Answer collectively - everyone contributes to one full answer.
What are the strongest 2-3 arguments for euthanasia? The strongest 2-3 against? Reference your readings. Note important vocabulary and distinctions, like what's physician assisted suicide (PAS) and how might that differ from euthanasia.
In the case of Euthanasia, there are many arguments for and against it. As for the question of the strongest arguments for and against euthanasia; my belief is one that surrounds itself in the guise of mercy killing; this being the main argument for it. It is also considered a moral offense; one that assumes you or any persons can place value on one's life based on assumptions of quality of life. This is something that can only be predicted, but not known. In James Rachels article on page 395 in the book, there are several stories that stress the patient's suffering as the case for euthanasia. One such story describes the patient with incurable cancer of the throat, and is in terrible pain that is no longer able to be alleviated. The patient, being of sound mind requests the physician to administer a lethal injection to end it all. His family supports him in this decision. This is an example of physician assisted suicide. This is not legal in most states, and goes against conventional doctrine. Another case describes an infant whose surgery is denied, which inherently causes death. This decision is based on the infant's gene mutation, Down's syndrome. Where is the mercy in this case? Denying the surgery actually causes pain and suffering. The decision made that this infant's life is not worth sparing, made by the family and physicians collectively. A form of passive euthanasia that is within an acceptable doctrine. Physician assisted suicide, within the context of being legal, may be that a patient alone decides his life is no longer a quality of his acceptance due to a poor prognosis of an advancing disease; and requests this of the physician, whom then may do it under the allowance of the law. Euthanasia, on the other hand may look different; because as I mentioned above, there is a form of passive euthanasia that comes to the same end as active euthanasia.
ReplyDeleteI am struggling with the term euthanasia period in these articles, Gloria. To me euthanasia is physician assistaed suicide; passive euthanasia in our practice is more comfort measures/ comfort care/ pallaitive care. Unlike what Rachels uses as an example, care is not just withheld. First, there must be no other alternative, it must be that any life saving attempt is truly futile, even then, they will likely try it temorarily. There's no selecting based upon daingoses like Downs, etc. Then, when comfort care is initiated, it's just that, they are given measures to make certain they are as comfortable as possible. These may include, fluids, antibiotics, pain medication, sedation, nasal/ mask oxygen. It can't be generalized, it's on a case-by-case need.
DeleteI did my paper about euthanasia and it does make you think the result is the same so what is the difference if we keep them comfortable or give them a lethal dose of medication? I think for me it comes down to being able to sleep at night. Having the burden of killing someone on my shoulders would be too much for me.
DeleteIt totally agree alex, I am not confident that I could actually give medicine knowing that it would cause a patient to breath his last breath. however, I am thankful for nurses that work with dying patients daily in tough situations.
DeleteI agree Alex. I don't think I could live with that either. When someone is already dying we tend to look at comfort meassure and withdrawing of care as allowing them to die with dignity and in peace. I guess education on how one can commit suicide or killing them in my office is not in my moral realm.
DeleteI disagree with everyone I think. Sorry to be the sore loser. I think that this is equivalent to respecting someones wishes to withdraw care. We just are respecting the patients wishes in a different way. And quite frankly I feel that if we offered this and they were able to have closure with their families and things like that they could avoid putting all the stress on their family about making the decision about withdrawing care. Because what happens if that patient with a terminal disease drops one day because of that disease process and didn't have anything set out about what he or she wanted to happen in the even something were to happen, we are leaving that for the family to decide. I just think that we respect patients wishes for comfort measures, then why can we not respect their wishes about this. I don't know I toy back and forth with opinions all the time
DeleteI personally feel like we as humans should have the right to die. Why is it that an inmate on death row who essentially has no rights is allowed to be put to death, but an innocent, terminally ill and suffering patient does not legally have that right?
DeleteThe discussion of "euthanasia" is difficult without clarification of terms and medical conditions and patient wishes. The many readings and cases sighted span a time period of three decades. In that time what is and is not “euthanasia” has changed greatly.
ReplyDeleteThe greatest arguments against euthanasia is the one by James Rachels (Degrazia et al, pp. 395- 399). He argues that there's no moral difference between "active euthanasia", the act of helping someone to die or physician assisted suicide, and "passive euthanasia", the act of letting someone die. In his argument, he repeatedly sites there is no difference morally and even implicates it's less cruel to help someone to die versus withholding treatment. This is a difficult article to grasp, as today's "euthanasia" does not lie along the lines he implies it did when he wrote this article. The article was written in 1975, and as a health care professional, I personally did not experience what active and passive euthanasia were back then. I can assure you that the cases he sites, would not occur in today's medicine. Each time he mentions passive euthanasia, he implies all care, including comfort care stops when they “withhold treatment”, and that is not the case in today’s “passive euthanasia”, which is more appropriately called comfort measures and palliative care.
A more realistic and reasonable arguments against “euthanasia” is that of Callahan. He makes a clear distinction between active euthanasia, the act of taking a patient’s life, and that of passive euthanasia “allowing a patient to die”. The article by Callahan was written in 1989, 14 years after Rachels’ article, which might be why his argument seems so much more evolved and relevant to me. According to Callahan there is a distinction between the two depending on the metaphysical, moral and medical perspectives (Degrazia et al, pp. 399- 402), emphasizing the difference between physical causality and moral culpability. He does point out in some cases, when moral culpability and physical causality cross lines due to poor medical decisions, the two are not that different. He notes physicians should use their knowledge and experience to try to cure, then when that has been exhausted, to then comfort, but never to kill. He says it is a powerful misuse, and an intrinsic violation of what it means to be a physician, when they use their skills and knowledge to bring life to an end.
A study that argues for euthanasia, but I think shines a light against euthanasia is the Oregon Death with Dignity Act (Degrazia et al, pp. 421- 426). This is simply because I struggle with physician assisted suicide and to me this is “active euthanasia”. Just the fact that this patient is prescribed a lethal dose of a medication, the ingest it, and they will then experience certain death at that time, without any chance for any other course to take effect naturally. A case could be argued they are going to die anyway, which is likely true, but I have seen many people with terminal illnesses give their “life sentence” and they live far beyond that and experience wonderful moments with their loved ones. While one may argue that they should not suffer, they can now receive palliative care and comfort measures to keep them from suffering, while their illness takes a more natural course, and those possibilities of the unexpected still have the opportunity to happen. I think the most valid article for “euthanasia” is Wicclair’s Medical Futility: A Conceptual and Ethical Analysis (Degrazia et al, pp. 359- 363). This article, written in 1993, shows a more modern look at it and more of a comfort/ palliative approach when it is futile, either physiologically, in relation to the patient’s goas, or in relationship to professional integrity, to prolong suffering. The cessation of life-prolonging treatment is based upon specific grounds that support it’s the most humane and civil thing to do. This is very much the approach we take now in palliative care and comfort measures.
I really think that in today's world we want to spin things a certain way to make us feel good about ourselves. In regards to the Oregon Death with Dignity Act its still euthanasia or PAS or what ever you wanna call it we are still killing a person. Its no different if you give them an IV dose of lethal medication or pills to swallow or extubate a patient to let me die the result is same. I still believe it is wrong and you can't really sugar coat something to make yourself feel better.
DeleteI agree completely, Alex. I was just trying to address as requested. It wasn't my endorsement by any means. Just trying to compare and contrast the different spins.
DeleteAlex, do you disagree with comfort care or palliative measures with a patient who has no brain function? Or were you talking specifically about the active acts of euthanasia?
DeleteSince this is a collective effort I will focus on the a reason I think you shouldn't allow euthanasia. With euthanasia and PAS (there really is no difference in the result it is just who preforms the action of killing the patient)once you allow them I believe there is a moral threshold you cross and you can never go back. Once that threshold is crossed I feel the criteria you use to even consider euthanasia will be come looser and looser. Obviously that patient has to be on board for something like this to take place but, I fell like you could make a patient feel like this is the best option for them because they don't want to be a burden to there families. For example if you have a elderly patient that has a terminal illness and say they have four months to live but she doesn't want any more financial burden on her family as well as time out of there schedule to take care of her she might feel obligated to pick euthanasia. As a result I think we would start killing patients that we wouldn't dream of killing today because they still have valuable time left here on earth. A more classic and conventional argument against classified as theological. St. Augustine urged the 6th commandment of the bible thou shalt not kill (Biomedical ethics pg. 390). Which is a very valid argument and from my faith perspective if God commands it we must follow it. So to me it makes the argument a lot easier.
ReplyDeletewell said, I could not agree more.
DeleteAll the articles we read talk about 2 topics, killing and allowing to die. Call it euthanasia, physician assisted suicide, active, passive, in the end it is all the same. Someone has been dealt a horrible hand and they have made the decision that they no longer wish to live. The difference comes in who actually causes the death. Having never been placed in the situation, I can not say what I really feel is the right answer. I have seen the cases of infants that are born too soon and there is nothing more to do but provide comfort care and wait for its little heart to stop beating. Does that mean that I have participated in passive euthanasia? Advances in science have come such a long way since many of these article were written that we may somehow, someway save that tiny baby, but the poor quality of life that child will have is much to think on.
ReplyDeleteDan Brock, I believe, provides one of the best arguments for support of voluntary euthanasia. He states there are two fundamental ethical values supporting the patient's right to decide about life sustaining treatment and also support the ethical permissibility of euthanasia. A patients right to individual self determination and individual well being (Degrazia, et al.pp. 402-404). They may chose to have palliative care, passive euthanasia, or active euthanasia. It is their choice. Dr. Atul Gawande also provides a good argument. He talks about a person's right to live with autonomy, dignity, and live what life they have left with meaning (Gawande, 2014). The book leads to more thought of palliative or comfort care. Ultimately it is still the patient's right of self determination to receive palliative care instead of harsh treatments that may decrease quality of life in the end.
I agree that it must be up to the patient to decide his own fate. Babies have no say so in what happens to them. That is the only problem I have with PAS. They must be able to choose for themselves. I know that allows some to fall through the cracks but we must protect those who cannot protect themselves.
DeleteJocelyn I cannot imagine what it must be like to watch an newborn baby take its last breath. maybe in textbook this would be considered passive euthanasia, and as nurses we are trained to do as much as we can to save lives. with that being said, the outcomes of advances in medicine, as you know, do not always make the best quality of life for that little child.
ReplyDeleteI did enjoy our reading assignment and especially the Frontline video. The question about the morality of euthanasia and PAS is a difficult one on many levels. I understand both sides of the coin with regard to the patient's autonomy and dignity. A terminally ill patient, who can still make rational decisions, has the right to decided how he wants to live out his last days. With active euthanasia being against the law, the patient's only option in our society, other than in Oregon, is to invoke palliative care. On one hand, I wonder if palliative care isn't a possible form of passive euthanasia. All non-essential treatments and medications are stopped and only comfort medications and treatments are continued. It's the patient's rational choice to pursue palliative care. However, is some instances of extreme pain and suffering, wouldn't it be the patient's right to choose PAS or active euthanasia? In chapter 6 in our book, there is much discussion of how euthanasia and PAS will cause the deterioration of the value of life and be a detriment to society. It also states that euthanasia and PAS goes against the professional oaths taken by the physician. It further states there is a significant difference between killing and allowing to die. (Degrazia, et al.pp. 378-384). In my mind, it comes down again to the patient's choose. They have the right to autonomy and respect of their wishes. Do I think euthanasia should be legalized? I'm not sure how it would work as a law nationwide. Do I think physicians are missing the mark in some instances? YES! Physicians need to be more interested in end of life care for the terminally ill and dying no matter what their age is. Dr. Atul Gawande did his research and by life experience, learned how to say the difficult words to the terminally ill patient. He learned when to say treatments are futile, lets start looking at making the lasts days some of the best days.
ReplyDeleteAs a hospice nurse, we often get patients on the unit directly from the hospital setting. Their doctors haven't had those crucial end of life conversations with them. The patient doesn't understand what palliative care means. But I also understand, the patient may not be listening because they have been given the grave news that they only have a short time to live. I often hear from patients "give me a shot to end this suffering". Sometimes I feel the patient has been misled to believe that, in someway, hospice will perform euthanasia, which is not the case. Comfort care and the patient's right to autonomy is most important.
I agree Tracy. I believe hospice is more along the lines of passive where PAS is active. We as nurses view hospice care is a beautiful thing, and allows that person to die with dignity and without suffering. Although most of the time in emergency medicine we can sometime exhaust medical staff and resources in saving one. On the contrary, there are times where enough is enough and they should be allowed to die with respect. Comfort care is their right! Just because we can save them does not mean we should.
DeleteI enjoyed the frontline video as well although it brought me to tears! I have great respect for you as a hospice nurse, I do believe that is one area of nursing I am not strong enough to withstand.
DeleteI have seen friends and relatives pass away in hospice. Some of them in great pain due to the nature of the disease which they have. I know that both would of perfected PAS rather than passive euthanasia. It is as dividing an issue as politics.
DeleteI have to applaud you and what you do. Being advocates for patients and having to talk them through something like end of life care is not an easy thing to do. I do wish more physicians would take the time to sit with their patients like Dr. Gawande does and really find out what their values and goals are for end of life care.
DeleteI feel that physician assisted suicide and euthanasia differ in the way that physician assisted suicide is when the physician provides the means for death such as a prescription, the patient then (not the physician), administers the medications causing death. Euthanasia on the other hand is the physician acting directly to cause death such as administering a lethal injection.
ReplyDeleteArguments for euthanasia are very subjective but the most common arguments that I have found in my readings are autonomy and freedom of choice when it comes to oneself. Also, as James Rachels’ article, Active and Passive Euthanasia points out, if passive euthanasia (such as refusing treatment to prolong life) is morally permissible then why isn’t active euthanasia (such as a lethal injection to end suffering). He makes an extremely valid point of active euthanasia is typically more humane than passive, however, society and the law views it as killing versus letting die. (Brand-Ballard, Degrazia, Mappes, 2011)
Arguments against euthanasia are also very subjective but have a familiar recurrence in the readings. Those include religious and moral reasons for not being acceptable as well as expecting healthcare providers to ethically and morally carry out the assisted suicide if it goes against their beliefs.
Brand-Ballard, J., Degrazia, D., Mappes, T. (2011). Biomedical Ethics 7th ed. pg. 395-399. New York, NY. MCGraw Hill.
That's an interesting perspective and makes very valid points. I hadn't thought of the two differing quite like that. It opens the mind to an entirely new series of questions and possibilities.
DeleteYou point out a very important theme that I have noticed in our readings and responses and that is religious and moral reasoning. I think some topics are hard to discuss due to ones religious view. It is hard sometimes to step back and leave out religion, whether it is respecting your own, or someone else's. If a story about refusing to grant marriage licenses to gay couples made such headlines, I'm surprised that that has not made waves in the medical community as much.
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ReplyDeleteActive and Passive Euthanasia has been an argument since I was a child. I can remember the support and outrage Dr. Kevorkian received in 1999 in his trial for the voluntary euthanasia. Active euthanasia is the medical professional basically giving the patient a medication which causes them to die. “Part of my point is that the process of being” allowed to die’ can be relatively slow and painful, whereas being given a lethal injection is relatively quick and painless. (Brand-Ballard, Degrazia, Mappes, p.396). The argument allows for the patient not to undergo prolong agony for a few days that really do not matter to the patient. It also allows the patient to make the determination and allow himself undue pain and suffering. My second argument for active euthanasia is that it allows us not to look at death as a disease. It is going to happen to everyone who walks the earth. You should be able to make the decision if you want to live or die at the end of one’s life.
ReplyDeleteThe arguments against are more for those who cannot make the decisions themselves. The example of not performing bowel surgery on a child who has Down’s syndrome. This allows the parents and society to dictate who is worth saving. The end of life case with Terri Schiavo, were the husband removed her feeding tube and she died. It caused outrage throughout the country. The family through the courts tried to block his decision but failed. She died but had no way to express if that was her wishes.
Physician assisted suicide is now legal in 5 states. The law states they must have a terminal illness and less than 6 months to live. The physician is allowed to prescribe medication that speeds up the dying process. This allows the MD to coach or help the patient end his or her life.
Brand-Ballard, J., Degrazia, D., Mappes, T. (2011). Biomedical Ethics 7th ed. pg. 395-399. New York, NY. McGraw Hill.