NUR30001 Voluntary Assisted Dying Assignment Sample

• Subject Code : NUR30001
• University : Swinburne University of Technology My Assignment Services is not sponsored or endorsed by this college or university.
• Subject Name : Nursing

End of Life Care

Table of Contents

Introduction.

Definition of voluntary assisted dying.

Critical analysis of ethical dilemmas of a nurse in context of voluntary assisted dying.

Critical analysis of legal dilemmas of a nurse in context of voluntary assisted dying.

Strategies used by healthcare professionals to manage the complexities of this context

Conclusion.

References.

Introduction to Voluntary Assisted Dying

Voluntary assisted dying is well-known process in which an individual who is suffering from illness and at end of their life, are able to choose the method and timing of their death. Specifically, those people who are suffering from an incurable progressive disease, or medical condition are able to access voluntary assisted dying. The laws for voluntary assisted dying were initially passed by Victoria, present in Australia. According to the legislation passed by Western Australia, voluntary assisted dying become a choice for people in mid- 2021 (Voluntary assisted dying, 2020, para. 1-2). Nurses play a major role in assisting the patient for their end-of-life care, and in variety of cases they work to develop the process of voluntary assisted dying. However, they face several ethical and legal issues while voluntary assisted dying process, which are needed to be reduced by maintaining effective strategies (Health practitioner information, 2020, para. 2-3). Hence, the thesis statement of this essay is “to address the ethical and legal dilemmas of nurse during voluntary assisted dying, and the strategies to manage them”.

Definition of Voluntary Assisted Dying

Voluntary assisted dying refers to those people who are at end stage of life and suffering from advanced diseases, and are not willing to live anymore. They are able to choose the timings of their death and can take medications which are prescribed by the healthcare workers that helps to bring death at the time they have chosen. People who follow the set process and meet the specified conditions in the laws are only able to access voluntary assisted dying medications. These set conditions involve the health condition of an individual, that means the incurable disease, medical condition, pain or intolerable illness that an individual is facing which can be controlled by voluntary assisted dying. Usually, it is self-administered process and an individual itself initiate it and volunteer (Monteverde, 2017, p. 3–8).

According to this law, person may be given some medications by healthcare practitioners by which they can die at the time they have chosen. This process ensures that the decision of the person is enduring, voluntary, and gives a crisp clear guidance about the way by which medical workers can support the person in assisted dying. This law also mentioned the varied range of protections to ensure the safely monitored and implemented voluntary assisted dying (Pesut et al., 2019a, pp. 152–167). The person who wants to access voluntary assisted dying can start the process by discussing with their healthcare worker about voluntary assisted dying. If the person is found eligible, then the process is again repeated with another doctor who carry out second assessment. They are needed to make sure that the person is aware about the available palliative care ways, and is making a fully informed decision. For further procedure, person needs to make written declaration about their end-of-life at their chosen time. Lastly, they administer the prescribed medication by themselves and end their life at their own decisions (Fujioka et al., 2018, pp. 1564-1576).

Critical Analysis of Ethical Dilemmas of A Nurse in Context of Voluntary Assisted Dying

Nurses play a vital role in assisting a patient for their end-of-life care and voluntary assisted dying. They are the constant care providers to the patients, whether at hospital or residential care. Sometimes nurse will be in a dilemma situation where they could not differ the wishes of patient and their families, decision making of physicians, and legal considerations in regards to voluntary assisted dying (Ethics in practice, 2015, pp. 10-37). There are various ethical dilemmas that a nurse face in context of voluntary assisted dying, they are mentioned below:

• Nurses and caretakers face difficult with the thought of allowing an individual to die of dehydration or starving. However, some nurses reported it as an easy process as no interventions are required to hasten death time. Nurses may also face struggle in understanding the concepts of the people, because every individual has their own beliefs and values. Some people argue that it is against the religious process and trust in holiness of life in principle to choices that may accelerate death. Further, some people say that providing only food services is not a kind of treatment, and duty of care must be prescribed to maintain the requirements of life (Usberg et al., 2020, para. 5-9).
• When a person stops drinking or eating, then it can cause emotional distress among nurses. However, it is critical for a nurse to recognize their own beliefs and values for the people whom they provide care and understand the fact that who is suffering from this decision (Ethics in practice, 2015, pp. 10-37).
• Another major concern is the ambiguous and unclear language of the patients and were found to obey the advanced care direction requirements. In regards with this, laws should be made in which it has been stated that there should be a person with these kinds of patient, who can act and talk in behalf of their injury, and disability (Elmore et al., 2016, pp. 955–972).
• Sometimes situations occur where patient disagrees to their support and treatment, which also cause stress among nurses. They may also face conflicts regarding their own religious and moral beliefs, due to which they are not able to follow the policies and procedures, and eventually refrain from providing care to the patient (Bélanger et al., 2019, pp. 48-53).

Critical Analysis of Legal Dilemmas of A Nurse in Context of Voluntary Assisted Dying

Various countries follow laws and legislations to allow voluntary assisted dying. As mentioned earlier, nurses play vital role in providing care and support to the patient. In various countries it has been reported that they face legal dilemmas by following their laws and procedures while assisting the patient for voluntary assisted dying. These legal dilemmas are discussed below:

• In Spain, nurses are active to read the proposed laws and legislations, and they found that one regional parliament present there had created laws that specify about the care and support of terminally ill people. They noticed that they had not mentioned the responsibilities of nurse anywhere in their document, and they raise their concern and argue that nurse are the communicators in behalf of patients who makes everyone to understand the preferences, process, and directives of the patient. Nurse face lack of consensus and their involvement and recognition in the process of voluntary assisted dying (Pesut, 2019b, pp. 216-230).
• In Norway, nurses experience communication difficulties and are not able to speak openly with the patients and their families about the medical prognosis. Patient’s relatives also claim that there is need of lot of efforts for getting the information, which the nurses could not give them due to the laws and legislations. However, they have appreciated the comfort and compassionate care provided by the nurse. So, laws could be made in favour of nurses in which they are able to gather and deliver the information to the patients and their families (Grace et al., 2019, pp. 46-53).
• In Switzerland, nurse who work with patient’s end-of-life services and care found that patients make contradictory statements about their values and wishes. Moreover, it is also reported that there are conflicts between the information in what the physicians say and what nurse say. This is because nurses know the patient well because they care for them for longer time, whereas the physicians told on the basis of what they just listen. This conflicting information also cause stress among nurses, if the physician will not listen to their voices. So, there must be a law which support the nurses and makes it compulsory for physicians to interact with the nurse as well (Beuthin et al., 2018, pp. 511-520).
• In United States, the role of nurse in assisting death is somewhat legal after the declaration by American Nurse Association. However, the nurse cannot administer medication for assisted dying of the patient. This situation cause dilemma among the nurses, which can be maintained by adequate laws which support the end-of-life medications provided by nurse (Pesut et al., 2019a, pp. 152–167).

Major variations in legislations are not needed to achieve the goals to deal with the death. In spite of this, goals will be measured to make differences from a culture that looks death as life’s part, to a culture that accept death as a medical event. Challenges faced by the nurses during end-o-life care are not new, but they are becoming more complex by improper laws of voluntary assisting dying (Stokes, 2017, pp. 150-155).

Strategies Used by Healthcare Professionals to Manage the Complexities of This Context

These challenges and issues faced by the healthcare professionals, specially nurses can be managed by help of some strategies that the nurse must follow while assisting the patient for voluntary assisted dying. These strategies are mentioned below:

• Nurses that are involved in providing the end-of-life care to the patients need to understand deeply about the disease and its associated symptoms. Nurse take the directions and wishes of the patient seriously and investigate about it. Otherwise, the treatment process provided by nurse like nutrition, hydration, ventilation, and resuscitation, are taken as illegal and becomes an ethical question for them (Voluntary assisted dying, 2020, para. 4-7).
• Nurse must ensure initially that nursing care is provided to them by their own informed consent. If the patient wants to withdraw or refuse the consent care, then they have right to withdraw from the treatment and care any time.
• Nurses are needed to be beware of all the mentioned laws and legislations that governs the advance care directives. They should also be aware about the workplace procedures, practice standards, and policies developed in regards to nursing body regulatory (Health practitioner information, 2020, para. 3-5).
• Nurse work to relieve the patient from suffering and pain and try to reduce them by effective pain and symptoms management. Nurse must follow this rule always to maintain the dignity of their patients.
• Nurse need to keep this in mind that when a person is not able to make any decision due to their illness, then nurse assist them and support the patient in decision-making process according to their capabilities. Moreover, nurse must respect the laws and legislations that are made and substitute process of decision-making in their own jurisdictions (Beuthin et al., 2018, pp. 511-520).
• Healthcare workers and nurse need to maintain a strategy which is required to be clear about the practice standards, ethics of death and dying and its respective laws that are developed by the workplace policies and regulatory bodies. This is in order to prevent the potential limitations and errors in their judgment. This will also help the nurse practitioners to practice with higher level of confidence in their support and knowledge (Pesut et al., 2019b, pp. 216-230).
• Nurse must maintain a standard which follows a fact that never refuse or abandon to provide safety and comfort measures to the patient. Those nurse who works in the jurisdictions where assisted death is legal must inform their employers consistently about the patient condition (Variath et al., 2020, pp. 1501–1516).
• Nurse should involve in discussions and development of end-of-life policies on National and local levels, including the hospice and palliative care services provided to the patients. Moreover, deep research has been undertaken for better understanding of any phenomena (Yousefy et al., 2015, pp. 73-78).

Conclusion on Voluntary Assisted Dying

It is to be noted that nurses are able to strengthen the patient’s focus when further treatment is not commenced or applicable. Presence of nurses is paramount and extremely important while assisting the patient and provide care and support. Nurse can seek, advocate, and share to complete the wishes of the patients as well as their families at their best possible extent. The only treatment for a patient is care, thus nurse can respond the patient with effective communication, composure, and understanding. However, from this essay it is concluded that there are various legal and ethical dilemmas that nurse and health-care team face during end-of-life care. Effective strategies must be followed to maintain these legal and ethical issues of nurses. Thus, thesis statement can be restated as:

“there are several ethical and legal dilemmas of nurse during voluntary assisted dying, and mentioned strategies must be followed to manage them effectively”.

References for Voluntary Assisted Dying

Bélanger E, Towers A, Wright DK, et al. (2019). Of dilemmas and tensions: a qualitative study of palliative care physicians’ positions regarding voluntary active euthanasia in Quebec. Canadian Journal of Medical Ethics, 45, 48-53.

Beuthin, R., Bruce, A., & Scaia, M. (2018). Medical assistance in dying (MAiD): Canadian nurses experience. Nursing Forum, 53(4), 511-520. https://doi.org/10.1111/nuf.12280

Elmore, J., Wright, D. K., & Paradis, M. (2016). Nurses’ moral experiences of assisted death: A meta-synthesis of qualitative research. Nursing Ethics, 25(8), 955–972. https://doi.org/10.1177/0969733016679468

Ethics in practice. (2015). Respecting choices in end-of-life care: Challenges and opportunities for RNs, 10-37. Retrieved 29 October, 2020 from: https://canadian-nurse.com/~/media/canadian-nurse/files/pdf%20en/respecting-choices-in-end-of-life-care.pdf

Fujioka, J., Mirza, R., McDonald, L., & Klinger, C. (2018). Implementation of medical assistance in dying: A scoping review of healthcare providers perspectives. Journal of Pain and Symptom Management, 55(6), 1564-1576. https://doi.org/10.1016/j.jpainsymman.2018.02.011

Grace, S., Tasha, P., & Christine, M. (2019). Medical assistance in dying: A scoping review to inform nurses’ practice. Journal of Hospice & Palliative Care, 21(1), 46-53. https://doi.org/10.1097/NJH.0000000000000486

Health practitioner information. (2020). Retrieved 29 October, 2020 from: https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/end-of-life-care/voluntary-assisted-dying/health-practitioner-information

Monteverde, S. (2017). Editorial: Nursing and assisted dying: Understanding the sounds of silence. Nursing Ethics, 24(1), 3–8. https://doi.org/10.1177/0969733016684967

Pesut, B., Greig, M., Thorne, S., Storch, J., Burgess, M., Tishelman, C., … Janke, R. (2019a). Nursing and euthanasia: A narrative review of the nursing ethics literature. Nursing Ethics, 27(1), 152–167. https://doi.org/10.1177/0969733019845127

Pesut, B., Thorne, S., Greig, M., Fulton, A., Janke, R., & Dunbar, M. (2019b). Ethical, policy, and practice implications of nurses’ experiences with assisted death. Advances in Nursing Science, 42(3), 216-230. https://doi.org/10.1097/ANS.0000000000000276

Stokes, F. (2017). The emerging role of nurse practitioners in physician-assisted death. The Journal of Nurse Practitioners, 13(2), 150-155. https://doi.org/10.1016/j.nurpra.2016.08.029

Usberg, G., Uibu, E., Urban, R., & Kangasniemi, M. (2020). Ethical conflicts in nursing: An interview study. Nursing Ethics, 096973302094575. https://doi.org/10.1177/0969733020945751

Variath, C., Peter, E., Cranley, L., Godkin, D., & Just, D. (2020). Relational influences on experiences with assisted dying: A scoping review. Nursing Ethics, 27(7), 1501–1516. https://doi.org/10.1177/0969733020921493

Voluntary assisted dying. (2020). Government of Western Australia. Department of Health. Retrieved 29 October, 2020 from: https://ww2.health.wa.gov.au/voluntaryassisteddying

Yousefy, A., Rezaei,H., & Beigzadeh, A. (2015). The perspective of nurses towards euthanasia and assisted suicide: A review article. Report of Health Care, 1(2), 73-78.

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