ethical dilemma

Suicide with Kevorkian

1. Describes the ethical dilemma in adequate detail. 2/2
2. Explains what happened in the dilemma that should not have happened. 2/2
3. Describes the ethical principles or values (autonomy, beneficence, non-maleficence, justice, dignity, truthfulness or honesty) that were violated. 2/2
4. Discusses how the basic tenets of a law or report impacted the dilemma. 2/2
5. Locates a code of ethics that is applicable to the APN/DNP and how the code impacts the ethical dilemma. Provide an example of an advance practice nursing situation that could violate one ethical principle using supportive references. 2/2

Sample of the assignment is below

Suicide with Kevorkian
The interest in assisted suicide spans not only the United States, but other countries such as the United Kingdom, Australia, and Canada as well. The historical influence of assisted death dates back to the 5th century B.C. to Hippocrates (MacLeod, Wilson, & Malpas, 2012). Hippocrates stated that the physician must refrain from causing harm. In the 13th century, the Judeo-Christian era brought about new ideas on life and death and the thought of suicide was no longer acceptable (MacLeod et al.). In the early 1900’s, law did recognize the perceived hopeless medical case, and questioned whether such a law to allow physician assisted suicide would be abused by lay persons if practiced openly (MacLeod et al.). The topic of assisted suicide has been heavily debated and the concern of patient suffering and personal rights combined with societal and religious norms generate much conflict. The following discussion will describe suicide with Dr. Kevorkian, the ethical dilemmas surrounding assisted suicide, and the application to the role of the advanced practice nurse.
Dr. Jack Kevorkian, a pathologist who challenged the legal system, healthcare system, and the political system at least seventy-five times, by offering patients the right to terminate one’s life with physician assisted suicide. Dr. Kevorkian began his crusade offering assisted suicide to patients in June of 1990 (Roberts & Kjellstrand, 1996). Although Dr. Kevorkian is known for his persistence in offering patients the choice to end life, he is not the only physician offering physician assisted suicide (PAS). Advanced directives have become a popular means of communicating one’s wishes about medical decisions when one nears the end of his or her life. The distinction between the right to die versus the right to refuse medical treatment seems unclear according to the Cruzan case heard by the Supreme Court (Benton, 1993-1994). Following the Cruzan case, individual states secured legislation to address PAS in some form or another. The ethical dilemma of personal autonomy when juxtaposed to societal norms is strengthened by the risks associated with physicians applying interventions to cause harm instead of relieving harm. At the core of the medical profession is the ethical foundation found in the Hippocratic Oath (Benton, 1993-1994). At the core of the individual are the right of personal autonomy and the right to make decisions regarding his or her own life. Physicians, confronted with the request to assist in a patient’s suicide, face the dilemma to respect the patient’s wishes and rights to personal autonomy (MacLeod et al., 2012).
Dr. Kevorkian’s actions sparked tremendous controversy and initiated a dialog over the patient’s right to die with dignity versus the Hippocratic Oath. Advocates for Dr. Kevorkian and PAS claim no differences exist between withdrawing treatments at the end of life and providing one with the means to end life. The controversy prompted many states to pass laws designating PAS illegal. Eventually, the state of Oregon passed The Oregon Death with Dignity Act allowing for PAS and this legislation came into force in 1997, having survived numerous legal challenges (Benton, 1993-1994).
Foremost, among the principles, are the patient’s right to common rule and the right to control one’s person (Sui, 2010). While recognizing that some terminally ill people may be entitled to seek medical assistance to end life, the Oregon law ensures appropriate safeguards are in place to avoid abuse. For instance, only people aged 18 years and above can avail themselves of the benefit of the law. Beside the requirement of being 18 years old, the person must also be suffering from a terminal illness. As to whether one is actually suffering from a terminal illness or not is to be determined by both an attending and a consulting physician, respectively. Insisting on having a consulting physician reduces the risk of abuse to the process. Also, the statute insists that a request be made in a prescribed form and witnessed by two people (Drum, White, Taitano, & Horner-Johnson, 2010).
Another important principle is the protection of the integrity of the medical profession. The medical profession is known throughout the world to be committed to life. The American Medical Association’s (AMA) formal position is in opposition to PAS but recognizes the dilemma facing the medical community. Acknowledging patient’s right to self-determination, the AMA concedes the need for guidelines in an attempt to safeguard patients (Sui, 2010). The Oregon Death with Dignity Act ensures integrity by placing numerous responsibilities on participating physicians. Such duties include the need to ensure that terminally ill patients requesting PAS make informed decisions through informed consent. This will require the physician to explain the consequences of the decision to a patient that is coherent, mentally intact, and capable of making informed decisions (Drum et al., 2010).
In 2001, Beauchamp and Childress created a principle-based model for ethical decision making. In this model, four principles are considered: (a) respect for autonomy, (b) nonmaleficence, (c) beneficence, and (d) formal justice (Beauchamp & Childress, 2001). When confronted with assisted suicide, Advanced Practice Nurses (APN) must implement this model to ensure that ethical principles are not violated.
Autonomy relates to an individual’s right to self-direction to include the right to refuse treatment and the right to informed consent (Zaccagnini & White, 2011). Many healthcare practitioners are comfortable with terminally ill patients who refuse treatment. However, many providers experience moral distress when confronted with treatment which would result in death. Although PAS may not be a violation of a patient’s autonomy, many nurses are reluctant to participate in the process. In a survey of 1,509 nurses conducted in 2008, 62.9% responded that they would not insert a needle that would be used for PAS and 54.1% do not view PAS as being within the scope of nursing practice (Bruchem-van de Scheur, Arend, Wijmen, Abu-Saad, & Meulen, 2008).
Hamric, Spross, and Hanson (2012) define nonmaleficence as: “the duty not to inflict harm or evil” (p.324). Assisted suicide is a violation of nonmaleficence, as it inflicts harm. Zaccagnini and White (2011) echo this violation: “Actively assisting a patient to die is killing, and although it may end suffering, euthanasia is in contradiction to the principle of nonmaleficence” (p. 322). Beneficence indicates that an individual is practicing in a manner that is beneficial to another. Assisted suicide is a violation of beneficence as this medical intervention does not prevent harm. Many experts support palliative care rather than assisted suicide: “In terminal sedation the intention is to relieve intolerable suffering, the procedure is to use a sedating drug for symptom control and the successful outcome is the alleviation of distress” (Materstvedt et al., 2003). The principle of justice implies that access to healthcare is equal to all. As only two states, Oregon and Washington, legally support assisted suicide, justice is violated. Should practitioners and patients support assisted suicide, justice would be obtained in the United States if assisted suicide was a federal law.
The American Nurses Association (ANA) Code of Ethics does not support the practice of assisted suicide: “The ANA believes that the nurse should not participate in assisted suicide. Such an act is in violation of the Code for Nurses with Interpretive Statements (Code for Nurses) and the ethical traditions of the profession” (American Nurses Association, 2001). As an APN, one should not participate in PAS. PAS is in violation of the ethical principle of nonmaleficence and a violation of nursing practice. In a personal case study written by Richard Ratke in 2005, an APN might initially be willing to support this man’s right to personal autonomy and participate in PAS. This individual was diagnosed with multiple sclerosis (MS) and was given a prognosis of death within five years. Radke (2005) stated, “…I thought about suicide. If procedures were available to help me end my life, I might well be dead now” (p. 58). Instead, an APN should explore other avenues to increase the quality of life for this individual. Ratke (2005) later writes, “We need to work toward better life, not toward ways to end it” (p. 58).
In conclusion, the topic of PAS creates moral and ethical dilemmas for healthcare providers. As APNs, we must support initiatives that promote quality of life during a terminal illness. This paper addressed the issues surrounding PAS including: (a) a discussion of suicide with Dr. Kevorkian, (b) the ethical dilemmas surrounding assisted suicide, and (3) the application to the role of the advanced practice nurse. Although individuals have their personal beliefs regarding PAS, an APN should not lose sight of the professional codes that guide their practice.