Euthanasia: The Nurses Role

 What is Euthanasia?

• Euthanasia is sometimes defined as “good death”. It is a “deliberate and intentional act which causes the death (often by the administration of a lethal injection) at the voluntary request of an individual who is incapable of causing his or her own death” (Schwarz, 1999).
• There are two types of euthanasia: active and passive. Active euthanasia means that something is done to end a person’s life (like an overdose of morphine).  Passive euthanasia means withholding treatment and thus letting the natural disease process end life (like a DNR order).
• One way of looking at this is that this fine line (or thick, depending on your way of thinking) means that it is permissible to let patients die, but not to kill them (Gorman, 1999).  Our blog will be focused on active euthanasia.

 Legalization and the Nurses Role:

• April 2001: The Netherlands was the first country in the world to legalize euthanasia
  • Nothing noted about the nurse’s role in the literature
• September 2002: Belgium legalized euthanasia
  • Nurses have been deemed an integral part of the health care team and are involved with the euthanasia process.
• Oregon and Washington in the United States have also legalized euthanasia
  • Nothing noted about the nurse’s role in the literature
• In Canada Bill C-384 has been brought to parliament three times and each time it has been refused. Euthanasia is illegal in Canada.

Barriers to Legalization:

The barriers surrounding euthanasia are both barriers to the legalization of it and barriers to the discussion of euthanasia. The main barriers we would like to discuss are the government, religion, education, fear, and the media.

• Bill C-384 has been brought to and rejected by parliament three times. This bill would allow individuals in Canada to “die with dignity.” The government is a large barrier to the discussion of euthanasia because they decide whether or not to pass bills. Canadians need to voice their opinions to and have discussions with their MLA’s about euthanasia so that when their MLA votes on bills like this, their opinions are being represented.
• The second barrier to the discussion of euthanasia is religion. A person’s religion often dictates how they should feel about euthanasia. With more religious people being against euthanasia and less religious and atheists often being for euthanasia. (Verbakel & Jaspers, 2010).  This also appears to be the same for educated and non-educated people.  The more education a person has, the more they believe a person has a right to autonomy and therefore, believe a person should have the right to decide to end their life or not.
• The third barrier to the discussion of euthanasia is fear or, more specifically, the slippery slope argument. This is the “…fear that euthanasia will be abused result[ing] in people from vulnerable groups and people living in countries with low responsive healthcare systems being more opposed to euthanasia” (Verbakel & Jaspers, 2010, p 109). Often times when a person starts to think about euthanasia in these terms, it can make them afraid of what may happen if euthanasia is legalized and they will be against it. This argument can also be seen as a fear mongering argument put forth by anti-euthanasia protestors because if euthanasia was legalized, it would be so tightly regulated that this probably wouldn’t happen.
• The media is the final barrier to euthanasia talks. The media can influence the masses so easily and people need to be aware of the fact that what they are seeing on television is what the media wants them to see. Also, it is a lot more compelling to watch a news story about a person who wants euthanasia to be legalized than it is to watch one about a person who doesn’t want to legalize euthanasia (Somerville, 1997).

Video: Legalizing Euthanasia in Canada

Pros and Cons of Euthanization
Pros	Cons
Provides a way to relieve pain	Ethical dilemma among health care providers who have differing views.
Provides relief when a person’s quality of life is low	Slippery Slope Argument: family members can collect inheritance, terminate responsibilities as a health care provider, kill off a family member they don’t like, or relieve financial burdens.
Relieve financial strain on the health care system and allows resources to be spent on other people	Loss of respect for the value of human life
It is freedom of choice	Religious view that God can only choose when to end life

Ethical Considerations:

Criminal Code of Canada:

• Section 14 states “no person is entitled to consent to have death inflicted on him, and such consent does not affect the criminal responsibility of any person by whom death may be inflicted on the person by whom consent is given”
• Section 241 states a physician or any other person cannot counsel “…a person to commit suicide or [aid] or [abet] a person to commit suicide, whether suicide ensues or not, is guilty of an indictable offence and liable to imprisonment for a term not exceeding fourteen years”

Canadian Nurses Association Code of Ethics for Registered Nurses (2008):

• “Serves as a foundation for nurses’ ethical practice” (CNA, 2008, p. 1)
• Ethics defined as “the moral practice, beliefs, and standards of individuals and/or groups” (CNA, 2008, p.24).
• Conscientious objection is “a situation in which a nurse requests permission from his or her employer to refrain from providing care because a practice or procedure conflicts with the nurse’s moral or religious beliefs” (CNA, 2008). 
• This means if the nurse can still provide “safe, compassionate, competent, and ethical care until alternative care arrangements are in place to meet the person’s needs or desires” then he is responsible to do so until that time (CNA, 2008, p. 44). 

Education:

In countries where euthanasia is currently legal, such as Belgium, palliative care nurses have an increased scope of practice and responsibilities in working with these patients and their families. These nurses have a very important role, which is not simply limited to assisting the doctor while they’re administering life-terminating drugs. The nurse’s involvement begins when the patient requests to be euthanized and ends by supporting the patient’s relatives and loved ones, as well as the health care team after a potential life-terminating procedure. It is important for them to have an open mind, use palliative techniques, such as pain management, and to understand the context of the patient’s decision making process. During the act of euthanasia, the nurse needs to assist the patient, their family and the physician by being present, even if they don’t agree with the patient’s decision. Because nurses have a unique relationship with the patient and their loved ones, they are in a key position to provide these patients with valuable care. If euthanasia were to be legalized in Canada, our nursing education, especially in the areas of counseling and end of life care, would have to be expanded to include specific training on how to support and assist patients and their families in this difficult decision making process.

Alternatives to Euthanasia:

Since euthanasia is currently illegal in Canada, there are many alternatives that are currently being employed, such as:

• Appropriate medical care including: the withdrawal of treatment upon patient request, or if there is no more therapeutic benefit and dispensing drugs as necessary to control pain
• Additional care and comfort measures upon patient request in their dying days
• Advance decisions such as DNR and the specific requests associated with it, such as no CPR and no intubation, but full medical management
• Palliative sedation: giving a person medication to make them unconscious and unaware of pain
• Withdrawing life-sustaining treatments such as feeding tubes, dialysis and ventilators

Statistics:

• According to a survey conducted in 2010 by the Euthanasia Prevention Coalition, Canadians are moving away from supporting legal assisted suicide and euthanasia. They found that not only have MP’s shifted their vote away from supporting euthanasia, the public has as well.
• Bill C-384, which would support legalizing euthanasia, was defeated by MP’s by 228 to 59.
• Only 22% of the general public strongly supported legalizing euthanasia.
• The province with the highest support for euthanasia was Quebec.
• The provinces with the lowest support were Alberta and Saskatchewan.
• 71% of the public that were surveyed stated that the government should place a higher priority on improving palliative care instead of legalizing euthanasia.
• Many Canadians worry that if euthanasia were legal, many people would be coerced into getting euthanized without true consent.

Our Opinions:

Group Member 1: I believe that when a person is so compromised that they have no quality of life, they have the right to make the decision of whether to live in that condition the rest of their life or to die.  If Canada could somehow make enough legal parameters so that people don’t get unjustly coerced into it, then our legal system should make euthanasia an option.

Group Member 2: I believe that the value of human life is important and should be valued. No person has the right to choose when the life of an individual should end, but I do believe the individual has the right to refuse medical treatment and let the disease take its natural course. Euthanasia should not be legalized.

Group Member 3: In a perfect world there would be no need for euthanasia because no one would be in so much pain that they see it as their only valid option, but, ours is not a perfect world. To me the debate about euthanasia comes down to autonomy and that people deserve the right to choose to end their life. That is why I believe that euthanasia or at the very least “death with dignity” should be implemented.

Group Member 4:  I believe that human life should be valued. I am against active euthanasia but the issue is not resolved for me. I believe that good palliative care needs to be initiated more often and nurses need to make sure that patients and their familes understand it and their options. This might eliminate the need or desire for active euthanasia for some patients.

Questions to Ponder?  What do you think?

1. Do you think the slippery slope argument is valid or is it a scare tactic or somewhere in between?

2. Do you think there will ever be a ‘solution’ to the euthanasia debate? If so, what would it entail?

3. Do people have the right to decide to end their own life?

4. What influences your decision about euthanasia?

 

References:

• Canadian Nurses Association (2008). Providing nursing care at the end of life. Retrieved from http://www.cna-nurses.ca/CNA/documents/pdf/publications/PS96_End_of_Life_e.pdf
• Criminal Code, R.S., c. C-46 (1985). Retrieved from http://laws.justice.gc.ca/PDF/Statute/C/C46.pdf
• De Beer, T., Gastmans, C., & Dierckx de Casterle, B. (2004). Involvement of nurses in euthanasia: A review of the literature. Journal of Medical Ethics, 30(5), 494-498. doi:10.1136/jme.2003.004028
• House of Commons. (2009). Bill-C384. Retrieved from http://www2.parl.gc.ca/HousePublications/Publication.aspx?Language=E&Parl=40&Ses=3&Mode=1&Pub=Bill&Doc=C-384_1&File=24.
• Picture One: http://alexschadenberg.blogspot.com/2010/12/belgium-euthanasia-study-finds-that.html
• Picture Two: http://www.cbc.ca/news/pointofview/2010/11/euthanasia-should-it-be-legalized.html
• Somerville, M. (1997). Euthanasia in the media: Journalists’ values, media ethics and “public square” messages. Humane Medicine Health Care, 13(1). Retrieved from http://www.humanehealthcare.com/Article.asp?art_id=787
• Verbakel, E & Jaspers, E. (2010). A comparative study on the permissiveness toward euthanasia: Religiosity, slippery slope, autonomy, and death with dignity. Public Opinion Quarterly, 74(1), 109-139.