• Subject Name : Nursing

Ethical and Legal Dilemma’s Linked with Voluntary Assisted Dying

One of the main debatable topics of the healthcare sector is voluntary assisted dying as it is related to both major pros and cons which can be balanced. The voluntary assisted dying is the patients wish to use medical resource which can help to end the suffering of the patient with the help of health care professionals (Onwuteaka-Philipsen et al., 2019). There have been different legal and ethical aspects that are related to the voluntary assisted dying as it directly challenges human rights which increase its negative aspect. The ethical and legal aspect of the voluntary assisted dying is contradictory as the patient’s autonomy, beneficence and legal aspect are not balanced to assist the patient (Sinmyee, 2019). The health care professionals are expected to support the patient in need and provide the right care that leads to a decrease in suffering. Health care professional working with a patient with the severe disorder and demanding for assisted dying face issue while opting for palliative care medicine or euthanasia for the patient benefit (Rutherford et al., 2020). The essay is going to uncover the different aspect related close to the voluntary assisted dying to understand the issue.

The voluntary assisted dying means that an individual wish to die has been considered and the patient will be provided by the access to the medication which will help to prefer the time of the death. The term voluntary assisted dying to emphasize on the voluntary nature of the death opted by the patient that solely includes the decision of the patient result of the increased suffering (Government of Western Australia, 2020). Moreover, the article presented by Inbadas et al. (2019) added that assisted dying is one of the major concerns in the health care sector as it expects the health care professional to help the patient in decreasing the suffering by ending their life using medications. The patient wish is not influenced by any other individual and all the different aspect of care are considered before proceeding for the voluntary assisted dying. The issue with the voluntary assisted dying is due to the misbalance between the Right to die and Right to live which lead to the issue in the legalization of the process. The advancement in the palliative care process has increased the chances of the patient get the right health facilities that can increase the quality of life of the patient by decreasing suffering facing major issue due to lifetime major disorder. The study presented by Gerson et al. (2019) added that voluntary assisted dying help the person to lawfully attempt the medical treatment that leads to death and finish the suffering. The voluntary assisted dying contradicts with the palliative care services as it leads to the better care of the patient with the life-limiting disorder. The issue arises as some of the findings state that palliative care and voluntary assisted dying should go hand in hand, on the other hand, some of the findings discuss the synergistic effect of both on each other. There is an issue on the end of the guideline for the voluntary assisted dying process which also increases the complication in the legalization process due to the negative image of the population.

There are many ethical dilemmas that health care professional are expected to suffer when they are working with a patient with serious illness and asking for the voluntary assisted dying. One of the ethical dilemmas arises due to the autonomy that differs from patient to nurses and it increases the complication for the health care professional to assist the patient in the process. One of the article presented by Geest & Satalkar (2019) added that patient’s autonomy in the care is considered to be one of the important aspects as it helps to improve the patient participation in the care which leads to patient satisfaction. The researchers also added that the autonomy of the patient should also be respected during the decision related to the voluntary assisted dying as the severity of the illness sometimes increase complications for the patient like severe pain, negative mental episodes. The study also presented that nurses are expected to support the patient and help to improve the patient’s decision making while explaining all the particular aspect of health status. Researchers added that sometimes the patient autonomy cannot be maintained due to the poor health status then family and health care professionals are expected to intervene in the decision making.

Moreover, the study presented by Pesut et al. (2019) added that nurses play an important role in negotiating and assisting the individual during the decisions making related to the assisted dying. Sometimes nurse ethics and values concerning the care of the patient do not match the patient autonomy decisions which lead to the state of the ethical dilemma. The nurse’s perspective concerning the patient will include different care alternative that can be used to support the patient health which can reduce the pain or suffering but patient preferences for voluntary assisted dying to contradict with each other. The nurse’s communication ability and rapport with the patient is important to reduce the chances of an ethical dilemma that arises due to the difference in the autonomy approach of the patient and nurses which lead to confusion. Both of the findings reveal that difference of autonomy of the patient and nurses increase the complication for the care due to the ethical dilemma.

Two other ethical dilemmas that arises due to the ethical principles includes beneficence and non-maleficence which includes doing well with the other individual that leads to a positive impact on the other individual and not harm another individual. There are two aspects of the voluntary assisted dying concerning the beneficence principle and the synergistic effect of both leads to an ethical dilemma state. One of the studies presented by Shibata (2017) added that patient facing immense pain and suffering due to the disorder need urgent attention and should be helped with the voluntary assisted dying to finish the suffering. The researchers discussed that principle linked with the assisted dying reveals that individuals should not suffer unnecessarily and artificially extended in life in increasing complication for the patient. The article also states that ending of the life of the person facing major issue related to the physical, mental and emotional health is considered to be the merciful act that benefits the individual by ending the suffering that helps to reduce the harm of the patient. When health care facilities are not able to reduce the complication and suffering of the patient that increasing their suffering then voluntary assisted dying is viewed as a beneficence act that will help to decrease patient issue.

Moreover, the study presented by Nunes & Rego (2016) added that human life is a god gift and intentional ending of the life will not be cover in the beneficence as it is not right to kill someone because of the suffering. The author added that the intentional death of the individual cannot benefit anyone thus voluntary assisted dying will not come under the beneficence act as it is involved in the ending someone’s life. The study also added that different alternatives can be adapted to support the patient which comes under the beneficence principle should be used to decrease the suffering of the patient, not the voluntary assisted dying. The findings of the article also added that voluntary assisted dying is not the solution of the patient suffering and it is not the act of beneficence.

The legal dilemma that is linked with the nurse's role in the voluntary assisted dying arises due to the lack of legalization in a different country that leads to the issue with the permission of the voluntary assisted dying. One of the studies presented by Fontalis et al. (2018) added that there has been great debate in the favour or against of the legalization of the voluntary assisted dying that directly over the nurse's role. The lack of proper information concerning the guideline of the assisted dying lead to the lack of the right assistance of the patient in the care. Moreover, the study presented by Dierickx et al. (2019) added that there are different countries where the voluntary assisted dying is legalized are Netherlands, Belgium, Luxembourg, Canada and Colombia. Some other place includes different states of American and Switzerland where voluntary assisted dying is legalized. The legal dilemma linked with the voluntary assisted dying is right to live that is violated in the process as no one has rights to end the life of any other individual.

The study presented by Castro et al. (2015) added that there is a difference in the law of the assisted death and thus health care professional face issue while assisting the patient during the decision making process. One of the Latin American countries where assisted dying is permitted is Colombia and thus the health care professional are expected to be aware concerning all the laws and procedure that are important to help the patient. Only five of the fifty states of the United States have legalization of the assisted dying and thus these five states require a specialised health care professional to assist the patient. The legal issue that is related to the voluntary assisted dying also leads to the legal issue concerning the code of ethics of the health care professionals due to the ultimate death of the patient. 

There are the different strategies that can help to deal with the ethical dilemma by improving the practice and one of the strategies following the code of ethics which help you to deliver the right care to the patient. Nursing and Midwifery Board of Australia (2017) proposed the code of ethics for the nurses that help to set the clinical practise guideline which improves the ethical practice of the nurses. The code of ethics helps the nurses to understand the right process to perform the clinical practise that is ethically right and benefits the patient in the care. There are eight codes of ethics that are important to maintain the nurse’s ethical practice which leads to a better quality of care with a commitment to the professional role. Moreover, the study presented by Nora et al. (2016) added that nurses are expected to reflect the ethical leadership in the practise which is important for decision making in the care that helps to deliver the effective care to the patient. The ethical decision making helps the individual to critically evaluate all the different aspect of the patient and the health care services so that the right care can be delivered to be patient to improve the assistance. Ethical decisions making process help the nurses to rationalize both professional and personal values together to improve the care process that benefits the patient. Both of the strategies are important of the nurses to improve the ethics in the care which lead to a better quality of care and it helps in supporting the patient in preferring voluntary assisted dying if there is no option to reduce the suffering of the patient. The code of ethics and leadership in combination will improve the patient benefit from the care that is following the preference of the patient.

The essay can be concluded by ending up that voluntary assisted dying is a debatable topic due to sides the topic and it has been legalized in many countries to support the patient in the major suffering. The voluntary assisted dying is the process in which individual wishes for the poison medication to end the suffering and pain related to the severe suffering. Different ethical dilemmas are voluntary assisted dying due to the different perspective of the patient and the health care professionals. Some of the ethical dilemmas nurses face include the opposite effect of autonomy related to patient and health care professionals, the issue with the beneficence and non-maleficence. The legal dilemma that arises due to the voluntary assisted dying for the nurses includes lack of legalization in the different country increases the complication of the nurses. The strategies that can help the health care professional to reduce the ethical dilemma in the care includes following code of ethics and leadership in nursing that improve the decisions making process. These strategies will help to improve the patient preferences concerning the voluntary assisted dying and improve the nursing care perspective.

References for Euthanasia and Assisted Suicide

Castro, M. P., Antunes, G. C., Marcon, L. M. P., Andrade, L. S., Ruckl, S. & Andrade, V. (2015). Euthanasia and assisted suicide in western countries: A systematic review. Rev. Bioét, 24(2), 355-367.

Dierickx, S., Onwuteaka-Philipsen, B., Penders, Y., Cohen, J., van der Heide, A., Puhan, M. A. & Chambaere, K. (2019). Commonalities and differences in legal euthanasia and physician-assisted suicide in three countries: A population-level comparison. International Journal of Public Health, 65(1):65-73. https://doi.org/10.1007/s00038-019-01281-6 

Fontalis, A., Prousali, E. & Kulkarni, K. (2018). Euthanasia and assisted dying: ~What is the current position and what are the key arguments informing the debate. Journal of the Royal Society of Medicine, 111(11), 407–413. https://doi.org/10.1177/0141076818803452 

Geest, S. & Satalkar, P. (2019). Autonomy and dying: Notes about decision-making and “completed life” euthanasia in the Netherlands, Death Studies, 1-10. https://doi.org/10.1080/07481187.2019.1671543

Gerson, S. M., Koksvik, G., Richards, N., Materstvedt, L. J. & Clark, D. (2019). The relationship of palliative care with assisted dying where assisted dying is lawful: A systematic scoping review of the literature. Journal of Pain and Symptom Management, 1287-1303 https://doi.org/10.1016/j.jpainsymman.2019.12.361 

Government of Western Australia. (2020). Voluntary assisted dying. Retrieved from: https://ww2.health.wa.gov.au/voluntaryassisteddying#:~:text=Put simply, voluntary assisted dying,and they are suffering badly.

Inbadas, H., Carrasco, J. M. & Clark, D. (2019). Representations of palliative care, euthanasia and assisted dying within advocacy declarations. Mortality, 1–13. https://doi.org/10.1080/13576275.2019.1567484 

Nora, C. R., Deodato, S., Vieira, M. M. & Zoboli, E. L. (2016). Elements and strategies for ethical decision-making in nursing, Texto Contexto – Enferm, 25(2). DOI: https://doi.org/10.1590/0104-07072016004500014 

Nunes, R. & Rego, G. (2016). Euthanasia: A challenge to medical ethics. Journal of Clinical Research & Bioethics, 7(4). https://doi.org/10.4172/2155-9627.1000282 

Nursing and Midwifery Board of Australia. (2017). Professional Standard. Retrieved from: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements.aspx

Onwuteaka-Philipsen, B., Willmott, L. & White, B. P. (2019). Regulating voluntary assisted dying in Australia: Some insights from the Netherlands. The Medical Journal of Australia211(10), 438–439.  https://doi.org/10.5694/mja2.50310

Pesut, B., Thorne, S., Greig, M., Fulton, A., Janke, R. & Vis-Dunbar, M. (2019). Ethical, policy, and practice implications of nurses' experiences with assisted death: A synthesis. ANS. Advances in Nursing Science42(3), 216–230. https://doi.org/10.1097/ANS.0000000000000276

Rutherford, J., Willmott, L. & White, B. P. (2020). Physician attitudes to voluntary assisted dying: A scoping review. BMJ Supportive & Palliative Care, 1-9. https://doi.org/10.1136/bmjspcare-2020-002192 

Shibata, B. (2017). An ethical analysis of euthanasia and physician-assisted suicide: Rejecting euthanasia and accepting physician-assisted suicide with palliative care. Journal of Legal Medicine, 37(1-2), 155–166. https://doi.org/10.1080/01947648.2017.1303354 

Sinmyee, S., Pandit, V. J., Pascual, J. M., Dahan, A., Heidegger, T., Kreienbühl, G. & Pandit, J. J. (2019). Legal and ethical implications of defining an optimum means of achieving unconsciousness in assisted dying. Anaesthesia. https://doi.org/10.1111/anae.14532

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