Enhancing Patient Care: Ethical Issues

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Table of Contents

Introduction
Ability to respond to patients
Access to Healthcare
The Issue on Euthanasia
Conclusion
References

Introduction

Ethics in nursing practice entails many facets of professional conduct. This kind of professional commitment is demonstrated through the desire to help, a sense of obligation and a compliance with professional standards. Professional accountability is one of the many important ethical issues when one looks at this closely. This will all depend on one’s sense of responsibility and personal integrity.

Professionals are governed by the standards of conduct set forth by their respective professions. Ethics in nursing practice is concerned with the conduct of nurses in performing acts which are deemed ethically right or wrong. Nurses who violate professional ethics may be subject to discipline by nursing associations and may be legally liable for their actions. This paper looks at the ethical standards in patient care and the impact of these ethical issues on health care professionals. It shall focus particularly on euthanasia and its many ramifications in the nursing field.

Ability to respond to patients

The word ethics comes from the Greek word ethos meaning “habitual usage, conduct and character” (Code of Ethics for Nurses). Today, nurses are faced with ethical and critical decisions on patient care involving new technology which can have potential benefit or harm to patients. A patient’s life may depend on the nurse’s ability to think and respond while he/she is on duty (Code of Ethics for Nurses). The nurse must also take note that the right of patients to know the truth about their condition, prognosis, and treatment is an issue between the physician and the patient. The current trend now is toward more frankness on the part of physicians (Ngo-Metzger et.al. 2008).

In the past, the moral obligation to disclose the truth—because the patient has the right to know and adjust to it—was often overcome by the professional need to protect the patient from the potential physical or emotional harm that could be caused by knowledge of a critical or terminal condition. In some cases, the professional could not deal with the truth, and therefore avoided discussion of the situation with the patient.

Access to Healthcare

Access to decent healthcare is a right of everyone. Healthcare or the administration with appropriate treatment and attention during times of illness or health problem is a basic need that goes with our innate tendency to preserve human life. Among the medical field practitioners, the nurses are the ones most exposed to delivering immediate and constant care to patients. Even if nurses mainly stay behind the shadows of the doctors, as the latter have more comprehensive training and wield greater decisional power, nurses are nevertheless the most visible members in the delivery of care to patients as well as to patients’ close relations. Such a crucial task entails a solid, clear-cut, and binding set of standards and regulations. And since nursing is directly involved with the life and death of individuals, the practice is intertwined with ethical issues and moral debates. Hence, each nation has formulated its own laws on healthcare, and many of these laws are reflective of the Code of Ethics for Nurses, which is universally recognized. (Code of Ethics for Nurses).

The nurse’s responsibility exceeds more than the physical needs of an individual. Nurses must also respect the dignity of the patient and recognize him as a human being, not just another item or case in their record that needs to be accomplished and be done with. The ICN Code of Ethics for Nurses has established the ideal manner in which nurses should function within work and society. Australia also has enacted laws that respect personal right and decision involving one’s body. Furthermore, the Code of Ethics for Nurses in Australia details the Australian’s nurses’ obligations and rights, which is of course founded on the universal ICN Code. These three will be used in the succeeding discussions of this paper (Code of Ethics for Nurses).

The Issue on Euthanasia

People involved in the caring of the sick and dying have a tradition of concern about moral issues and the application of ethics to the decision-making process. This tradition is due, in part, to the tenets of the Hippocratic oath. Most people die in acceptable degrees of comfort but for some, dying is a most distressing experience. The things that can make dying so distressing include physical pain, mental distress, and the knowledge that the suffering is pointless in the sense that it has to be borne without hope of subsequent improvement in health or relief in suffering. (Dowbiggin xi).

This remains to be one of the longest running debates among various sectors of society, which has been carried on from the past to the modern world, is the issue of euthanasia. Euthanasia has elicited intense debates among people. Ambivalence is the name of the game when it comes to the question of whether a person has the right to take the life of a patient who is terminally-ill.

The word euthanasia is taken from the Greek word for “easy death” (Dowbiggin xi). Euthanasia is generally classified into either passive or active euthanasia, depending on the actions undertaken by the attending physician. However, some groups opposing euthanasia of whatever form provide no distinction between the two because of the argument that in both ways, men, more particularly physicians, act as God. According to Ian Dowbiggin, “for centuries, euthanasia had normally been understood to mean the process whereby the relief of pain for the dying was the best way to ensure an easy death” (Dowbiggin 1). Thus, in essence, euthanasia is supposed to benefit the patients suffering from pain or agonizing lives.

Euthanasia has a certain way of changing the public conscience

Active euthanasia in the form of physician-assisted suicide is given mostly to patients who suffer from a deterioration of his abilities as a person. This includes those suffering from unbearable pain or finding their lives to have turned into agony. For example, in the country of Netherlands, the law euthanasia is restricted “to terminal patients suffering unbearable pain with no hope of improvement, and who request to die when they are of sound mind” (Associated Press). Meanwhile, in the USA Terri Schiavo’s case seemed like passive euthanasia since she was allowed to have her feeding tube removed (Grossman). Even the Associated Press reports that in 2005, euthanasia was legalized in countries like Belgium and Netherlands, including the state of Oregon in the USA. (Associated Press).

There is a strong argument to support this and this is called the “slippery slope” theory. It states that the practice of allowing euthanasia, although regulated by the state, is open to abuses and exploitation. Opponents argue that allowing euthanasia is like opening the medical world into abuses not just of medical practitioners but also of the patients and their relatives. Once euthanasia becomes an option, people and medical practitioners might make this an easy option or even an escape from their responsibilities to the patients.

When the patients themselves request that their life be cut short due to the extreme suffering from their disease, then this can become another issue. Still, opponents may not be ready to give in to this request. According to Rizkalla, these kinds of request might have been made due to the erratic emotions during a crisis. They still think that there might be a possibility that a patient, who has decided to undergo euthanasia, might still change his mind the next day. The variability of human emotions as well as the different situations can change a person’s sense and rationality.

Euthanasia also has a certain way of hardening people’s hearts and taking people’s lives for granted. An example of this are infants with Down’s syndrome who need operations for congenital defects unrelated to the syndrome to live. Sometimes, there is no operation, and the baby dies, but when there is no such defect, the baby lives on. An operation such as removing an intestinal obstruction is not prohibitively difficult. The reason why such operations are not performed in these cases is clearly, that the child has Down’s syndrome and the parents and the doctor may think that because of that fact it is better for the child to die. Still, when one looks closely at this situation, this life and death situation is decided on irrelevant grounds. It is the Down’s syndrome, and not the intestines, that is the issue. The matter should be decided, if at all, on that basis and not be allowed to depend on the essentially irrelevant question of whether the intestinal tract is blocked.

Euthanasia violates accepted codes of medical ethics

Values of people motivate their behavior. The judgment of right and wrong or good and bad is moral judgments based on values. In the course of human interactions there are many situations in which it is difficult to make a decision because values come into conflict. Conflict between moral values results in an ethical problem. Major influences on moral decision making on the dying are personal, personal. Clarification evolves because of serious consideration of the effect decisions have on others. An individual must engage in values clarification in order to develop a personal decision-making process that fosters ethical behavior. Decisions that deal with morality are decisions that have significant social importance in terms of the way they affect the welfare of others. Moral decisions are those which are correct according to philosophical principles. Introspective consideration of one’s value hierarchy leads to a personal ethic. Ideally, a person can make morally correct choices by following a decision-making process which involves contemplation and weighing the effects of each choice according to ethical principles.

Dr. Jack Kevorkian, upon request of his patient suffering from amyotrophic lateral sclerosis, performed active euthanasia by injecting poison to stop the heart of the latter (Dowbiggin xi). According to Dowbiggin, the procedure shown in a CBS television program was not the first for Dr. Kevorkian who had performed the same procedure for several patients resulting to various criminal charges of assisting suicide against him from which he was acquitted except to the last one shown on CBS arguably for him crossing the line (Dowbiggin xi). It has always been contrasted with the most accepted euthanasia- the passive euthanasia- whereby active euthanasia, as the name implies, needs the active participation of the doctor to hasten the death of a patient in an agonizing pain while passive euthanasia is more of letting the patient dies his natural death by switching off life support machines. The American Medical Association has made the pronouncement that “Physician assisted suicide could undermine the trust that is essential in the doctor-patient relationship by blurring the time-honored line between healing and harming.” Physicians also cannot heal all the time, and it is their responsibility to use his/her best skills in the best interests of the patient, whatever those happen to be—to heal when possible, to comfort always, and when neither healing nor comforting is possible, to do then whatever is in the patient’s best interests. (American Nurses Association).

Euthanasia denies patients the final stage of growth

Good care can help manage pain and other physical problems, although sometimes at a high cost from the patient’s point of view. Loving care can usually keep existential problems within a tolerable range. But even the best palliative and supportive care cannot always make life tolerable and at the end of their lives, some people simply want to bring their useless suffering to a close. (Brock 11).

In order to support this argument, some say that they are in favor of active euthanasia since they be giving terminally-ill patients the dignity until the end of their lives. Active euthanasia gives patients the chance to die with dignity instead of prolonging their lives but degrading their being a person. However, one argues that there is real growth even during the last moments of one’s life. Polls indicate that most requests for assistance in dying come not from the least privileged members of society but from the most privileged. Perhaps the privileged are more accustomed to being in charged and in control of their lives. The poor may be better at tolerating dreadful conditions because they have more experience of having had to do that. (Brock 11).

People are still concerned with having dignity until their last days and having control with their own lives (Brock 11). When patients are put into a life-support system or whose lives are only sustained by medical technology, most of them are becoming worthless relative to what they had been before they were struck by these deadly diseases. According to Dan Brock, “the central aspect of human dignity lies in people’s capacity to direct their lives” hence, once terminally-ill patient losses his capacity to take responsibility for his life, he, in effect loses his dignity as a person (Brock 11).

Conclusion

Indeed, decisions about when or whether life-support measures should be initiated or terminated are often difficult to make. Moreover, the definition of “extraordinary” life-support measures has not yet been established. Questions involving what circumstances is it justifiable as well as is legal sanction must be considered. In these situations, the concept of “death with dignity” is a critical issue in these decisions. Society is rapidly changing its attitudes about major ethical issues. These changes often have a direct effect on nursing practice. Nurses in many instances are faced with providing nursing care in situations which contradict their own personal values. New emphasis on equal rights and individual rights brings up issues and an expanded role for patient care in making informed decisions about their own care, treatments and about their right to die with dignity.

References

American Nurses Association. 600 Maryland Ave. SW, Ste 100 West, Washington, DC. Web.

Associated Press. Dutch Government to Give Opinion on Expanding Euthanasia Policy. USA Today 2005. Web.

Australian Nursing Council, Australian Nursing Federation & Royal College of Nursing. (1993).Code of Ethics for Nurses in Australia. Web.

Brock, D.W. (1992):Voluntary Active Euthanasia. The Hastings Center Report. 22.2

Code of Ethics for Nurses with Interpretive Statements (2003). Health Care Industry. Alabama State Nurses’ Association. Web.

Code of Ethics for Nurses. Web.

Dowbiggin, I.( 2003). A Merciful End: The Euthanasia Movement in Modern America. New York: Oxford University Press,

Euthanasia Case Studies. (2005). Web.

Grossman, C.L. (2003). Experts Draw Distinct Line in Cases of Schiavo and the Pope. USA Today. Web.

International Council of Nurses.(2006). The ICN Code of Ethics for Nurses. Web.

Ngo-Metzger, Q. Srinivasan, M. L. Solomon, Meyskens, F. Jr. (2008). End-of-life care: guidelines for patient-centered communication. American Family Physician, Web.

Otlowski, M. (1992). Active Voluntary Euthanasia _ A Timely Reappraisal. Web.

Rizkalla, M. (2005). An Analysis of the Arguments for Active Euthanasia (doctor-assisted suicide) and Rebuttals against It. Modern Social Issues: Active Euthanasia. Web.

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