ETHICS AT THE END OF LIFE
- Hastened death: It refers to the act of accelerating the dying process as a response to suffering in the context of a life-threatening condition where the patient sees no other way out.
- Assisted Death: This form of euthanasia involves aiding an individual who expresses a desire to die prematurely, either through counseling or by providing a lethal substance.
- Assisted suicide: It involves self-killing with the assistance of another person, often a physician or healthcare provider.
- Physician-assisted suicide (PAS): This term specifically refers to assisted suicide carried out by a physician or healthcare provider.
Causes/Reasons for Hastened Death
- Feeling like a burden to others.
- Loss of control over the circumstances of death.
- Lack of social support.
- Perceived loss of dignity.
- Poor quality of life.
- Lack of meaning in life.
Approach of a Nurse to a Request for Hastened Death from a Patient
When faced with a request for hastened death, as a nurse, it is important to:
- Ensure a clear understanding of what the patient is asking for.
- Acknowledge and validate the patient’s suffering.
- Actively listen to the patient, paying attention to both verbal and non-verbal communication. Assess the patient for physical, psychosocial, and spiritual distress.
- Collaborate with the patient to develop a comprehensive care plan.
- Inquire about the patient’s physical symptoms, including pain, dyspnea, nausea, fatigue, constipation, insomnia, itching, and other symptoms specific to their condition. Uncontrolled symptoms can contribute to a request for hastened death if the patient feels it is the only escape from suffering.
- Explore the patient’s past experiences with death, which can provide insights into their fears and concerns about their own future.
- Identify signs of depression, as it can be challenging to differentiate between physical symptoms of advanced illness and depressive symptoms.
- Identify a team member who can establish a strong rapport with the patient and gain a deep understanding of their personal history, cultural background, and relationships. This team member can facilitate communication with other healthcare professionals and provide counseling support based on their expertise.
- Understand the nature of the patient’s suffering, considering all dimensions of their experience. Suffering arises when there is a perceived threat to the person’s integrity or continued existence.
- Consider the patient’s personal history, including previous experiences with illness and death, significant losses, and unfulfilled hopes and dreams, to ensure that no sources of suffering are overlooked.
- Actively investigate and effectively treat symptoms.
- Refer the patient to palliative care specialists, anesthetists, interventional radiologists, psychiatrists, and psychosocial and spiritual care providers to ensure comprehensive medical, psychological, and spiritual treatment of the patient’s pain and other symptoms.
Ethics and Legal Considerations in Hastened and Assisted Death
- The Controversy: There is an ongoing debate surrounding hastened and assisted death. Advocates argue that terminally ill patients should have the right to die with dignity, while opponents believe that ending one’s own life goes against the principles of the Hippocratic Oath and the sanctity of life.
- Ethical Implications of Physician-Assisted Death:
a. Patient Autonomy: Patients possess the ultimate authority over their lives. However, the question of whether physicians should assist them in carrying out suicide raises ethical concerns.
b. Persistent Ethical Arguments: Despite legal and political changes, the ethical arguments against the legalization of physician-assisted suicide remain compelling.
- The Right to Choose:
a. Dying with Dignity: Advocates assert that terminally ill patients should have the right to die with dignity. Allowing assisted suicide would provide them with a final exercise of autonomy in their dying process.
b. Humanizing the Choice: By granting the right to choose when to die, individuals would be recognized as active participants in their own lives rather than being seen as mere spectators waiting for death.