Ethical Legal Dilemma Advanced Practice Nursing (assisted suicide services)

Question

Instructions:

The ethical legal dilemma in assisted suicide services.

                This is a fact-based Assignment that will not include your opinion.
This will require research and support for what is written.
The Assignment should be in your words after reading the scholarly and fact-based publications and have proper citations. There should be no quotations. The professor wants to hear your voice as a masters-level trained nurse. 

An important point to note: SOURCES CITATION NOT MORE THAN 5 YEARS OLD (2012-2017)

The CLASS BOOK  is Westrick, Susan J.. Essentials of Nursing Law and Ethics. Jones & Bartlett Learning. Second Edition.   I have attached a rubric and two additional files of what I’ve done so far.   Add the content I’ve provided in your work (see files called “Introduction” and “Part of the paper”). To use this content, you’ll need to paraphrase it to make it original !!.

Answer

The Ethical Legal Dilemma in Assisted Suicide Services

Contents

Introduction. 2

An Ethical-Legal Decision-Making Dilemma. 2

Ethical Principles and Laws Likely to Be Violated: Civil or Criminal Liability?. 3

Constructing a Decision Demonstrating Integrity Which Prevent Ethical and Legal Violations. 4

The Legal Principles and Laws That Apply to the Ethical Dilemma. 5

Differences Between Ethical and Legal Reasoning: Application of an Ethical-Legal Reasoning Model in the Case Study. 6

Recommendations. 7

Conclusion. 7

References. 9

Introduction

Advanced practice nurses (APNs) faced moral, ethical, and legal dilemmas from time to time when dealing with their patients in their practice. This is especially common when it comes to dealing with cases of assisted suicide. Unlike euthanasia which is the intentional act of using painless means to put a terminally ill patient to death, assisted suicide refers to the occasions in which a nurse provides the patient in question with the means by which they can use to commit suicide (Jie, 2015). This assistance as provided by the APNs or other healthcare practitioners can be in the form of drugs or equipment.

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Terminally ill patients are in most cases subjected to so much pain as their life comes to an end in what is known as the end-of-life stage (Steck et al., 2013). During this stage, nurses are often the ones that associate with the patients on a daily basis and as such the patients become emotionally attached to them in certain ways. The patients may sometimes trust nurses enough to express their suicidal thoughts. The burden that falls on nurses is in regards to deciding whether to share the information with other healthcare professionals and if they should give into the patient’s demands regarding assistance with suicide plans. This whole situation present a moral, ethical and legal dilemma because, in addition to preserving life, they must also consider their obligation to assist patients on their needs.

An Ethical-Legal Decision-Making Dilemma

Mrs. Wyatt, a 66-year old woman was diagnosed with aggressive prostate cancer at a renowned hospital in the United States, after which she insisted that the proposed surgical procedures were unnecessary and that she was not ready at the time. She therefore requested for an alternative form of treatment that included frequent visits to her urologist. Six years after diagnosis, the patient had not taken care of her health problem at all. She neglected to visit an urologist during the period after her diagnosis and as a result, the cancer had spread to her bones and lymph nodes. After additional tests, doctors discovered that her primary tumor was now making its way to her bladder and was in the process affecting her left kidney. Over a period of four months following the second diagnosis, Mrs. Wyatt had been readmitted a total of 11 times.

Unfortunately for Mrs. Wyatt, on her last admission at the hospital, the physicians determined that she had around 6-12 months left to live and that the best option would be to live in a palliative care regimen seeing as any surgical procedures would not have any curative effect. Two months into palliative care, Mrs. Wyatt confided in her nurse saying that she did not see the use for prolonged pain when she knew for sure that nothing could change her situation and her death would be certain. She further explained that she felt she was both an emotional and financial burden to her family and as such had decided to end her life and needed the assistance of the nurse to do it. On hearing her request, the nurse felt that was obligated to do good for the patient, express her sensitivity of the matter and ultimately find a moral, ethical and legal solution to the unfolding dilemma.

Ethical Principles and Laws Likely to Be Violated: Civil or Criminal Liability?

All registered nurses and health practitioners are guided by the stipulated ethical principles, laws and the code of ethics in their decision making. Based on the dilemma presented above, it goes without saying that the principle of autonomy is likely to be violated by the nurse. Autonomy refers to the ability to respect the choices that have been made by an informed patient without coercion (Parahoo, 2014). In this case, if the nurse decides against carrying out the wishes of the dying patient, then he/she would have violated the principle of autonomy. While choosing to ignore the wishes of Mrs. Wyatt can be considered a morally correct decision, it may lead to other consequences. For instance, patients whose nurses fail or choose not to assist them during suicide may in turn opt to kill themselves in any way they know-how.

Therefore, in such a case, by choosing not to do something about the wishes of the Mrs. Wyatt, the patient may choose to commit suicide. According to Australian law, letting people die as a result of choosing not to act is considered illegal and as such is considered a criminal act(MacLeod, Wilson & Malpas, 2012). However, while it is important to consider the autonomy of the patient, it is also important to note that in most countries in the world, there is a common law that prohibits assisted suicide.

Constructing a Decision Demonstrating Integrity Which Prevent Ethical and Legal Violations

Ignoring the suicidal wishes of the patient would easily lead to an actual suicide, an action that is considered illegal. Therefore, in the best interest of both the nurse and Mrs. Wyatt, it would be wise to share the information provided by the patient with other healthcare professionals. This decision is both ethically and legally permissible as it takes into account the code of conduct of the nurse involved (MacLeod, Wilson & Malpas, 2012).Moreover, involving other individuals in this case would enable the team to exchange ideas to be able to come up with a moral choice that could possibly prevent suicide. Such a decision, therefore, not only prevents the violation of the principle of autonomy but also contributes to the avoidance of the violation laws that consider it illegal to lead a patient to suicide by choosing to do nothing about the suicidal wishes of a patient.

The Legal Principles and Laws That Apply to the Ethical Dilemma

There are legal and ethical considerations to assess in resolving the ethical dilemma that is presented in the case of Mrs. Wyatt and her appointed nurse. In addition to autonomy, there are two other major principles that apply to the ethical dilemma presented, and they include non-maleficence and beneficence (Parahoo, 2014). Non-maleficence is a principle that guides against doing intentional harm to any patient while beneficence is the principle that guides all nurses and healthcare practitioners to do right and good by their patients at all times.In the case of Mrs. Wyatt, the nurse needs to decide on an effective course of action that would ensure that the patient does not harm herself, and this calls for the need to apply the principle of non-maleficence.

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Moreover, the nurse can succeed in applying beneficence by coming up with a decision that would work for the benefit of the patient. According to the Department of Ageing Disability and Home Care, Beneficence requires that the health care staff do the best they can to promote the health and well-being of the patient. While most states are against assisted suicide, some have legalized it. For example, in Oregon, the Death with Dignity Act has been enacted. It allows terminally ill citizens of the state to be allowed to self-administer lethal injections to end their lives.

According to the Death with Dignity Act of 1997, it is permissible for terminally ill to engage assisted suicide if it is considered the best option for the patient in question under the principles of autonomy, beneficence and non-maleficence. Under the Act, the nurses and physicians are allowed to prescribe lethal medication to the terminally ill patients who then administer the medication to themselves (Maynard, 2014). However, the law provides for the protocol and considerations that must be made before arriving to the point of assisted suicide. For instance, in Washington, the patient must be over the age of 18, of sound mind, with less than 6 months left to live as prescribed by a physician and must be provided with an informed consent.

Differences Between Ethical and Legal Reasoning: Application of an Ethical-Legal Reasoning Model in the Case Study

In the case of Mrs. Wyatt, the nurse involved had to apply both ethical and a legal reasoning. The ethical reasoning would ensure that as a nurse, what she does is actually the right thing to on. To meet all legal requirements, the nurse must come up with a solution that falls within the requirements of all applicable statutes to ensure that the outcome arrive at does not land him/her or anyone involved in jail for complicity in murder (Abu-El-Noor & Mysoon, 2014). To be able to come up with the best possible course of action, the nurse has to apply an ethical-legal reasoning that not only ensures that the needs of the patient are addressed but also ensures that the process of addressing these needs is completely legal.

In seeking to address the suicidal thoughts of Mrs. Wyatt in the best way possible, the nurse should first provide her with psychological comfort to ensure that she does not become aggressive in decision-making. Once the nurse is certain that the patient is emotionally and psychologically stabilized, they can now inform the other healthcare professionals involved with the care of the patient (Negri, 2012). The persons involved should then employ effective communication with the patient so as to find the real reason as to why they want to commit suicide.

After determining the cause for the suicidal thoughts, it is imperative that the healthcare professionals involved try to address the issues one by one. In the case of Mrs. Wyatt it is clear that among the reasons leading to her decision is the excruciating pain that she has to face every day. Based on this, the nurse can choose to readjust her pain medication to make it more bearable. By addressing the needs of the patient when one can, it is more likely that the patient would reconsider their decision to commit suicide.

Recommendations

Based on the dilemma presented above in the case of Mrs. Wyatt, there are three recommendations that can be made that would go a long way in resolving the moral distress that nurses face every so often, and they are as follows:

  1. Nurses should always seek to engage in efficient communication with their patients. Effective communication would ensure that the nurse is able to identify the underlying reasons for the patient wanting to commit suicide.
  2. To prevent suicide, the nurses should intervene whenever they can. For instance, in the cases of extreme pain, the nurses can consider getting stronger pain medications to relive some of the pain that the patients experience thus making their end more bearable.
  3. Collaboration among the healthcare professionals involved in the care of a patient goes a long way in ensuring that the best decisions are made regarding the health and well-being of the terminally ill patient.

Conclusion

Recent advancements in the healthcare industry have made it more possible to save more lives than ever before by curing them or reducing their suffering. In the same way, these advancements have played a vital role in fostering and sustaining the lives of terminally ill patients. This has led to a reduction in cases of assisted suicide. While it is commendable that the human race now has a means of prolonging the deaths of the terminally ill patients, some of them usually reach a point where they no longer see the value in continuing to live, and as such, decide to ask their nurses to help them commit suicide. As a nurse, such decisions can be very overwhelming as they pose both a moral, ethical and legal dilemmas.

It is imperative that nurses make ethical and legal considerations before making a decision that could grant the patients’ wish to end their lives. This is why they should apply the principles of autonomy, non-maleficence and beneficence when resolving the dilemmas. However, in situations where apatient decides that the best course of action is suicide assistance, then the nurses should be keen to cooperate with other medical professionals in evaluating all the ethical and legal issues that are likely to emerge and devise ingenious ways of addressing them.

References

Abu-El-Noor, N. I., & Mysoon, K. A. (2014). End of life decisions: An Islamic perspective. Online Journal of Health Ethics, 10(1), 1-19.

Jie, L. (2015). The patient suicide attempt – An ethical dilemma case study. The International Journal of Nursing Sciences, 2(4), 408-413.

MacLeod, R. D., Wilson, D. M., & Malpas, P. (2012). Assisted or hastened death: the healthcare practitioner’s dilemma. Global journal of health science, 4(6), 87.

Maynard, B. (2014). My right to death with dignity at 29. CNN. November2, 2014.

Negri, S. (2012). Self-Determination, dignity and End-of-Life care: Regulating advance directives in international and comparative perspective. Leiden: Nijhoff.

Parahoo, K. (2014). Nursing research: principles, process and issues. London: Palgrave Macmillan.

Steck, N., Egger, M., Maessen, M., Reisch, T., & Zwahlen, M. (2013). Euthanasia and assisted suicide in selected European countries and US states: Systematic literature review. Medical care, 51(10), 938-944.

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