“ARE RIGHT AND WRONG CONVERTIBLE TERMS, DEPENDANT UPON THE POPULAR OPINION”? : A famous quote by William Lloyd Garrison poses a critical question to each one of us. Certain questions carry a lot of dimension to look through and in such cases there are enough supportive reasons to justify the rightness of each dimension. One such question stands whether it is ethically justifiable to use narcotics to speed up the end of life. Right from its inception the question has been a cause celebre and continues to exist as one. Effective pain relief especially at the end of life has always been surrounded by a lot of ethical obligations based on beneficence, patient’s autonomy and the concept of double effect.
The Pragmatic approach of treatment and pain management however, begins with complete assessment of the patient incorporating words, intensity, location, duration and alleviating factors along with considering the component of total pain which are physical, emotional, social and spiritual pain. If a patient is suffering from intolerable pain and is not showing any chances of recovery, it may be a better choice to allow him to go to permanent rest with the help of narcotics. The ethical question, hence attached with the use of narcotics for speeding up the death of a person more or less has a circumstance based justification. Such question appears ethical enough if the patient is suffering from great mental trauma and has no chances of recovery.
In such cases allowing the person to go to permanent sleep may be an option to let him free, from his suffering. Also, as the patient has no chances of recovery such measure could even allow the hospital resources to get available for the other patients. These patients can in turn be assisted by hospital staff to get healed up. Keeping the resources reserved for a person who has almost no chances of recovery may lead to loss of many other lives that otherwise could have been saved.
Another factor supporting the use of narcotics in speeding up the end of life is the financial burden that the family members have to encounter even though the patient does not have chances of recovery. An example can be quoted of Euthanasia. Euthanasia or mercy killing is the practice of allowing a person to go to permanent rest if he has null chances of recovery. Voluntary Euthanasia, one in which Euthanasia is issued on the consent of patient or his relatives, is practiced in many parts of the world and is well considered as an ethical choice. But, in some other parts of the world it is declared as illegal and strictly banned. For example, in Canada, a Saskatchewan farmer, Robert Latimer, killed her daughter, Tracy who was suffering from immense pain and mental illness. Tracy was on the death bed during her birth but anyhow doctors saved her life. This accident gave her some serious brain damage. Seizures start to develop in her brain as she began to gain consciousness. Her mental illness grows with her sometimes.
Her parents and doctor tried everything they could to control her illness but nothing helped. Till the age of 10 she had undergone 2 major operations which again increased her problem. The second operation gives her severe scoliosis. To cure scoliosis she undergone one more very major operation which increases her pain and makes her very rigid like board. Whenever, anybody tries to move her leg or touch her back she cried out in pain. Her father couldn’t see her, bearing immense pain and suffering from mental sickness. He gave her rest forever. But as euthanasia is strictly banned and illegal in Canada he was punished. Although, by seeing his love towards her daughter Supreme Court doesn’t gave him severe punishment like murder. (Ethics-euthanasia.ca) (Leiva, 528)
Although, the question of such practices being ethical, is put on stake when mala fide intentions are involved with such activities. Some fraudulent activities performed in the disguise of justified killings raise a question on its exercise. Strict and stringent rules and regulations need to be associated with such practices to turn it even more transparent making it ethically justifiable.
According to a survey conducted majority of the nurses were willing to perform Euthanasia or assisted suicide while a few rejected the concept stating it as highly unethical. The nurses who were willing to perform assisted suicide supported there stand with the reasons such as concern about the overuse of life sustaining technology, a sense of responsibility towards the sufferer’s welfare, a desire to relieve suffering and a desire to overcome the perceived unresponsiveness of physician towards that suffering. These justifications involve deeply held professional values which thus may turn out to be a source of high professional regard nurses enjoy.
These practices are actually the reflection of the behaviour of a physician towards a patient. Some of the physician on the one hand may accept the request of the patient whereas some other may reject the concept. A strong argument made during the practice of assisted suicide is that patients may come to fear physicians or distrust their motivation. Moreover, some special characteristics like age, religion nursing speciality have a great influence on the nurse’s opinion. Arguments that encourage the nurses to indulge in such practices involve dissatisfaction with the current condition and respect for autonomy whereas the arguments against the practice of assisted killing are religious objections, fear of abuse and right to good death. Religious objections are a great influencing factor that stops nurses from getting indulged into these practices. Religion looks at these practices as a sinful act and hence does not let many nurses get involved into it. Social abuse is another factor that many nurses are afraid of. Once been involved in assisted suicide the society looks at it as a murder making the nurses feel guilty at every moment. Fear of such accusations and social abuses constrains many nurses from practicing it. Yet another factor is inquiry conducted by the authorities in such cases. Inquiries are never appreciated by anyone and more importantly they bring a person in the danger zone of being accused. The questions involving the voluntary consent of the patient pushes the nurses half a way of being accused. And later the inquiry relating to the consent being provided under any external pressure further blurs the scenario.
The opinion of nurses can however be tracked by a survey. Certain data were collected through anonymous mail survey of 1560 nurses. Of these nurses 73% responded. Nurses were mainly asked whether they have been asked to get engaged in euthanasia and in that request whether they actually did involve themselves in euthanasia. Of 852 nurses who were identified as practising in adult extensive care unit.19% reported they had engaged in euthanasia whereas 76% recorded that they had not been involved in this practice and 4% could not be qualified. Interestingly just 30% believed that euthanasia is unethical. Further the studies indicated that the nurses that were religious or were practicing in cardiac care unit were the ones carrying less favourable attitude towards Euthanasia. The result of the survey helps to explain the extent to which the US critical care nurses have engaged themselves in euthanasia despite of professional and legal prohibition on it. Being a nurse they carry a deep understanding of the critically ill patient’s need which when amalgamated with the results of survey indicates that the current guideline on such practices needs to be revised and made more physician friendly. (“New England Journal Of Medicine”, 971-974.)
Doctors and nurses after all are reflection of god himself and hence using narcotics to relieve patient from endless suffering by the doctors and nurses should not be considered unethical instead punishing them and pushing them to courts for such practices, surely is.
(2014). Retrieved 6 November 2014, from http://www.cfp.ca/content/56/6/528.short
Ethics-euthanasia.ca,. (2014). Ethics, Euthanasia & Canadian Law :: Robert Latimer. Retrieved 6 November 2014, from http://ethics-euthanasia.ca/case-study-robert-latimer/
Leiva, R. (2010). Death, suffering, and euthanasia. Canadian Family Physician, 56(6), 528-530. Retrieved from http://www.cfp.ca/content/56/6/528.short
Unboundmedicine.com,. (2014). Unbound MEDLINE : Euthanasia and assisted suicide in Dutch hospitals: the role of nurse. Retrieved 6 November 2014, from http://www.unboundmedicine.com/medline/citation/18482123/Euthanasia_and_assisted_suicide_in_Dutch_hospitals:_the_role_of_nurses_
The Role of Critical Care Nurses in Euthanasia and Assisted Suicide. (1996). New England Journal Of Medicine, 335(13), 971-974. doi:10.1056/nejm199609263351312