In the context of community psychiatric nursing (CPN), autonomy is the authority to engage in decision making process and act as per the professional knowledge level. It refers to the agreement made in relation to a person’s right to decide on the course of action supporting independent decision making process (Grace and DRN 2017). In the present scenario, there have been two cases where the concept of autonomy is an issue for the CPN. The first case relates to Bernie’s religious inclination as he has the accountability of taking holy orders. He is not in support of medical interventions due to his past experiences as well as the strong belief for religious interventions. The second case relates to Jim, who is found to be unforthcoming and uncommunicative. The CPN faces the concern of making Jim and Bernie communicate the concerns faced with the family members. Further, the CPN faces challenges to promote the capacity of these individuals to demonstrate autonomy (Chadwick and Gallagher 2016).
The practice of ensuring benefits for others as ethical conduct is termed as beneficence. On the other hand, non-maleficence refers to the avoidance of harm (Kangasniemi, Pakkanen and Korhonen 2015). In the present scenario, the CPN is facing an ethical dilemma as a choice between beneficence and non-maleficence. The first step for reducing harm, in parallel to increasing the benefits that the CPN can consider taking, is to convince the family members, Bernie, Edna and Jim to take up appropriate treatment. The CPN has to show dedication, advocacy, loyalty and truthfulness for solving issues faced by the individuals. On the other hand, the CPN must not enforce any treatment process on the patients. Well-established treatment procedures are to be applied for improving the quality of life of Bernie. It is necessary to engage in effective communication with Jim, Edna and Bernie to create a warming relationship. A supporting environment is to be created that can promote adherence to appropriate interventions. Such an environment would be such where ethical principles of non-maleficence would be applied. This would also ensure beneficence as a reduction of benefits would not take place (Chadwick and Gallagher 2016).
Bernie has been suffering from bipolar disorder and anxiety as he is engaged in compulsive activities. His actions such as locking himself and delusions imply that his experiences and beliefs are not in alignment with realities and established facts. Bernie can be sectioned under Mental Health Act in case his actions are directed towards self-harm (Stuart 2012). This would mean that Bernie would be detained in a mental health institution against consent for administration of relevant medication. Justice would be met as he would be given required adequate treatment in the context of legitimate resources. Complete fairness for the patient is to be maintained for treating him well with the aim of reducing the chances of self-harm and harm to others. Justice is ensured of CPN applies procedures to perpetuate care and help for the patient (Morrison-Valfre 2016).
Ethical issues in medical and clinical practice involve multidimensional factors that have a deep impact on the care professionals, patients and other stakeholders. Ethical considerations are imperative for appropriate decision-making process for ensuring that the philosophical standpoints applied are in alignment with moral principles. Medical practices such as abortion and euthanasia are highly controversial in contemporary society in healthcare and social context. Legalization of euthanasia has been much debated about by scholars who argue about the ideals of this longstanding practice. Public discussion about euthanasia is empowering the healthcare sectors to deliberate over the issue. The intrinsic disvalues involving such practices have repeatedly been highlighted across literature (Herring 2014). The present paper focuses on euthanasia, which is a topic for current ethical debate worldwide. The issues regarding euthanasia are explained in this paper. The consecutive section applies the philosophical standpoints of Deontology and Consequentialism to the ethical topic. A conclusion to the paper is drawn by providing a personal opinion on the morality of the practice of euthanasia based on the research undertaken.
For a considerable period, euthanasia is an important topic of debate among the masses, particularly in modern societies. Indeed, in western societies such as UK and US, euthanasia adds to situations for ethical dilemma faced by healthcare professionals, including community nurses. Euthanasia is the practice of ending the life of an individual in an intentional manner with the aim of relieving pain and suffering. Euthanasia is classified under three categories; voluntary euthanasia, involuntary euthanasia and non-voluntary euthanasia. There are at present different approaches to define euthanasia in the medical context. One approach explains it to be the “painless inducement of death”. Another approach has the notion that euthanasia is the “painless killing of a patient who is suffering a painful and incurable disease, or is in a coma”. Numerous attempts have been made to legalize euthanasia; however, a number of them have succeeded (Fremgen 2015). The issue is more severe since the arguments put up supporting and opposing the legalization of euthanasia is significant in their own respect. Those in support of euthanasia argue that euthanasia is to be me made legal since it relieves the suffering of the patient. Moreover, euthanasia is ethical since it ends the life of a person who is terminally ill, or is in a vegetative state, about to die within a short span. More significantly, the patient has the right to choose what is in the best interest for his life. Personal autonomy of the patient is maintained if he is allowed to end is life at his own wish. Moreover, the practice of euthanasia contributes to the reduction of burden on healthcare organizations as hospital resources are utilized in an appropriate manner due to the acquittal of beds. In this context, it is also to be mentioned that euthanasia also ensures that the spread of diseases is controlled within case settings.
As opined by Király (2016) euthanasia does not deserve support on ethical grounds due to multiple reasons. Firstly, it is not moral to end an individual’s life since all human beings have the right to live longer. Giving the permission to end the life of an individual is to be considered as ‘murder’. Principles of the sacredness of life also oppose euthanasia, owing to the fact that religious morality decrees that no individual has the right to take another person’s life. Herring (2014) Support this by stating that voluntary euthanasia provides a certain group of the healthcare professional with power that might be influenced in appropriately. A lack of accountability might also be shown from the care professional’s end if euthanasia is made legal as patients might not be informed about alternatives present, owing to their perception of a need of end-of-life practices.
A number of ethical philosophies have guided the debate regarding euthanasia where each puts forward arguments embedded in moral principles. Ethical philosophies, such as deontology, Consequentialism, and utilitarianism put forward propositions regarding the topic based on the concepts of right and wrong. In the context of moral philosophy, deontology is the ethical position taken after judging the morality related to a particular action based on a certain set of rules. It has also been denoted as ‘rule’, or ‘obligation’, or ‘duty’- based ethics since one is bound to his duty while engaging in the decision-making process. Deontology has been compared with consequentialism and virtue ethics (Koenane 2017). According to Kimsma (2016) deontologists have the belief that morality is to be perceived as a matter of duty and whether an action is right or wrong has nothing to do with the consequences of the same. Instead, it is a particular aspect of the action that makes it wither wrong or right in itself. There are numerous answers regarding how we can understand the moral duties, which are predominantly distinct and irreducible. Proponents of deontology argue that the duties are decided based on sheer practical rationales.
According to Lopez-Castroman (2017), involuntary euthanasia is the case when the patient does not wish to die. Non-voluntary euthanasia refers to those situations when the patient has not shown any expression of supporting the choice. In case of voluntary euthanasia, the patient expresses the wish to engage in end-of-life actions that lead to death. Among these three types, voluntary euthanasia grabs the most attention, which is controversial. From the deontological point of view, it is argued that people committing suicide are in a position to destruct the rationality in service to pain. It further highlights that rationality of human beings is of more importance as compared to anything else. Committing suicide or requesting for euthanasia has a negative influence on one’s perspective of respecting own rationality. However, this is not the case for situations when a personal request for euthanasia as he is about to lose the rational faculties, as in dementia disease, or he does not have rational faculties. One group of scholar might argue that reasonableness is something that bequeaths dignity on human beings and that we must respect the dignity of human beings. Thus, a human being losing his dignity through pain and illness might request for euthanasia in a legal manner. If euthanasia is allowed in such a case, then the person’s dignity is respected as he is helped to die as per his wish. This comes up as a valuable argument supporting euthanasia. Nevertheless, deontologists do not support the notion that one must be respecting another person’s choice when the action is morally wrong. At times, it is morally right to prevent a person from what he plans to do, and such is the case for euthanasia. Therefore, voluntary euthanasia is wrong if the wish to die is adjudged to be wrong.
Deontology perspective strongly disapproves euthanasia while providing a strong rationale to support such arguments. The God gives each human being a life and the right to live is immutable. Any infringement made in this regard, notwithstanding the justification or motivation, is a representation of an ethical transgression that is highly serious. Such contravention is to be prevented under all circumstances. Deontologists object euthanasia since the act is a deviation from the ethical standards founded in Christianity. A healthcare professional is obliged to protect and save the lives of individuals, and not take it away. In this viewpoint, euthanasia does not gain support as the precious gift of God that is life, is only to be cherished, and not ended (Ethical issues in health 2018).
As opposed to deontology, consequentialism refers to the ethical philosophy in support of decision making and actions based on the consequences of the conduct. From this standpoint, an act can be considered as morally right if the outcome, or consequence, of the same, is good or positive (Armstrong 2014). The principles of consequentialism are autonomy, beneficence, non-maleficence and justice. In relation to euthanasia, the principle of autonomy relates to the patient’s freedom to act as the advocate for their health. The principle of justice entails that discrimination is avoided while caring from patients with different needs, and equity is maintained. The principle of beneficence when applied brings into limelight the need of acting in a manner that is according o the best interest of the patient. Non-maleficence is to be applied for balancing the benefits emerging because of application of the principle of beneficence (Swazo 2017). In addition, the process of euthanasia supports the dignity of the person about to face death in near future. As per the supporters of consequentialism, is the fundamental right of the person to end his life if he feels that it is not worth the living. Euthanasia is also humane, as put forward by its supporters.
Euthanasia ends the suffering that is experienced by the individual, and this is perhaps the strongest argument put forward by those supporting euthanasia based on consequentialism theory of ethics. As discussed by Lam (2017) patients considered for euthanasia are those who are seriously ill and are untreatable. They are at the last stage of their lives, and their poor quality of life is manifested by unbearable pain and sufferings. The individual expresses a desire to end his life since the end is in any case inevitable. People, who are terminally ill, can be provided with relief if euthanasia is supported, thereby fostering outcomes that can be perceived as good. In the case where patients suffer from incurable diseases, the pain suffered due to the ailments is adverse, and the patient survives in hoping to die soon. Euthanasia is the end to such apprehension and agony, ensuring that the end of life is peaceful. If a patient who is terminally ill is subjected to painful, slow, and long death, it is much kinder to spare the individual this suffering. Medications that relieve patients of pain might be having side effects and might leave the patient sedated. Under such cases, it is expected that the patient would long to die. Avoidance of torturous existence through euthanasia is a positive outcome that demands support from healthcare domain. Another positive consequence of euthanasia has been linked with the reduced burden on healthcare settings. Patients who are terminally ill or are in the vegetative state take up hospitals beds. Palliative care undertaken for a long time has been denoted as the huge wasteful drain of medical resources. The same resources that are being spent on a patient about to die can be used for another patient who has all the chances of living life ahead. The resources can also be re-allocated for carrying out researches in future about the nature of diseases suffered by the patient. This would allow the future group of patients to receive better quality care by alleviation of symptoms (Vaughn 2015).
Paterson (2017) put forward an argumentative discussion on euthanasia. As the pros of euthanasia, the researcher pointed out death with dignity, end to suffering, freedom to choose and reduction in funds. The pain faced by the patients who are terminally ill is debilitating, and euthanasia is the way to stop the suffering. Death with dignity is achieved since living as a bed ridden person can be very much degrading. These individuals are to be given the opportunity to take a control over their lives. The biggest benefit of euthanasia is simply having a choice. It puts people back in control of their own life. The cons of euthanasia are that it devalues human lives, there lies certain religious problems and there is a chance of corruption. Euthanasia gives the impression that lives of humans have less value. The majority religions have very strict views on taking lives, raising concerns with euthanasia. Corruption can occur if health care professionals resort to euthanasia for saving money and other resources without the need of the same.
In conclusion, euthanasia is a highly debatable matter that draws on different ethical principles. A substantial amount of public debate analyses the suitability of euthanasia from a different dimension. The arguments against euthanasia are mostly dependent on the deontological perspective, while the support provided to euthanasia is based on the consequentialism perspective. Although the arguments coming up from both the sides have some valid key points, it is very much crucial to understand the implications for each. Patients suffering from constant misery and pain due to health complications are to be allowed to die with dignity if they express the desire to do so. In a society where individuals are concerned about personal rights and autonomy, there is no rationale why the freedom to choose death is perceived as unjustified. In my opinion, euthanasia is to be supported on ethical grounds. I firmly believe that it is the right of the patient to choose whether he is to live in the case when he is subjected to immense pain and suffering. Euthanasia, in my viewpoint, is a humane way of ending life, in a manner that promotes respect for personal autonomy. Suffering is often considered as a basic element of the human condition and evitable for human beings. Nevertheless, I feel that this does not support the endurance of endless pain solely because it is a part of everyone’s life. Briefly, my support is in favor of legalization of euthanasia.
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