence that could be used in care practice for M in supporting her need for euthanasia.

Feelings:

In regard to euthanasia for M, I feel that trying to identify supportive NHS policies and guidance which allows euthanasia was waste of time. This is because being a nurse in the UK, it is already known to me euthanasia is illegal in the country. However, I currently feel that it was an effective approach as I was trying to gather supportive legal references to ensure euthanasia be legalised for patients. I feel that evidence-based practice approach to prove the ethical aspect of euthanasia for M was an effective action. This is because evidence-based practice allows gathering of potential scientific information in proving and arguing different aspects regarding care in clinical practice (LoBiondo-Wood and Haber, 2017). In relation to euthanasia, I feel developing perception on the basis of deontological ethical theory regarding it would lead it to be considered as ethically important act. The deontological ethical theory mentions that morality of any action is based on right or wrong of the act itself under certain rules and condition rather than considering its morality on the consequences of actions (Mandal et al., 2016). Thus, the theory led me to feel that euthanasia is ethically appropriate for M as it would help her overcome immense suffering which is more than her current living ability.

The Utilitarianism is referred to the ethical theory which informs that ethical choice is the one which will develop greatest god for wide number of individuals (Sanderson, 2018). In support to the theory, I feel that euthanasia is ethical for M as it would resolve her pain as well as resolve the care burden, increased cost of M’s treatment and emotional pressure on M’s family due to her disease, offering greater good for all. As argued by Groothuizen et al. (2018), theory of virtue ethics mentions that the action executed is ethical if the moral character of the person executing the action is appropriate. This indicates that virtue ethics do not consider the action to be ethical based on the consequence or outcomes of the activity but the moral character of the person. In relation to this theory, I doubt to support euthanasia for M. This is because moral character of a nurse or health profession is supporting life of the patients and not taking it (Gallagher, 2017). Thus, by supporting euthanasia for M, it would be immoral of being a nurse who supports death of patients instead of motivating the person to live and show compassion along with care to ensure the person’s improved zeal to live.

Evaluation:

The good regarding the situation towards supporting euthanasia for M was use of research and evidence-based practice. This is because it led to gather supportive evidence from eminent authors to determine need of euthanasia and where it is currently practised. The evidence gathered through electronic search in the article of Kalal (2018) is that euthanasia is effective for the patient and to be legalised as it allows death of the patients with dignity and creates end to the suffering from the patient. According to the NMC Code of Practice, the dignity of the patients is to be upheld by the nurses under all condition (NMC, 2018). Thus, supporting euthanasia for M as nurse is effective as it ensures supporting her dignity in dying. The existing NHS policies and guidance mention euthanasia is equal to murdering of patients and should not be allowed (NHS, 2020). The Suicide Act 1961 developed under the English law mentions that assisted suicide or euthanasia is illegal and individuals supporting the act are to face legal punishment (legislation.gov.uk, 1961). Thus, evaluating the NHS policies and UK legislation was a good act to understand the reason why euthanasia is not supported for M by the health professional. (Refer to Appendix 1)

The NHS Patient Safety policy mentions to deliver care to patients without causing any harm (NHS, 2018). The Care Act 2014 informs that effective care is to be provided to patients to avoid any risk or abuse towards them (legislation.gov.uk, 2014). However, in supporting euthanasia for M, the legal aspects would be violated as it would lead to M’s death that do not ensure her safety. The principle of nursing ethics mentions beneficence and non-maleficence to be abided according to which least or no harm to be made to patient to ensure their beneficial health outcome (Preshaw et al. 2016). However, in supporting euthanasia for M, I would fail to abide by the nursing ethics as supporting death of the patient is not beneficial for them. According to Kouwenhoven et al. (2019), in 2015, nearly 4.5% of deaths are due to euthanasia and in 95% of in these cases was performed by a health professional with effective medical expertise. This also allowed gathering evidence that euthanasia is supported in the Netherlands and not to be considered entirely unethical as otherwise it would not be supported by the country. However, evidence-based practise also led me to understand why legalisation of euthanasia for M could be harmful. This is evident from the study of Titko et al. (2020) where it is mentioned that legalising euthanasia may lead to show disrespect towards religious beliefs, support “light death” under influence of burden of care, inappropriate death support to patients and others. The bad experience regarding the situation was that I think I compromised my duty and moral character towards supporting M in euthanasia. This is because as a nurse it is my duty to care and save life of patients (Euchner and Preidel, 2018). The other bad experience was that I was unable to gather valid evidence of individual for whom euthanasia has been performed and it proved to ensure effective intervention. (Refer to Appendix 1)

Analysis:

The thing that went well in this situation while supporting euthanasia for M was that I was able to identify two key ethical theories that are Dentology ethics and Utilitarian ethics to be used in ethically supporting the act. Moreover, I was able perform effective evidence-based research to identify the barriers that are acting towards supporting euthanasia being an ethical act. This led me to sense the reason behind health professionals and family members of M not supporting the execution of euthanasia. The thing that did not go well was that I failed to abide by the moral responsibility of being a nurse for M in supporting euthanasia. As a nurse, it the duty under the Nightingale Pledge to provide care by performing the profession faithfully and restrain from any deleterious or mischievous activity (florence-nightingale.co.uk, 2020). In case of M, by supporting her will to die makes me respect her dignified death but in my profession to perform it would regarded as mischievous activity for allowing death of patient instead of caring for the individual to overcome the thought. The other thing that did not go well in trying to support M was that I failed as nurse to abide by legal principles of patient safety and moral care. Moreover, I was unable to find any valid NHS policies that remotely support euthanasia in the UK. This led me to sense that euthanasia is not able to currently established for M as there are wide number of hindrances and legal obstacles that would avoid its implementation.

Conclusion:

The situation led me to learn that clinical governance considered euthanasia as illegal act in the UK and it currently cannot be supported for M irrespective of her wishes and medical condition. I learned that deontological and utilitarian ethics are effective ethical theories that can be used to support euthanasia but the virtue ethics theory act against for establishing euthanasia as a nurse. I realised that I have avoided following certain professional code, legal and moral principles of nursing while going to support M for euthanasia. Thus, to make it a more positive situation where abiding by the nursing code is ensured as well as the needs of the patient is fulfilled I require upgrading my knowledge and guidance regarding NMC Code of Practice. I think that more effective research could have been done to develop evidence-based practice regarding euthanasia. I learned that though there are certain barriers to euthanasia, but the way to resolve them is not known to me.

Action Plan:

In future, to support ethical aspect of euthanasia I would execute more effective research to gather potential evidence of patient cases where the act led to beneficial impact on the patient and their family members. Moreover, I am going to further research and gather evidence to determine the legal, ethical and moral ways in which euthanasia can be performed. I would also gather evidence for the ways in which barrier to euthanasia can be resolved in future to support it as an ethical act to be executed for the patient. Moreover, I am going to access intense training regarding the way professional activities and code of practices as a nurse can be ensured by at work while supporting euthanasia.

Conclusion

The above discussion informs that euthanasia which is known as mercy killing through medical intervention for the patient is determined to be unethical. However, a patient named M who is suffering from last stage brain cancer has expressed the wish to avail it. In reflection on the situation, I identified that based on the virtue of being a nurse the activity cannot be supported but the determining its ethical context based on the outcome for the patient could lead it to be considered as ethical. The existing NHS policies mention euthanasia to be a criminal activity and the Suicide Act 1961 deems it to be illegal and punishable offence under the law. Moreover, further collection of evidence is required to support ethical context of euthanasia and training of the nurses is required to implement the act.

References

De Lima, L., Woodruff, R., Pettus, K., Downing, J., Buitrago, R., Munyoro, E., Venkateswaran, C., Bhatnagar, S. and Radbruch, L., (2017). International association for hospice and palliative care position statement: euthanasia and physician-assisted suicide. Journal of palliative medicine, 20(1), pp.8-14.

Emanuel, E.J., Onwuteaka-Philipsen, B.D., Urwin, J.W. and Cohen, J., (2016). Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe. Jama, 316(1), pp.79-90.

Euchner, E.M. and Preidel, C., (2018). When morality policies meet governance: private governance as response to value-driven conflicts. Journal of Public Policy, 38(1), pp.57-81.

Gallagher, A., (2017). Care ethics and nursing practice. In Key Concepts and Issues in Nursing Ethics. Springer, Cham.

Groothuizen, J.E., Callwood, A. and Gallagher, A., (2018). NHS constitution values for values-based recruitment: a virtue ethics perspective. Journal of medical ethics, 44(8), pp.518-523.

Inbadas, H., Zaman, S., Whitelaw, S. and Clark, D., (2017). Declarations on euthanasia and assisted dying. Death studies, 41(9), pp.574-584.

Kalal, N., (2018). Euthanasia: Right to live & right to Key Words: Euthanasia, Legitimate medical Euthanasia, Pros and cons of euthanasia. International Journal of Current Research,10(11),pp.7554-7556.

Kouwenhoven, P.S., Van Thiel, G.J., van der Heide, A., Rietjens, J.A. and van Delden, J.J., (2019). Developments in euthanasia practice in the Netherlands: Balancing professional responsibility and the patient’s autonomy. European Journal of General Practice, 25(1), pp.44-48.

Li, Y., Chen, W., Liu, C. and Deng, M., (2020). Nurses’ Psychological Feelings About the Application of Gibbs Reflective Cycle of Adverse Events. American Journal of Nursing, 9(2), pp.74-78.

LoBiondo-Wood, G. and Haber, J., (2017). Nursing research-e-book: methods and critical appraisal for evidence-based practice. Elsevier Health Sciences.

Mandal, J., Ponnambath, D.K. and Parija, S.C., (2016). Utilitarian and deontological ethics in medicine. Tropical parasitology, 6(1), p.5.

Preshaw, D.H., Brazil, K., McLaughlin, D. and Frolic, A., (2016). Ethical issues experienced by healthcare workers in nursing homes: literature review. Nursing ethics, 23(5), pp.490-506.

Sanderson, C.D., (2018). Ethical and bioethical issues in nursing and health care. Contemporary Nursing E-Book: Issues, Trends, & Management, p.161.

Saunders, D.R., Arnold, E., Seaman, K., Green, A. and Gullick, K., (2018). Graduate registered nurses’ reflections on implementing safety and quality improvement projects. Reflective Practice, 19(5), pp.678-689.

Titko, E., Dei, M., Smalii, O. and Yuldashev, S., (2020). Impact of Palliative Care/Medicine on Realization of" Right to Life" and" Right to Dignity" in The Context of Human Rights Protection. Journal of History Culture and Art Research, 9(1), pp.49-68.