Running head: Euthanasia Euthanasia: Perspectives on the Issue Angela Long Irina Fonaryuk Nancy Zoro Suzanne Bridges Dawn Drury Lillian Amador Talia Reed Pacific Lutheran University Table of Contents ? IntroductionPage 3 ? History of EuthanasiaPage 3 ? Legal Aspects of EuthanasiaPage 5 ? ProsPage 7 o Self-Determination, Individual Autonomy and Quality of LifePage 7 o Preservation of Dignity Page 7 o Social and Legal Arguments Page 8 o Changing Professional Attitudes Page 9 ? ConsPage 9 o Religious Perspectives Page 10 o ANA Position on Euthanasia Page 10 Slippery slope Page 11 o Euthanasia as a health care cost containment Page 12 ? Nursing Implications of Euthanasia Page 12 o As a Profession Page 12 o Nursing Education Page 13 o Nurse as an Individual Page 14 ? Conclusion Page 14 Euthanasia: Perspectives on the Issue The debate over euthanasia and physician assisted suicide is a multifaceted issue that surges throughout political, religious, and social circles. Currently in the United States, physician assisted suicide is only legal in Washington and Oregon states.It is crucial that nurses understand the various aspects of this topic, and are able to formulate an educated opinion on the issue. This paper will examine the various aspects of euthanasia, including pros, cons, and nursing implications, in order to assist student nurses in formulating their own opinions on this highly charged topic. In order to examine this issue, it is first necessary to define its various aspects.

Passive, or inactive, euthanasia involves stopping life support, or ending life-promoting treatments (such as dialysis or tube feedings).Active euthanasia is when life is purposefully ended, as in a physician administering a lethal dose of a medication. Physician assisted suicide is a type of active euthanasia where the patient ends his life with medication prescribed to him by his physician. History of Euthanasia Being able to understand the issues surrounding euthanasia requires an understanding of its history. History holds many lessons to be learned and it can be a vital aspect of any ethical discussion. Euthanasia has been a historical fact since Ancient Greek and Roman times (Westendorf, 2008).The majority of Spartans and Athenians believed that in order to make the state fit and functional, those who were ill, elderly, or deformed could end their lives or have others end it for them (Emanuel, 1994).

It was thought that this was for the good of society. There were a minority of physicians who opposed euthanasia as part of the Hippocratic Oath and had pledged “never (to) give a deadly drug to anybody if asked for it, nor……. make a suggestion to this effect” (Emanuel, 1994). In this respect, the physicians believed that death was a part of life and to cause premature death was cowardly.The early modern discussions of euthanasia included Sir Thomas More’s idea of an early 1500’s Utopian society (Emanuel, 1994). Sir Thomas More believed that in a Utopian society suffering should be alleviated; and is not a part of a perfect society.

In the 17th century, Francis Bacon argued for the belief that a physician is not just to restore health, but to also alleviate pain (Emanuel, 1994). Even though many people of this era were proponents and voiced interest in euthanasia it did not have a major impact on medical practice at that time.The 19th century saw many advances in medicine including the discovery of anesthesia.

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Morphine, ether, and chloroform were used by physicians to relieve pain. Many physicians of this era believed that anesthesia should be used to alleviate the pain of the dying. Samuel D. Williams, who was not a physician, went a step further by advocating the “use of chloroform or other medications not just to relieve the pain of dying, but to intentionally end a patient’s life” (Emanuel, 1994).

Journals rejected this view because of the fears many held that euthanasia would be abused (Emanuel, 1994).These arguments reflect current arguments for and against euthanasia. Though many continued to push for euthanasia, its opposition gained momentum with the outbreak of World War II and the discovery of Nazi death camps. The German Euthanasia Program began two full years before the outbreak of the war as a way to get rid of the non-Aryans and to purify the German race by means of involuntary euthanasia of individuals who had physical, emotional, or mental disabilities (Westendorf, 2008).These killings were termed “mercy killings” and in the early days were directed towards ridding society of unfit children and eventually progressed to include the elderly, those with neurological and other diseases, those committed to an institute for more than five years, those who did not have German citizenship, and those who were not of German or related blood, including Jews, Negroes, and Gypsies (The History Place, 1996).These mercy killings postponed any advancement in the movement for euthanasia and although there have been many petitions, initiatives, and court cases since World War II, it has not been until recently that the movement for euthanasia has made any significant ground. Legal Aspects of Euthanasia The laws regarding euthanasia differ greatly from one nation to another, and in some places, laws for or against suicide do not exist at all. One of the most well known nations to have legislation on this controversial issue is the Netherlands.

On April 10, 2001, the Netherlands became the first country to legalize not only physician assisted suicide, but also euthanasia under strict medical guidelines. Belgium and Luxembourg soon followed the Netherlands (Vollmar, 2008). Within the last decade, many countries around the world are seeing movements for legislation both for and against the subject though not all of the countries with laws have clearly defined laws. Within the United States, physician assisted suicide has been a highly publicized and controversial issue for many years.After a rocky battle, Oregon was the first and, until this past month, only state to legalize physician assisted suicide. Since the Oregon law was passed in 1997, three hundred forty-one people have died using the medications given to them by their physicians under this law (Oregon DHS, 2008). This demonstrates clearly, that when given the option, people will exercise their right to die.

In November 2008, the voters of Washington State made it the second state to legalize physician assisted suicide with Initiative 1000. Supporters of this law, like those for the Oregon law, had to fight for this issue.In 1990, the first state initiative on the issue was filed, and subsequently rejected by the voters in 1991 (Longwood University, 2002).

In Washington Initiative 1000 was filed in January 2008 and was modeled after Oregon’s Death with Dignity law. The laws in both Washington and Oregon are similar and carry the same stipulations for anyone who wants to utilize euthanasia. Two different physicians must deem a person terminally ill with less than six months to live. If they suspect the patient is depressed or that they have been coerced into requesting the medication, they must require a psychiatric examination.The patient must be able to administer the medication himself or herself without anyone’s help. The patient must make three separate requests. The two oral requests must be separated by a minimum waiting period, and the written request must be witnessed by two people who know the patient and are not affiliated with the patient’s medical care. The physician is required to counsel the patient on all alternatives, including hospice, palliative care and pain management.

There is no requirement to tell family members, but the physician must recommend this to the patient.Groups in many other states have tried to pass similar legislation to no avail (Longwood University, 2002). Between 1994 and 2006 there were seventy five legislative bills to legalize physician assisted suicide in twenty-one states (Robinson, 2008). All of them failed. Pros Self-Determination, Individual Autonomy and Quality of Life The concept of self-determination is inextricably linked to any discussion regarding euthanasia. Derek Humphrey, an advocate for euthanasia says, “The right to choose to die when in advanced terminal or hopeless illness is the ultimate civil liberty (Humphry, 2000). It can be argued that the ability to have a controlling voice in determining the manner, place and time of one’s death as with all other major life decisions cannot justifiably be taken from someone.

This is especially true for a person who is of sound mind but ill body. According to proponents of physician aid in dying, terminal individuals suffering with unremitting, unbearable pain, should not this decision taken from them (APA, 2008). The experience of the individual and their own perception of quality of life will have a substantial weight relative to the decisions an individual would make regarding euthanasia.Laws that limit the range of options available to a person, in themselves diminish the person’s quality of life even further as it leaves him or her feeling even more powerless. Quality of life is balanced against the individual’s values of the sanctity of life. These are very individual matters and are subject to the person’s own sensibilities and tolerance (Humphry, 2000).

Preservation of Dignity In the vast majority of people, death comes without prolonged, unrelenting pain and a compromised quality of life that would lead one to consider suicide as a viable option.However, those who do find themselves in this state must have as many options available as possible. For many people, there may be no real relief from the agony that illness and medical intervention can offer. And for some, the only effective relief comes with death (AAHPM, 2007). ). The medical community and their codes of ethics (ANA, 2005) as well as the modern version of the physician’s Hippocratic Oath (Louis Lasagna, 2001)) explicitly support the principles of self-determination and the autonomy of the person.

It directs professionals to serve people with compassion while honoring their values, rights and wishes.In other words, holistic medical treatment is necessary. For medical professionals to disregard a person’s rights or wishes or impose their own values onto their patients, would be violations of the codes and oaths. However, the American Medical Association and the American Nurses Association have both settled on the side of clear opposition to physician aid in dying and have interpreted their own codes of ethics in a manner inconsistent with that type of intervention (ANA, 2008) (AMA, 1996). Social and Legal Arguments Legalizing physician assisted suicide would offer a variety of benefits to society.Both the individuals who seek that option and the medical professionals who serve them would benefit.

First, it would bring the practice out from the shadows where it is already certainly being conducted (AAHPM, 2007). Brought to the light of day, the practice would be regulated and would have standards of care which would both hold professionals accountable and provide protection for the patient and their family in the presence of negligence or criminal conduct. It would also benefit patients who would suffer needlessly without this additional option. Changing Professional AttitudesSupport for Death with Dignity legislation is growing among professional organizations.

Recently, organizations such as the American College of Legal Medicine and the American Public Health Association have issued statements of support for physician aid in dying (Compassion and Choices, 2005). Organizations, such as the American Psychological Association and the American Academy of Hospice and Palliative Medicine, who are not yet prepared to support these laws have issued statements declaring essentially “studied neutrality” (Compassion and Choices, 2005).While there remains a great deal of opposition to physician aid in dying, the trend is increasing toward acceptance in the professional, legal and public spheres.

It will take a very long time to achieve universal acceptance, if it ever comes. In the meantime the debate continues with strong arguments on both sides. Cons Medicine has advanced in technology and life sustaining treatments have increased greatly; which has brought euthanasia to the forefront even more. People are living longer, but not necessarily more quality lives.The arguments for legalizing euthanasia emphasize the autonomy of the patient and the pain alleviating factors.

We have to recognize that euthanasia and assisted suicide lead to ethical, psychological, and religious challenges and have implications for healthcare practice. Religious Perspectives Religion plays a vital role in the debate against euthanasia. Many religions view life as a sanctified gift. Many believe that only God has the authority to give and take someone’s life. The Catholic Church opposes the practice of suicide in any form because the act intentionally takes an innocent human life (Praskwiecz, 2000).Most importantly, the Vatican’s 1980 Declaration on euthanasia states “No one can make an attempt on the life of an innocent person without opposing God’s love for that person, without violating a fundamental right, and therefore without committing a crime of the utmost sin. ” Furthermore, the Jewish faith also states that suicide may be regarded as worse than murder.

“A murderer may repent after the deed, but the person who takes his own life forfeits that possibility” (Rose, 2007). The Islamic faith views suicide as sinful, but humans are regarded as fallible.The act that intentionally causes the death of an innocent person is held to be absolutely immoral in many religious circles. Many feel strongly that the physician does not have the authority to take a person’s life. ANA Position on Euthanasia The American Nurses Association (ANA) holds the position on this issue that assisting an individual to die is not compatible with the nurse’s role in society.

Non-maleficence means to do no harm and this is the pledge nurses make to society. By assisting the patient in suicide, it destroys the trust between the nurse and the patient.Medical deontology influences duties that physicians hold to their patients. “They have a duty to treat, duty to save and preserve life, the duty to relieve suffering, and the duty not to abandon their patients” (Praskwiecz, 2000). The duty to relieve suffering does not override the duty to preserve life. If cure is not possible, then the physician has the duty not to abandon the patient, but to provide palliative care (Praskwiecz, 2000). Effective palliative care gives the patient and their loved ones a chance to spend quality time together.They can use this time to bring any unfinished business in their lives to a proper closure.

Slippery slope As history has documented, assisted suicide is a threat to vulnerable populations such as the poor, elderly, women, and physically and mentally disabled. This group of people would be more likely to cede to pressure to request suicide. For example, depressed patients might seek to end their lives rather than seek psychological treatment since depression in terminally ill patients is frequently and often misdiagnosed.

Families may force patients into accepting death if they cannot or will not take care of the patient. Physician assisted suicide could become an easy substitute to caring for the terminally ill rather than being reserved as an option when all attempts to alleviate suffering have failed (Rose, 2007). Euthanasia is the beginning of a slippery slope leading to involuntary euthanasia. As in WWII in the Nazi death camps, this could eventually end up leading to a social policy endorsing involuntary euthanasia (Dieterle, 2004).Since vulnerable people often do not have a voice, they are especially at risk for involuntary euthanasia, as history has demonstrated.

Euthanasia as a health care cost containment Allowing euthanasia will discourage the search for new cures and treatments for the terminally ill. “It is striking that when taking into account the savings from suicide (from not having to treat their depression or pay for pensions and nursing home care); there is a net savings to society as a whole” (Yang and Lester, 2006).The study done by Yang and Lester focuses on the cost of suicide and includes the potential savings from assisted suicide.

Even though they highlight the financial gain, this observation has already been made by the Oregon Health Plan that offered terminal cancer patient Randy Stroup (as well as many others) the opportunity to end his life but refused to pay for treatment of his terminal disease (Springer, 2008. ) Cost containment was, in fact, one of the persuasive arguments used by the Nazi regime during WWII.The government argued that vulnerable populations were a financial burden and that it would be in their best interest to end their lives since they were miserable anyways. Money could then be used to help with the financial burden of war supplies and caring for soldiers (Hoskins, 2005. ) Nursing Implications of Euthanasia As a Profession Nursing has been a profession held in high regard for a very long time. Nurses are considered ethical and trustworthy by many. Nursing as a profession may suffer negative consequences as a result of euthanasia becoming legalized.Nurses operate under a moral code that includes beneficence, and non-maleficence.

Beneficence is the will to do good and non-maleficence is to do no harm. Many people consider that ending the life of a person who is terminal and enduring great suffering is doing good, but there are also many who do not (Berry et al, 1997. ) Similarly, non-maleficence could be viewed from either side of the spectrum. Those for euthanasia would not see it as doing harm, but as ending needless suffering, and therefore doing good. Those against it, however, would see it as a breach of non-maleficence (Berry et al, 1997. If the public views nursing as an ethical practice, but see some of its practices as unethical, then the practice as a whole becomes compromised and our high public regard may diminish over time. The practice of nursing has long had a high regard for and treasuring of life.

It is our job to save and protect lives, and so when considering euthanasia, how does that fit into nursing practice? Many consider helping a person to find peace and to gain some control over their death as a means of treasuring life. It provides them with the chance to die in a dignified manner, and to not suffer.Many also consider euthanasia a direct devaluing of life. People view euthanasia from both perspectives, and so the question that remains is how these varying perspectives will impact nurses (Volker, 2000). If we are expected to preserve lives, and yet we participate in taking them, how will that play out in the publics’ trust and perception of nurses (Volker, 2000)? Nursing Education In Washington State, euthanasia has been legalized, and so the focus needs to shift from questioning its legality to how we can prepare nurses and nursing students for its implications.There are many educational needs that arise with euthanasia that must be addressed. The nurse needs to be educated on the laws, and how our scope of practice fits into that.

The nurse needs to understand what their possible role in euthanasia might be, whether that be witnessing a patient’s verbal request as part of the process, or referring them to a doctor (Berry et al, 1997. ) The nurse needs to be knowledgeable about how to give a client information without interjecting their opinion and impacting the client’s decision.It is not our job to push our values on our clients. It is because of this that we must really have a strong understanding of both sides of the issue, because it is easier to have empathy and see it from the other’s point of view if you have already taken their view into account and attempted to process it. The nurse also needs to be educated about properly assessing depression, pain and mental health, as alterations cause a dying person to seek out euthanasia for an issue that can be fixed (Brown, 2004).Nursing institutions and nurse managers will also need education in order to handle the emotional aspects that will arise around euthanasia (Volker, 2000). Even if a nurse supports euthanasia, they may still find that they have conflicting emotions and possibly guilt after a patient has made a decision to end their life (Brown, 2004). This is a normal response and nursing institutions need to be prepared for it and have protocols in place for how to support the nurse through it (Volker, 2000.

) Nurse as an IndividualThe implications of euthanasia on the individual nurse are huge and require the nurse to do some values clarification. The nurse must make a definitive decision about where they stand on the issue. The nurse needs to evaluate all aspects of the issue and try to understand it fully and then make a decision that they feel comfortable with. Once they have made their decision, if they are against it, they need to consider if they can get involved with it on any level. If they cannot, then they need to make sure that their career path does not intersect with euthanasia.If a person feels strongly against something, and they participate in it anyways, then their actions clash with their values and their emotional response will not be a positive one. A nurse will confront many controversial issues during her career, including euthanasia and physician assisted suicide.

In order to provide the best care and advocacy to a client, it is crucial that a nurse be able to form her own opinions, and think critically about controversial issues. The issue of euthanasia will forever be important.States will continue to pass laws for and against physician assisted suicide, and all medical professionals will continuously have to examine exactly how to apply the oath to, “First do no harm. ” How we split up the research and paper Angela: Researched and wrote the history section, and created in-text citations for section, wrote own references in APA format Dawn: Researched and wrote the legal aspects/current legislation, and created in-text citations for section, wrote own references in APA format Irina: Researched and helped write the con section, assisted with the pro section in-text citations Lillian: Researched and wrote pro sectionNancy: Researched and wrote con section, and created in-text citations for section, wrote own references in APA format Suzanne: Helped research the pro section, wrote intro and conclusion, and compiled the reference page, functioned as group facilitator , compiled all the separate sections into one paper Talia: Researched and wrote the nursing implications section, and created in-text citations for section, wrote own references in APA format and edited the paper How we split up the presentation Angela: Compiled and presented history slides, and intro slide Dawn: Compiled and presented legislation slidesIrina: Compiled and presented con section slides with Nancy Lillian: Presented on pro info, found video clip Nancy: Compiled and presented con section slides with Irina Suzanne: Compiled and presented pro section slides Talia: Compiled and presented nursing implications slides and conclusion References Coogan, M. The New Oxford Annotated Bible. (2001). 3rd Edition Oxford University.

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