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Active Euthanasia

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Melanie Gurski

on 2 December 2013

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Transcript of Active Euthanasia

Active Euthanasia
What is Euthanasia?

Often referred to as “mercy killing”
Practice of intentionally ending a life in order to relieve pain and suffering

Jamie Delude, Melanie Gurski, Tanisha Howard, & Stephanie Lamartine
Jonsen Model
I Medical Indications
II Patient Preferences
IV Contextual Features
Stephanie Lamartine
Stephanie Lamartine
Begley, A. (2008). Guilty but good: Defending voluntary active euthanasia from a virtue
perspective. Nursing Ethics, 15(4), 434-445. doi: 10.1177/0969733008090514
Cherry, B., & Jacob, S. R. (2011). Contemporary nursing: issues, trends, & management (5th ed.). St.
Louis, MO: Elsevier/Mosby.
Chochinov, H. (2006). Dying, dignity, and new horizons in palliative end-of-life care.
CA: A Cancer
Journal For Clinicians,
56(2), 84-105.
Ethics in medicine.
(2013, 11 12). Retrieved from http://depts.washington .edu/bioethx/tools/
Gupta, D., Bhatnagar, S., Mishra, S. (2006). Euthanasia: Issues implied within. Internet Journal Of
Pain, Symptom & Palliative Care, 4(2)
Haigh, S. (2013, 02 08). Assisted suicide on legal agenda in several states . 
Associated Press State
MT. Retrieved from http://infoweb.newsbank.com/iw- search/we/InfoWeb?p_action=doc&p_topdoc=1&p_docnum= 1&p_sort=YMD_date:D&p_product=AWNB&p_text_direct- 0=document_id=( 14453716D4B77F50 )&p_docid=14453716D4B77F50&p_theme=aggdocs&p_queryname= 14453716D4B77F50&f_openurl=yes&p_nbid=D54U54NIMTM4NDIx MTA3Mi40NTc5Mjk6MTo5OkVCU0NPMTk5OA&&p_multi=MAP5
Hillard, B. (2000). The moral and legal status of physician-assisted death: Quality of life and the
patient-physician relationship. 
, 18, 45-63. Retrieved from http://www.units. muohio.edu/aisorg/pubs/issues/18_Hilliard.pdf
Holt, J. (2008). Nurses' attitudes to euthanasia: the influence of empirical studies and
methodological concerns on nursing practice.
Nursing Philosophy
, 9(4), 257-272.
Jennings, B., & Morrissey, M. (2011). Heath care costs in end-of-life and palliative care: The quest
for ethical reform. 
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, 7, 300-317. doi: 10.1080/15524256.2011.623458
Kan, K. [katrinakan]. (2012, October 6). Euthanasia-Should it be legalized? [Video file]. Retrieved
from https://www. youtube.com/watch?v=JkQKSS_g4LM
Klein, M. (2004). Voluntary active euthanasia and the doctrine of double effect: a view from
Health Care Analysis
, 12(3), 225-240. doi:10.1023/B:HCAN.0000044929.45563.4f
Potter, P. A., & Perry, A. G. (2013). Fundamentals of nursing (8th ed.). St. Louis, MO: Mosby.
Ramont, R. & Niedringhause, D. (2004). Fundamental Nursing Care. USA: Prentice Hall. Retrieved
from http://wps.prenhall. com/chet_ramont_fundament al_1/15/3883/994301.cw/index.html
Schumann, J., & Alfandre, D. (2008). Clinical ethical decision making: the four topics approach.
Hospital Physician, 44(12), 42-48. Retrieved from http:// turner-white.com/memberfile.php?PubCode=smp_dec08_ethical.pdf
Woodman, S. (2001). Last rights: The struggle over the right to die. Cambridge, MA: Perseus.

He is an 82 year old man with End Stage Renal Disease (ESRD) caused from longstanding Hypertension, Diabetes, and severe Peripheral Arterial Disease. He began hemodialysis treatment and was able to receive a renal transplant at age 74. Six years later, his body rejected it forcing him to continue hemodialysis. Shortly thereafter Mr. Tate had a stroke confining him to a wheelchair.
His family soon noticed Mr. Tate withdrawing from them and becoming apathetic. They encouraged him to see a psychiatrist to which Mr. Tate agreed. He expressed his desire to quit dialysis, but explained he did not want to hurt his family.
The psychiatrist encouraged Mr. Tate to talk with his family about his wishes. Mr. Tate's wife and daughter are very religious and express their desire for treatment continuation. His other daughter and son however, see their father's suffering and want to switch him to palliative care. Mr. Tate feels conflicted and simply stays quiet (Schumann & Alfandre, 2008).
Melanie Gurski
(Schumann & Alfandre, 2008)
Melanie Gurski
Systematic approach used to reach an ethical decision
Created by Jonsen, Siegler, and Winslade
Each box contains a set of specific questions used to make a conclusion about a particular case.
III Quality of Life
Defining the advantages and disadvantages of certain medical interventions by looking at certain patient characteristics; highly based on individual experiences and preferences (Potter & Perry, 2013).
Melanie Gurski
Questions in the Jonsen model are based on ethical principles of beneficence, non-maleficence, and respect for autonomy (Cherry & Jacob, 2011).
Mr. Tate
Case Study
Mr. Tate desires to stop treatment. He is 82 with several comorbidities.
(Schumann & Alfandre, 2008).
Ethical Dilemma
The debate about the morality of euthanasia is not new, but dates back to ancient Greece and Rome
(Gupta, 2006, p.167).
The primary arguments are:
Individuals have the right to death with dignity versus
the moral acceptability of deliberately “killing” someone, even when done under certain detailed conditions (Begley, 2008, 436-437).

Right to self-determination
End unnecessary suffering
Legalization would not produce harmful consequences

Sanctity of life
Possibility for abuse
Patients may feel pressured into the choice
“Slippery slope” argument

(Gupta, Bhatnagar & Mishra, 2006)

Tanisha Howard
Tanisha Howard
Evaluation of the medical facts
Guided by the ethical principles of beneficence (prevent harm) and non-maleficence (do no harm)
Healthcare providers use of clinical skills and knowledge to promote good patient outcomes
Takes into consideration the risks/benefits of all planned interventions in order to mitigate negative patient outcomes

Tanisha Howard
Beneficence & Non-malificence
What is Mr. Tate’s current medical problem?
Is Mr. Tate’s medical problem acute or chronic?
Chronic and permanent conditions
What are the goals of treatment and the likelihood of success?
To extend Mr. Tate’s life by continuing dialysis
What are the plans in the event therapy fails?
Discontinuing dialysis, providing palliative care, or assisting Mr. Tate with a “good death”

(Schumann & Alfandre, 2008, p. 37)

Tanisha Howard
1.) The intentional and purposeful act of causing the immediate death of another person by discontinuing life-sustaining treatment is called:
A.) Euthanasia
B.) Passive euthanasia
C.) Active euthanasia
D.) Physician-assisted suicide

2.) How much of healthcare costs are spent on end of life and palliative care?
c. 10-12%
d. 12-18%

3.) Which of the following statements best reflect the law in Oregon regarding euthanasia, which took place in 1977?

A.) Physicians can prescribe lethal medication doses to people meeting criteria.
B.) It is illegal to assist any client in hastening their death under any circumstances.
C.) Significant others may assist a client in hastening their own death.
D.) It is illegal for a client to approach a physician about assisted suicide.
(Ramont & Niederinghause, 2004)

Main consideration of this model
A patient can have a living will discussing their end of life wishes
An informed consent would be signed before any procedure would be conducted
Patients have the right to refuse treatment

Definition: A person’s ability to act and make decisions for themselves regardless of others influence (Butts, 2008).
In short: Self Determination
Our role as healthcare providers: We facilitate and support patient’s wishes with their treatment( Butts, 2008).
Autonomy can only be restricted when a person poses harm to themselves or another person (Klein,2004).

Jamie Delude
The patient has the right to end their life in the way they wish to uphold their dignity in death.
Based on the idea of : one’s right to die in a manner of their own choosing”
Autonomy: Is it hurting themselves or helping?
(Chochinov, 2006)

Autonomy r/t Active Euthanasia
Are the mentally capable of making their own decisions?
What is the patient stating about their preferences?
Do they understand their treatment?
Advance directives?
Is the patient’s right to choose being respected

Autonomy in this Case
Jamie Delude
His Advanced directive prior to transplant
Change of mind after rejection
Wants what is best for his family
He appears to be of sound mind and feels his death is near

Jamie Delude
5.) Which of the following responses by a nurse would be appropriate to reflect the ANA’s code of ethics regarding active euthanasia?

A.) “Ok I’ will go get the doctor to set up the paper work for the leathal administration of medication”
B.) “I know you are in pain and I want to honor your wishes to pass on, so I will go give you an extra dose of morphine to lower your respirations.
C.) Tell the patient that they could make a full recovery and there are more reasons left to live.
D.) Tell the patient you will make them as comfortable as possible but that she cannot administer any additional medication that could cause death.

What Nurses think about Active Euthanasia
Most studies that have been conducted deal with nurses in oncology, critical care and palliative care
Participants were asked about their willingness to assist with active voluntary euthanasia for an incurably ill patient if it were legal and at the patient’s request.
Responses showed that 78.9% of critical care nurses, 56.2% of aged care nurses and 33.3% of palliative care nurses expressed willingness to participate in active euthanasia.
Concluded nurses working in critical care or mental health are more willing to be involved in the provision of active euthanasia than those who work in aged or palliative care (Holt, 2008)
ANA Code of Ethics

Jamie Delude
(Schuman & Alfandre, 2008, p. 39)

4.) Which of the following countries have legalized euthanasia? Select all that apply.
A.) Netherlands
B.) Switzerland
C.) Australia
D.) Belgium

Passive Euthanasia:

withholding or withdrawing medical treatments or life-sustaining treatments

(Butts, 2008)
Stephanie Lamartine

Patients with appropriate decision making capacity authorize physicians to take their lives


Physician is able to euthanize a person without their direct consent

Active Euthanasia:
The intentional and purposeful act of causing the immediate death of another person, such as individuals with a painful disease, incurable disease, or a terminal illness
1973: American Hospital Association creates Patients Bill of Rights (gave patients the right to refuse treatment)
1974: First U.S. hospice opens in New Haven, Connecticut (Hillard, 2003)
1976: NJ Supreme Court allows Karen Ann Quinlan’s parents to disconnect her respirator. She lives for an additional 8 years
1976: California Natural Death Act is enacted
1977: CA, NM, AK, Na , ID,OR, NC, and TX have a right to die bill
1998: Doctor Death is aired on CBS
1999: Dr. Jack Kevorkian is Convicted of Murder
2005: Terri Schiavo has her feeding tube removed
2013: VT, OR, WA, MT- allow Physician-Assisted Suicide
(Hillard, 2000; Woodman, 2001; Haigh, 2013)

“All clinical encounters occur in a broader social context beyond the physician and patient, to include family, the law, culture, hospital policy, insurance companies and other financial issues”
("Ethics in medicine," 2013)
Family Burden
Cost implications
Available resources

Contextual Factors: Pros/Cons
Frees up medical funds to help others
-End of life care is 10-12% of total healthcare costs
-25-30% of Medicare program benefits are spent on care at the end of life
(Jennings & Morrissey, 2010)
Provides family members financial and emotional relief from the burden of taking care of a dying loved one
Allows patients to die with dignity

Potential to become a means of health care cost containment
Coercion of dying patient by exhausted care-takers
Coercion in the hopes to free up benefits such as life insurance and inheritance
Devalue human life

Stephanie Lamartine
CASE STUDY: Contextual Factors
Family dynamics:
-Son is the major caregiver
Senses that Mr. Tate no longer wants to continue dialysis and is ready for death

Family members have differing opinions regarding continuing versus withdrawing dialysis

Some citing religious reasons for sustaining life

Primary care physician obtains medico-legal opinion on the precedent and lawfulness of dialysis discontinuation
Cost of palliative care/ hospice is low when compared to cost of continued aggressive treatment and Mr. Tate’s frequent hospital visits

Stephanie Lamartine
• What does the patient want?
-He desires to discontinue dialysis
• He is in a tremendous amount of pain
• He feels that his quality of life has been lessened
• He is mentally competent, but conflicted
• There can be no resolution until Mr. Tate is able to initiate an open, honest discussion with his family and decisively express his feelings of wanting to die with dignity
– He wants “what is best for the family,” and yet is also ready to die in peace at home
6.) Which of the following states have laws approving the practice of physician-assisted suicide? Select all that apply.
A.) Oregon
B.) Washington
C.) Montana
D.) Illinois

7. Which of the following is associated as a “pro” for active euthanasia?
a. End unnecessary suffering
b. The “slippery slope” argument
c. Sanctity of life
d. All of the above are pros

8.) Which of the following is not an influential case in the euthanasia debate?
a. Quinlan’s Trials
b. Dr. Kevorkian Trials
c. Terri Shiavo Trials
d. All of the above are important trials

Stephanie Lamartine
Jamie Delude
Tanisha Howard
Meet Mr. Tate
Definition of Euthanasia
Ethical Dilemma with pros and cons
Case Study
Ethical Model
NCLEX questions
Melanie Gurski
Full transcript