Scholarly PaperNurses face numerous ethical dilemmas during their professional career. These include but are not limited to medication errors, unqualified or negligent fellow nurses, high nurse to patient ratio, reckless and unresponsive physicians and assignments in hospital units without the proper training. One particular ethical issue viewed as the most important to the nursing profession is end of life care. This is a significant issue because it involves death and the medical and nursing care given to a patient is not to cure but to comfort. An essential role of the nurse in end of life care is to fulfill the patient’s and family’s wishes. However, this role is challenged and tested with several difficult circumstances. This paper will discuss nursing and end of life care. Nursing field provides comfort and care to patients and families while implementing medical orders given by physicians. Though nurses carry out medical orders and procedures, giving care and comfort is a significant part of the profession. Thus end of life care is a sensitive and taxing subject for the whole nursing profession. According to the code of ethics for nurses, the nurse’s first obligation is not to the family or friends but to the patient. Patients capable of making their own decisions should be given an opportunity to voice their wishes on their medical care. This is part of self determination; the nurse needs to respect the patient’s wishes at all times. For instance, if the patient had agreed to do not resuscitate (DNR) and has signed the appropriate paperwork when mentally able, the nurse will follow the patient’s wishes even if it is contradictory to the families. In absence of a DNR , family members can make health care decision for the patient. The situation is even more difficult if conflicting views exist in the decision making process. The nursing code of ethics also emphasizes to give adequate care to everyone of different culture, religion and ethnic background. A nurse should be understandable of different cultures and religions during end of life. What is the rationale for considering this ethical/moral situation in current nursing practice as most important to the profession of nursing? How is this ethical/moral situation related to the Code for Nurses with Interpretive Statements? How do the four major ethical principles which are most important to nursing relate to this ethical situation? Nonmalficince, beneficence, justice and autonomyA key ethical principle in this ethical issue is autonomy. Under current law, when a person is incompetent to consent to or refuse treatment, evidence of that person’s views and wishes is used to determine whether she/he would have consented to treatment. A popular example is the 2003 case of Terri Schiavo. This woman was involved in a fatal accident and was in vegetative state, kept alive by a ventilator and fed through a gastrostomy tube. Her family wanted her kept alive but her husband chose otherwise. He and others testified Terri Schiavo would not have wanted to be kept alive in a vegetative state but her family an opposing view. Ultimately, the judge did not believe the family members story was credible. After analyzing the situation, the court determined Terri Schiavo would not have consented to be kept alive. This decision by the court was a demonstration of the ethical principles of autonomy and self determinationWhich ethical theory would be most appropriate as a basis for resolution of the situation? What is the rationale for the choice of this ethical theory for resolution of the situation? How do the justice perspective or the care perspective relate to the resolution of the situationconscious, mentally competent person, usually with a severe physical ailment, loses the will to live. Many have said that keeping them alive is a form of cruel and unusual punishment. They may want life support to be disconnected so that they can die quickly, painlessly, and with dignity. Most doctors are trained to try their best to defeat death, or at least try to delay it as long as possible. But if the patient is hopelessly ill, and would prefer to die, the doctor may consult the hospital ethics committee, and take him or her off of life support. It is done when a terminally ill patient’s family member chooses to take their loved one off life support. The patient may also been in a persistent vegetative state (PVS). A PVS patient has no self-awareness or any awareness of their surroundings. This is because the cerebral cortex, the part of the brain used for thinking, is dead. But the brain stem still works. A PVS patient will never become conscious again after entering this state. The patient will remain like this until they die. These patients are not brain dead though. Technically, brain death occurs when the brain tissue breaks down and disables the lungs and other vital organs. Machines are then required to keep the patient alive. The family may choose to have the patient taken off of life support if they wish. And if the doctor feels that it is okay, the patient will be removed from the life support ( Rachels, 20). From an ethical standpoint the debate of whether or not euthanasia should be allowed will always be on the table. Those in favor of euthanasia argue that a civilized society should allow people to die in dignity and without pain, and should allow others to help them do so if they cannot manage it on their own (McLean). They say that our bodies are our own, and we should be allowed to do what we want with them. So it’s wrong to make anyone live longer than they want. In fact making people go on living when they don’t want to violates their personal freedom and human rights. They say it is immoral to force people to continue living in suffering and pain. On the other hand, religious opponents of euthanasia believe that life is given by God, and only God should decide when to end it. This lays as another burning issue society has to face. I personally believe in discontinuing artificial life support systems which can kill a person. I believe even though God tells us not to kill, it is unnatural to go against the normal course of nature and death and keep a person alive who would have died if no technological measures were taken. However, I don’t believe in injecting lethal medications to help a person die. I believe that goes against the commandment ” don’t kill”. Rachels, J The End of Life: Euthanasia and Morality. Oxford University Press 1986McLean, S (ed.) Religious Issues and Euthanasia. Dartmouth 1996. http://nursingworld. org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics. aspxAbigail TamruMay 29, 2007Ethics PaperA major ethical/moral dilemma facing the current nursing practice is end of life care. Advanced directives play a great role leaves euthanasia is one of society’s widely debated moral issues. Cases have been seen in courts for a number of years, its ethics and morality being questioned. Euthanasia is defined by The American Heritage Dictionary as, ” the action of killing an individual for reasons considered to be merciful.” The word ” euthanasia” comes from the Greek eu, ” good”, and thanatos, ” death,” literally meaning, ” good death”; however, the word ” euthanasia” is much more difficult to define (Humphry, 97). Each person may define euthanasia differently. Euthanasia has been accepted both legally and morally in various forms in many societies. In ancient Greece and Rome it was permissible in some situations to help others die. Oregon, the Netherlands and Belgium are the only places in the world where laws specifically permit euthanasia or physician assisted suicide. Oregon permits physician assisted suicide. The Netherlands and Belgium permit both euthanasia and physician assisted suicide. The difference between Euthanasia and physician assisted suicide is that euthanasia is the intentional ending of a patient’s life by a physician, usually by lethal injection., where as physician assisted suicide refers to the ending of life through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose (Humphry, 121). The Times (24 January 2007) reported that, according to the 2007 British Social Attitudes survey, 80% of the public said they wanted the law changed to give terminally ill patients the right to die with a doctor’s help. In the same survey, 45% supported giving patients with non-terminal illnesses the option of euthanasia. A majority was opposed to relatives being involved in a patient’s death. There are three different types of euthanasia. The first type is active voluntary Euthanasia. This is where a conscious, mentally competent person, usually with a severe physical ailment, loses the will to live. Many have said that keeping them alive is a form of cruel and unusual punishment. They may want life support to be disconnected so that they can die quickly, painlessly, and with dignity. Most doctors are trained to try their best to defeat death, or at least try to delay it as long as possible. But if the patient is hopelessly ill, and would prefer to die, the doctor may consult the hospital ethics committee, and take him or her off of life support. When taken to court in these issues, the doctors defend themselves saying, ” I didn’t kill him, I let him die.” This is illegal throughout the United States and the rest of the world, but it still is a common occurrence (Rachels, 16). The second type is passive voluntary euthanasia. It is done when a terminally ill patient’s family member chooses to take their loved one off life support. The patient may also been in a persistent vegetative state (PVS). A PVS patient has no self-awareness or any awareness of their surroundings. This is because the cerebral cortex, the part of the brain used for thinking, is dead. But the brain stem still works. A PVS patient will never become conscious again after entering this state. The patient will remain like this until they die. These patients are not brain dead though. Technically, brain death occurs when the brain tissue breaks down and disables the lungs and other vital organs. Machines are then required to keep the patient alive. The family may choose to have the patient taken off of life support if they wish. And if the doctor feels that it is okay, the patient will be removed from the life support ( Rachels, 20). The third and most intensely contested type of euthanasia is physician-assisted suicide. Dr. Jack Kevorkian and his suicide machine have become famous for his contribution to this type of euthanasia. His first case in 1990, involved Janet Adkins of Portland, OR. The patient had Alzheimer’s disease. She had seen the doctor on Donahue and in Newsweek magazine, and contacted him. He outfitted his Volkswagen van with the suicide device, and on June 4th 1990 they drove to a local park in Michigan to do the procedure. The machine had three bottles of liquid hanging upside down inside a frame. One had a harmless saline solution in it; the next had a chemical that causes unconsciousness; and the third had potassium chloride, a compound that stops the heart. Kevorkian hooked Adkins up to a tube similar to that on an I. V. She died in less than six minutes. According to Kevorkian, just before dying, she looked at him with grateful eyes and said thank you. The doctor then called the police and reported what had happened. He was barred from using the suicide machine again, but four months later he assisted in the suicide of two women (Rachels, 27). From an ethical standpoint the debate of whether or not euthanasia should be allowed will always be on the table. Those in favor of euthanasia argue that a civilized society should allow people to die in dignity and without pain, and should allow others to help them do so if they cannot manage it on their own (McLean). They say that our bodies are our own, and we should be allowed to do what we want with them. So it’s wrong to make anyone live longer than they want. In fact making people go on living when they don’t want to violates their personal freedom and human rights. They say it is immoral to force people to continue living in suffering and pain. On the other hand, religious opponents of euthanasia believe that life is given by God, and only God should decide when to end it. Other opponents fear that if euthanasia was made legal, the laws regulating it would be abused, and people would be killed who didn’t really want to die (Kilner). Different religions deal with death in various ways. They also have different beliefs when it comes to euthanasia. Here is a brief description and comparison on how the two major religions of the world (Christianity and Islam) feel about the concept of Euthanasia. Muslims are against euthanasia. They believe that all human life is sacred because it is given by Allah, and that Allah chooses how long each person will live. Human beings should not interfere in this. Euthanasia and suicide are not included among the reasons allowed for killing in Islam. ” Do not take life, which Allah made sacred, other than in the course of justice (Quran 17: 33).” There are verses in the Quran that convey the message that suicide and euthanasia are explicitly forbidden, ” Destroy not yourselves, surely Allah is ever merciful to you” ( Quran 4: 29). Christians are mostly against euthanasia. The arguments are usually based on the beliefs that life is given by God, and that human beings are made in God’s image. Some churches also emphasize the importance of not interfering with the natural process of death. Christians believe that life is a gift from God. Birth and death are part of the life processes which God has created, so we should respect them (Barnard). Therefore no human being has the authority to take the life of any innocent person, even if that person wants to die. People should not ask for euthanasia for themselves because no-one has the right to value anyone, even themselves as worthless (Barnard). If looking at the Roman Catholic church in specific, it regards euthanasia as morally wrong. It has always taught the absolute and unchanging value of the commandment ” Thou shall not kill”. The church has said that nothing and no one can in any way permit the killing of an innocent human being, whether a fetus or an embryo, an infant or an adult, an old person, or one suffering from an incurable disease, or a person who is dying. The church believes that each person should enter the dying process with all its mysteries with trust in God and in solidarity with their fellow human beings. They should die with the dignity of letting themselves be loved unconditionally. Euthanasia and suicide are both a rejection of God’s absolute sovereignty over life and death (Barnard). The church believes that each human life is a manifestation of God in the world, a sign of his presence, a trace of his glory. ” The life which God offers to man is a gift by which God shares something of himself with his creature.” Since it is morally wrong to commit suicide it is morally wrong to help someone commit suicide. ” True compassion leads to sharing another’s pain; it does not kill the person whose suffering we cannot bear.”(Pope John Paul II, Evangelium Vitae, 1995). Some of the world’s biggest religions are against euthanasia. However, there are a lot of people supporting the concept. This lays as another burning issue society has to face. I personally believe in discontinuing artificial life support systems which can kill a person. I believe even though God tells us not to kill, it is unnatural to go against the normal course of nature and death and keep a person alive who would have died if no technological measures were taken. However, I don’t believe in injecting lethal medications to help a person die. I believe that goes against the commandment ” don’t kill”.
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