Abstract
Given the sensitive nature of the issue, many consider the issue of inducing death upon a patient a slippery slope. Euthanasia – assisted suicide – is a partisan issue that has sparked fierce debate over the years. According to the Hippocratic Oath, physicians and other medical experts to desist from offering a deadly drug to any patients even if they asked for it; neither will they make any suggestions to the patient to that effect. On the other hand, liberals believe that there are extenuating circumstances that render euthanasia acceptable as a mode of reducing pain and suffering for patients under intensive care.
Background
The constitutions of various states are unequivocal in their stance regarding the sanctity of human life. In the United States, for instance, human beings have a God-given right to life; no authority shall therefore deprive human beings of their inalienable right to live. There are mitigating circumstances, however, where a competent doctor/ physician, acting in their own volition, end the life of another where there is probable cause to believe that such action will help in relieving pain and suffering. The process of inducing death upon a patient via medical procedure is commonly referred to as ‘mercy killing.’ The medical term for mercy killing is euthanasia. Others refer to it as ‘assisted suicide. Assistance, in this context refers to providing a patient with the means – drugs, equipment or medical procedure – necessary to oversee this process (Chin et al, 2013).
The issue of inducing death upon a patient through the intervention of a medical expert is nonetheless very contentious given the sensitive nature of the issue. There is unanimous consensus amongst politicians, medical experts, religious leaders and the society at large that life is a God-given right. In view of this concession, the inalienable right of human beings to live ought to be the benchmark of any decision made to that extent. A section of liberals believes that it is reasonable to relieve the pain of a patient in intensive care by inducing death to do away with the suffering. According to them, assisted suicide is, in extreme circumstances, necessary on humanitarian grounds. On the other hand, religious leaders in liaison with other conservatives believe that the sanctity of life clause deters physicians from acting God. They believe that no human being ought to wilfully help another to commit suicide. Likewise, they are opposed to medically induced death irrespective of the fatality of the patient’s condition. Religious leaders believe that allowing assisted suicide is walking a slippery slope, which would be dangerous to the future of humanity (Inghelbrechtrt al, 2010).
The issue of assisted suicide has therefore generated a series of debates with the sanctity of life being the contentious issue. In the United States, assisted suicide is a partisan political issue with left-wing liberals advocating for it while right-wing conservatives condemn it in its entirety.
Significance to Nursing and/or Health care
How is the issue of assisted suicide relevant to nursing and health care? The health care profession is one that deals with the welfare of individuals. As such, there is a strict code of professional conduct, which is the ethical cornerstone that guides the behaviour of the personnel involved. The Hippocratic Oath upholds this code of conduct; health care professionals swear to uphold the dignity of the profession in line with the Hippocratic Oath. Medical personnel are charged with the duty of protecting human welfare; they are responsible for the wellbeing of humanity. As such, they should act with utmost diligence in bid to serve humanity. The rule of thumb in health care ethics states that while taking care of patients’ recovery, all health care personnel must act in such a way that other professionals in the same field would act given similar circumstances. This is to say that that they owe their patients a duty to care and responsibility to preserve their welfare at all times. This makes doctors liable to the patients’ welfare at all times; should anything happen to the patients due to doctors’ negligence or reckless disregard of professional ethics, such doctors are liable for prosecution within the law. This spells out the significance of the contentious issue of assisted suicides to the health care and nursing professions alike (Chin et al, 2013).
Identification of Conflicting Ethical Principles
Experts reckon that the Hippocratic Oath relates to the morality of physicians regarding their involvement in the demise of patients. Physicians’ morality is at play in issues relating to assisted suicides. While swearing the Hippocratic Oath, physicians proclaim that they will desist from offering a deadly drug to any patients even if they asked for it; neither will they make any suggestions to the patient to that effect. The religious stance shares the opinion of the Hippocratic Oath that such involvement of a physician, doctor, or nurse by way of assisted suicide is unacceptable.
The contentious issue that faces the health care profession in this respect is how the rationale of the Hippocratic Oath relates to the issue of assisted suicide within the realm of the fundamental values and goals of the profession itself. The American Medical Association holds that it assisted suicide are detrimental to the profession. Debate rages on with liberals arguing that while the rationale behind the Hippocratic Oath is to prevent reckless disregard of health care codes of conduct, following it to letter would be detrimental to patients’ welfare in certain circumstances. Such circumstances, as noted earlier, include the state of the health of patients under intensive care. Liberals argue that the health care profession compels medical professionals to act in such a way that their actions reflect the best option for patients at any given time. As such, if the circumstances dictate that it is reasonable – in the estimation of a competent doctor – to relieve the pain that a patient is suffering, it is prudent to do so by inducing death to get rid of the suffering. The Hippocratic Oath condemns assisted suicide arguing, and rightfully so, that it falls outside the domain of moral medical practice. That notwithstanding, there are extenuating circumstances in which assisted suicide is justifiable (Chin et al, 2013).
In the event of war, thousands of soldiers enter enemy territory. While in the battlefield, there is no telling what could happen; many soldiers die and the ones who survive sustain serious injuries. For those who sustain fatal injuries, the physicians have a duty to care and protect the dignity of human life. If they believe that the patient is in deep pain and is unlikely to recover, they have a moral obligation to end their suffering.
Analysis of Conflicting Ethical Principle of Autonomy
In the health care profession, as in all other professions, there is an underlying principle of discretion deeply entrenched in the professional code of conduct. In line with this underlying principle, the issue of autonomy arises. This draws from the fact that all professionals in the field have undergone the relevant training. As a result, they are able to act autonomously under their own volition. Autonomy, in this context, refers to the ability of a professional to act with reasonable care and diligently without undue influence caused by the restrictions of the law, or any other institutional framework. When attending to wounded soldiers in enemy territory, for instance, physicians have a moral obligation to act in a manner that responds to the immediate needs of the patient notwithstanding what the Hippocratic Oath or medical ethics dictate. Often, in the course of war, hundreds of soldiers sustain fatal injuries. Likewise, there usually is a shortage of physicians and doctors to attend to all the patients at once. If this were the case, physicians are under moral obligation to act in a manner that best serves the general welfare of all (Chin et al, 2013).
According to utilitarianism – Jeremy Bentham’s moral philosophy -, a moral and ethical act is that whose consequences serve the interests of the largest number of the population while causing minimal or no suffering to the rest. Through the utilitarian perspective, a physician has the autonomy to resolve to act as he deems fit given the prevailing circumstances. The autonomy principle is in line with the consideration that ‘the end justifies the means.’ Physicians shall not be held liable for their resolution to act as such provided that any other reasonable professional would have resolved to act in a similar manner in light of such as situation. The autonomy principle protects physicians from undue legal action that would otherwise intimidate them for acting in good faith. The cardinal rule in the utilitarian principle is that the physician must act in good faith (Glover, 1977).
Analysis of Conflicting Ethical Principle of Non-malfeasance
In his moral philosophy dubbed deontological/ duty-based ethics, Immanuel Kant espouses that one acts morally only when he does the right thing irrespective of the consequences. According to Kant, motive and consequences do not dictate morality. For instance, bending the law, even for the right reasons, is immoral. He put forth his deontological yardstick upon which he believes morality revolves around. Kant called this yardstick the categorical imperative, which comprises two maxims. First, one ought to act in such a way that they would wish to see the basis of their actions set the ground for universal law. Second, Kant believed that people ought to act so that their actions treats others as an end, not as a means to an end (Glover, 1977).
From a deontological perspective, assisted suicide is wrong, period. It is immaterial whether a physician indices death upon a patient in order to get rid of their pain and suffering, the act is still wrong. The principle of non-malfeasance is in line with the categorical imperative. The Hippocratic Oath categorically states that physicians will desist from offering a deadly drug to any patients even if they asked for it; neither will they make any suggestions to the patient to that effect. By assisting suicide, physicians abuse the very oath they swore to protect, which is repugnant to the principle of non-malfeasance as well as Kant’s deontological yardstick for determining morality (Perry, 2011).
Personal Position – Pro-Battlefield Euthanasia for extreme injuries if patient request
In the course of war, as mentioned earlier, soldiers sustain fatal injuries such that most of them succumb to these fatalities. Physicians are thus faced with a daunting task to stabilize the wounded soldiers while attending to those with fatal injuries. The letter of the law, as stipulated in the Hippocratic Oath, is unequivocal; it urges physicians and medical experts to desist from assisting suicide notwithstanding the prevailing circumstances. A section of liberals has argued that this unequivocal stance is unrealistic, not to mention, implausible in the battlefield. While the concerns of the law are understandable, they may be unrealistic in certain situations. There is need to appreciate that there are extenuating circumstances in which following the law to the letter may cause more damage than good (Perry, 2011).
Given that assisted suicide is a partisan issue, there are certain considerations that come with that. For instance, the physician inducing death upon a patient has to uphold high standards of morality. This goes to ensure that they act bona fide independent of their take on the issue.
Conclusion
Debate rages on, as the issue of assisted suicide has become a partisan one. This debate centres on the conflicting ethical principles of autonomy and that of non-malfeasance. The principle of non-malfeasance, which is in line with the deontological perspective, indicates assisted suicide is wrong, period. The principle of autonomy on the other hand indicates that a physician has the autonomy to resolve to act as he deems fit given the prevailing circumstances.
References
Chin, A., Hedberg, K., Igginson, G & Fleming, D (2013) “Legalized Physician-Assisted Suicide In Oregon — The First Year’s Experience” The New England Journal of Medicine Volume 340
Glover, J. (1977) Causing Death and Saving Lives London: Penguin
Gross, M.L. (2006) Bioethics and Armed Conflict: Moral Dilemmas of Medicine and War. London: MIT Press
Inghelbrecht MA, Bilsen, J., Mortier, F. & Deliens, B (2010) “The role of nurses in physician-assisted deaths in Belgium” CMAJ
Perry, D L (2011) “Battlefield Euthanasia: Should Military Mercy-Killings Be Allowed?” International Society for Military Ethics
