When it comes to physician-assisted death, several factors are critical that a nurse should consider. First, one should assess their personal values, which entails evaluating their position on human life. For example, one may argue that they consider human life sacred, and they cannot knowingly contribute to the death of another person. In such an instance, a nurse will not heed to a patient's request for a medically assisted death. Differently, another nurse can assess a patient's situation and feel that they are suffering more than they should. Thus when the patient requests such a nurse for a medically aided death, they opt to heed to the wish. Other factors that a nurse should are the ethical guidelines that govern the nursing profession. The nursing profession has a set of ethical provisions that nurses should consider before deciding on a patient's requests for assisted death.
From Kantian theory, one realizes that the philosopher held human life in high esteem. Kant thinks that any form of killing is wrong but does not imply that his theory perceives physician-assisted dying is wrong. However, one may argue that if killing is wrong, it is natural to think that assisting others to end their life is morally wrong. Kant on “treat humanity…as an end” creates for duties to humanity. "perfect duties to others," "perfect duties to self, and "imperfect duties to others" are the key principles most relevant to the discussion on physician-assisted death ( Brassington, 2006 ). Based on these principles, Kant seems to weigh on both sides of the debate. From the three principles, it means one should first consider their personal values and the needs of the others. If a nurse's values do not allow one to medically help another die, they should not engage in such a request. Nevertheless, evaluating Kant’s categorical imperative, one notices the sanctity that the theory places on human life ( Jordan, 2017). The Ethical Considerations of Physician-assisted Suicide. Dialogue & Nexus , 4 (1), 12. ). Thus, it is entirely wrong for a medic to help another to die.
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ANA Center for Ethics and Human Rights. (2019). The Nurse’s Role When a Patient Requests Medical Aid in Dying [Ebook] (1st ed.). Retrieved 4 August 2020, from www.nursingworld.org/~49e869/globalassets/practiceandpolicy/nursing-excellence/ana-position-statements/social-causes-and-health-care/the-nurses-role-when-a-patient-requests-medical-aid-in-dying-web-format.pdf .
In this article, the American Nursing Association (ANA) (2019) provides guidance on what a nurse should do patients request medical aid in dying. ANA basis its insights on the "ethical obligations" bestowed upon nurses, especially concerning end-of-life options (p. 1). The article objectively recognizes that there are different views on medically aided death, including several studies conducted on the issue. However, ANA does not give a conclusive statement for or against “medical aid in dying" (p.5). The focus of the statement is to guide nurses on the problem of compassion as it relates to their practice by leveraging the Code of Ethics for Nurses with Interpretive Statements. First, ANA recognizes that high quality and patient-centered care, including end-of-life care, is key to the nursing profession. In this statement, ANA recognizes that nurses should acknowledge patients' end-of-life "preferences and values," including "prevention and alleviation of suffering” (p.1). Undeniably, nurses should not be judgmental of the choices that a patient wishes upon themselves concerning their end-of-life moments. The lack of support for or against medically aided deaths by this ANA statement leaves nurses in a dilemma. On the one hand, nurses are ethically forbidden from administering medical aid in dying while on the other, they must accept to be engaged by patients in end-of-life discussions and evaluating the context of medical help in dying requests. Nevertheless, the ANA statement advises nurses to consider personal values related to medically assisted death requests so that they are in a position to objectively advise their clients. From the highly informative statement, one recognizes the weightiness of the topic and the associated debates. ANA provides nurses with the leeway to interrogate the ethical provisions of their profession and personal values that define an individual. I think that the ANA does well in absolving itself from providing a fixed position to nurses concerning medical aid in dying.
Hajar, R. (2017). The Physician's Oath: Historical Perspectives. Heart views: The Official Journal of the Gulf Heart Association , 18 (4), 154–159. https://doi.org/10.4103/HEARTVIEWS.HEARTVIEWS_131_17
In this article, Hajar (2017) focuses on medical ethics, the moral issues that define the profession, and the physician-patient relationship by studying the various ethics-oriented oaths employed in the medical world. Informed consent is the first ethical element discussed whereby the author states that it is "fundamental and important to modern medicine," which emphasizes the need to acknowledge the patients’ dignity (p. 155). Hajar notes that informed consent denotes a communication process between a doctor and patients that gives a patient a leeway to authorize or agree to a specific medical intervention. Another element of ethics discussed is the Hippocratic Oath, which the author writes is a "body of ethical statements developed for the benefit of patients" (p. 162). The oath primarily guides the professional conduct of physicians. The oath requires physicians to do good or avoid doing bad to patients. Hajar argues that in the modern medical landscape, the Hippocratic Oath is not sufficient to address ethical issues. I agree with Hajar’s position because I feel that the medical world has greatly changed, and so does the issues of ethics whereby today, there are more ethical challenges than before. Next, Hajar discusses medical bodies and how they have integrated the Hippocratic Oath and other principles of ethics. It is the World Medical Association that the author notes that it adopted the Physician’s Oath, a revision of the Hippocratic Oath. The last significant aspect that Hajar focuses on is the Islamic Medical Ethics. The motivation for the Islamic perspective is that Muslim physicians cannot swear allegiance to the Hippocratic Oath because of its invocation to numerous Gods. From this article, one acknowledges that the different oaths play a significant role in ensuring that medics' conduct is within moral boundaries.
Henry, T. (2018). AMA to Supreme Court: Doctor Participation in Executions Unethical . American Medical Association. Retrieved 4 August 2020, from www.ama-assn.org/delivering-care/ethics/ama-supreme-court-doctor-participation-executions-unethical .
Henry (2018), focuses on the ethical underpinnings surrounding the Supreme Court’s ruling affirming that the execution of Russell Bucklew should go on through lethal injection. Henry states the court’s majority ruled that “death by lethal gas would be significantly less painful for him than the planned method” (n.p.). A key point that the author makes is that the court did not consider the ethical responsibility of a doctor that requires one to desist from assisting or conducting a state-sponsored execution. Indeed, I feel that this was a significant omission by the court. Joel Zivot, the medical expert in question, had failed to assist Missouri officials in deciding which execution method was less painful for the death row inmate. The problem was if "the Eighth Amendment" predisposes an inmate to prove that "alternative method of execution" is less painful than the other (n.p). The article thus seeks to analyze the brief issued by the American Medical Association on the available "ethical principles" that guide physicians on "capital punishments" (n.p.). I agree with the writer’s position that capital punishment indeed has significant moral concerns that can jeopardize a physician’s ethical conduct. Henry writes that the work of medics should be pegged "humanity," and such professionals should "revere human life" (n,p). Thus, the authors acknowledge that it is unethical for a medical expert to assist and a person in death. Certainly, I agree that if Zivot had testified in any way, it would have undermined the doctor-patient relationship. Henry provides insights that physicians should make a statement against any sanctions to aid in terminating a patient's life either directly or indirectly.
LeBaron, Jr., G. (1993). The Ethics of Euthanasia . Quantonics. Retrieved 4 August 2020, from www.quantonics.com/The_Ethics_of_Euthanasia_By_Garn_LeBaron.html .
In this article, LeBaron Jr. (1993) provides an overview of the ethical conflict surrounding death in the US, especially concerning euthanasia and medically assisted suicide. Although the two topics are different, they have attracted related debates. The author basis his argument on assisted suicide on the premises that the action must have the aspects of “advance directive” and “competence” (n.p.). It is the last element that defines the responsibility of nurses. Professionalism requires a nurse to weigh the patient's impact to have medically assisted death on their personal values and the nursing profession's ethical requirements. A doctor is required to consider any advance directive from their patients about their end-of-life moments. In such instances, the physician is required to be nonjudgmental in their advice, which, coupled with their assessment of personal values, reflects their level of professionalism. However, I feel that the advance directive can place a medical practitioner in a precarious and conflicting position with their personal values. For example, through the advance directive, a patient may want their physician to stop their medication if their condition deteriorates, which will allow them to die. Differently, the medic may have the belief that life is sacred, which lays a foundation for a conflicting scenario. Instead, the article circumvents this issue by focusing on the instances when "assisted suicide" may be informed by selfish interests. Further, doctor-assisted suicide may result in the killing of patients who want to live post issuing an advance directive. The author does not make substantive input to address such a scenario. To atone for this, LeBaron writes about the low level of trust accorded to physicians by trust due to their poor communication skills coupled with their tendency to spend little time with the clients. However, I think that laying the blame in physicians without considering the conflict between their personal values and ethical code of conduct they are supposed to uphold that they experience in unwarranted.
Llamas, J. (2018). The Moral and Ethical Dilemma of Physician-Assisted Suicide - Minority Nurse . Minority Nurse. Retrieved 4 August 2020, from minoritynurse.com/the-moral-and-ethical-dilemma-of-physician-assisted-suicide/.
In this article, Llamas (2018) seeks to contribute to the debate on the moral and ethical dilemma of "physician-assisted suicide (PAS)” (n.p.). The author begins by quoting the definition of physician-assisted suicide by AMA, whereby they acknowledge the place of the doctor-patient relationship in the debate. The article is divided into three sections: public policy, risk and benefits, and the impact of nursing in PAS. First, Llamas recognizes that PAS's debate is often highly divided, a scenario compounded by "recent societal and technological advancements" (n.p.). As a result, nurses are left in an "ethical dilemma," which requires a consensus among all stakeholders. I think that the controversy behind this topic is informed by the conflict created by two sides of the alternatives available to nurses. Nurses are required to interrogate their personal values. In contrast, they are required to adhere to the available ethical codes of conduct and professional oaths. Second, the author discusses the risks and benefits of the conversation on PAS that nursing professions must understand. Llamas states that pro-PAS advocators argue that patients should have the “right to choose the timing and manner of their death…” (n.p). The principle behind this argument is that patients do not deserve to suffer needlessly. Differently, opponents of PAS argue for the "sanctity of human life," which should be honored. This section unambiguously describes the conflict that exists between the two schools of thought. I feel that the greatest burden is on nurses who have direct engagement with patients requesting medical assistance to end their lives. Last, Llamas delves into the effect of nursing in PAS. The author emphasizes the need for nurses to remain cognizant and prepared to face any repercussions associated with PAS. I nevertheless feel that clear directions should be given on the subject without leaving nurses at unnecessary dilemmas.
References
ANA Center for Ethics and Human Rights. (2019). The Nurse’s Role When a Patient Requests Medical Aid in Dying [Ebook] (1st ed.). Retrieved 4 August 2020, from www.nursingworld.org/~49e869/globalassets/practiceandpolicy/nursing-excellence/ana-position-statements/social-causes-and-health-care/the-nurses-role-when-a-patient-requests-medical-aid-in-dying-web-format.pdf .
Brassington, I. (2006). Killing people: what Kant could have said about suicide and euthanasia but did not. Journal of medical ethics , 32 (10), 571-574.
Hajar, R. (2017). The Physician's Oath: Historical Perspectives. Heart views: The Official Journal of the Gulf Heart Association , 18 (4), 154–159. https://doi.org/10.4103/HEARTVIEWS.HEARTVIEWS_131_17
Henry, T. (2018). AMA to Supreme Court: Doctor Participation in Executions Unethical . American Medical Association. Retrieved 4 August 2020, from www.ama-assn.org/delivering-care/ethics/ama-supreme-court-doctor-participation-executions-unethical .
Jordan, M. (2017). The Ethical Considerations of Physician-assisted Suicide. Dialogue & Nexus , 4 (1), 12.
LeBaron, Jr., G. (1993). The Ethics of Euthanasia . Quantonics. Retrieved 4 August 2020, from www.quantonics.com/The_Ethics_of_Euthanasia_By_Garn_LeBaron.html .
Llamas, J. (2018). The Moral and Ethical Dilemma of Physician-Assisted Suicide - Minority Nurse . Minority Nurse. Retrieved 4 August 2020, from minoritynurse.com/the-moral-and-ethical-dilemma-of-physician-assisted-suicide/.
