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Legal And Ethical Issues Of Euthanasia: Argumentative Essay

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Abstract

Euthanasia is one of the issues that has been the subject of intense debate over time. It has been a pertinent issue in human rights discourse as it also affects ethical and legal issues pertaining to patients and health care providers. This paper discusses the legal and ethical debates concerning both types of euthanasia.
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EDUCATION AND TRAINING
LEGAL AND EThICAL IssUEs Of EUThANAsIA: ARGUmENTATIvE EssAy
Bilal S. H. Badr Naga
Majd T. Mrayyan
(1) Bilal S. H. Badr Naga., MSN, RN, Prince Sultan Cardiac Center in Qassim,
Saudi Arabia
(2) Majd T. Mrayyan., Prof, RN, The Hashemite University, Jordan
Correspondence:
Bilal S. H. Badr Naga., MSN, RN,
Prince Sultan Cardiac Center in Qassim,
Saudi Arabia
Email: Bilal_badrnaga@yahoo.com
Abstract
Euthanasia is one of the issues
that has been the subject of
intense debate over time. It
has been a pertinent issue in
human rights discourse as it
also affects ethical and legal
issues pertaining to patients
and health care providers. This
paper discusses the legal and
ethical debates concerning
both types of euthanasia. It
focuses on both the supporter
of euthanasia and the opponent
of euthanasia. Several
statements for the Euthanasia
argument arediscussed:
a merciful response that
alleviates the suffering of
patients which is sometimes
wrongly perceived to be
otherwise unrelievable; the
autonomy in which the patient
has the right to make his own
choices; the regulation and
legislation of existing practices
of euthanasia to protect health
care providers and patients. In
this heated debate religious,
political, ethical, legal and
personal views are also
included. Among all these,
those who desperately want
to end their lives because they
simply cannot go on in any
way, are the ones who suffer.
Every individual or group has
a different viewpoint regarding
euthanasia. Euthanasia
is considered a practical,
emotional, and religious
debate.
Key words: euthanasia,
palliative care, type of
euthanasia.
Case scenario
A 56 year old female patient,
divorced 5 years ago, a mother of
one daughter, lives with her 20 year
old daughter. She was working as
a maths teacher, was well and very
active until six months ago; she
started to complain of generalized
pain and weight loss, severe
headache, multiple seizure episodes.
She was diagnosed as having a
metastasis brain tumor stage IV. She
received two cycles of chemotherapy
and refused radiotherapy. She
developed hypoxic damage to her
brain cells which left her paralyzed,
and blind.She has been lying in her
bed, depressed, with no contact with
the outside world. She is religiously
and sincerely fed by her daughter.
She is suffering from intolerable
pain. She asks her doctor to die in
peace and signed an agreement
consent form with the witness of her
daughter. Her doctor gave her a high
dose of morphine and terminated her
life immediately.
This case was used to discuss
the different opinions and answer
the following questions in order
to understand the concept of
euthanasia. Is euthanasia a legal
behavior? Does the patient have the
right to request death peacefully?
Despite the patient’s agreement
and consent, is participating in the
killing of a patient considered ethical
behavior and professional? Is there a
long term impact and a sense of guilt
by family and health care providers?
Finally, why are some suppor ting a
peaceful death and why some are
against it, with opinion support?
Introduction
Euthanasia is a concept used in
the medical eld which means easy
death or gentle death, and is dened
as the deliberate speeding up of
the death of an individual based
on terminal medical conditions
(Jonsen, Siegler, and Winsdale,
2002). Euthanasia reects one of the
current debatable issues and raises
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many questions that need to be
answered.
Health care professionals, including
oncology nurses, frequently
encounter ethical issues when
caring for end of life patients and
have to make a decision and choose
between dif cult or unacceptable
options and are frequently obligated
to use their own moral reasoning to
solve these ethical issues (Elis &
Hartley, 2007).
In today’s world, in spite of
technological and scientic progress,
especially in the eld of laws and
regulations related to human
health there is still ambiguity and
controversy over the concept of
peaceful death (euthanasia). Thus,
this ethical dilemma may impose
health care providers to legal and
ethical risk.
The ethical and legal aspects of the
concept of euthanasia are still widely
debated in many countries of the
world. There are several opinions
based on the principles of personal
morality and religious beliefs.
Thus, scientists and researchers
are still looking to reach a general
consensus on this ethical dilemma.
In Islamic countries there are
discussions and debates about
withholding or withdrawing the
life support therapies or allowing
a patient at the end of the life to
choose peaceful death. Based on
Islamic law, health care providers
are not protected and have no
immunity in case of deciding to help
patients to die. Thus, according to
the Islamic point of view; it is not
recognized for a patient to have the
right to die voluntarily because life
is a divine trust and an opportunity
to rene the spirit. Then, no one has
the right to quit human life through
any form of interference with active
assistance.
Some Muslim Clerics scholars
emphasized that life-saving
equipment cannot be stopped
unless physicians are condent
of the inevitability of death and no
hope (Zahedi, Ali Larijani, & Draper,
2007).
Therefore withholding or withdrawing
treatment of any patient is never
easy and cannot be generalized
without taking into consideration
the cultural, social, and religious
factors when making decisions. The
incidence of death as a result of
euthanasia has been found to differ
between countries (Onwuteaka-
Philipsen, Fisher, Cartwright,
Deliens, Miccinesi, Norup, et al.
2006; Ganz, Benbenishty, Hersch,
Fischer, Gurman, &Sprung, 2006).
In the Netherlands as an example of
a western country it is seen that nine
percent of all deaths in 1990 were
a result of euthanasia (Remmelink,
et al. 1991). Unfortunately, there is
a lack of statistics on the incidence
of direct terminating of life by
physicians in the Kingdom of Jordan
and no clear policy about euthanasia
for patients at the end of life stage
whether that is secondary to cancer,
or to any other end stage illness.
The advancement in medical
technology is bringing deaths
into hospitals where life, may be
prolonged for a long time. For
example, in Britain at any one
time there are about two thousand
people who have spent more than
six months in a persistent vegetative
state from which they will never
recover. Many dread the endless
indignity of such a fate. Worldwide
there is a need to address the issue
of euthanasia in order to manage
and support clients and staff who
are in a situation where a request
of death is in place. In Jordan, yet,
there are no studies that discuss
euthanasia, or end-of-life decisions
in any clinical setting.
This paper aims to discuss
euthanasia among different western
countries and Islamic countries and
focus on the legal, religious, and
social perspectives regarding this
controversial issue.
This argument essay is attempted
to decrease and limit the argument
among health care professionals
regarding euthanasia in order
to enhance clear decisions,
communication and accountability.
This paper is organized to discuss
and show viewpoints from both
sides of the arguments and is
concluded with the writer’s opinion.
A case scenario was selected and
discussed for better understanding
of this issue of euthanasia.
Denition and Background of
Euthanasia
The denitions of euthanasia are
not enough to nd a clear society
consensus. In order to increase
public support we need to keep clear
denitions so we know what we’re
talking about. Euthanasia is taken
from the Greek ward euthanos,
which means “good death.” Death
with dignity and without suffering,
but the question is, how do we go
about achieving this?
Euthanasia is the active killing
of a patient by a physician, on
the patient’s request and in the
patient’s interest (Tom and Arnold,
1979). There are two types of
euthanasia - passive and active.
Passive euthanasia is dened
as allowing a patient to die by
withholding treatment, whereas
active euthanasia is dened as
taking measures to directly cause
a patient’s death. Another division
of euthanasia is that it is voluntary,
involuntary, and non voluntary.
Voluntary euthanasia is when a
patient gives his agreement whereas
non voluntary is when the agreement
is unavailable because of a patient’s
coma (Singer, 2011). Involuntary
euthanasia occurs when euthanasia
is performed on a person who is
able to provide informed consent, but
does not, either because they do not
choose to die, or because they were
not asked. Nurses may encounter
many questions from patients and
their families when counselling
them about hastening the death of a
patient (Gorman, 1999; Lewis, 2007).
There are some statistics regarding
medical practitioners who support or
oppose euthanasia (Appendix A).
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Physician Assisted Suicide (PAS) is
dened as: ‘The situation where a
doctor intentionally helps a person
to commit suicide by providing
drugs for self-administration, at that
person’s voluntary and competent
request’ (Best, 2010). According
to Best, in PAS the doctor is not
doing the action but morally he is
involved as the motive intention
and the outcome are the same.
Thus, euthanasia and PAS are used
interchangeably in this paper.
Euthanasia Worldwide
Euthanasia is a controversial issue
in Australia. Although there are
different laws in Australia related
to euthanasia, the legislations in
most States consider it as illegal.
At rst, it was legal by Rights of the
Terminally Ill Act 1995, and then it
was overridden by the Australian
government. But an Australian Dr.
Philip Nitschke helped three patients
to achieve euthanasia (Alexander,
2010). In 2002 in Belgium the
Belgian parliament passed
legislation for euthanasia (Adams &
Nys, 2003).
Smets and his colleagues (2010)
conducted a survey and found
that most deaths by euthanasia
compared with other deaths were
more often younger, male, cancer
patients and more often died in
their homes. In almost all cases,
unbearable physical suffering from
uncontrolled pain, poor wound
healing, and poor social interactions
were reported.
Canadian laws on living wills and
passive euthanasia are a legal
dilemma. It is illegal to ‘aid and
abet suicide’ under Section 241(b)
of the Criminal Code of Canada,
which states that this is an indictable
offence with a potential fourteen-
year sentence if the appellant is
found guilty (Ministry of Attorney
General, 2010). Also the British
law has the same attitude toward
euthanasia by considering it as
illegal by all means.
In Indian laws, passive euthanasia
is legal supported by the Supreme
Court for brain death patients, but
any actions whatsoever to end the
life of a patient (active euthanasia)
is illegal (Magnier, 2011). The same
case applies to Ireland. Active
euthanasia is considered illegal
while passive euthanasia is legal.
The Israeli and Jewish laws consider
euthanasia as illegal, but in some
cases it can be accepted under the
Israeli law (Butcher, 2005; Brody,
2009).
Active euthanasia is illegal in
most of the United States. While
voluntary, passive euthanasia is
considered legal; the patients have
the right to reject medical treatment.
Italy witnesses a social and legal
crisis about a woman who had a
car accident and she has been
unconscious since 1992.
The Prime Minister Perleskony
refused to endorse euthanasia for
this woman claiming that nobody
has the right to end the life of
any human being. The Supreme
Court in Italy decided to end this
woman’s life by euthanasia and
they stopped giving her food or
drink. And so the decision taken by
the Italian government breaks the
sentence taken by the Supreme
Court according to the Italian law.
It is obviously noticed that in the
countries which allow euthanasia,
such as Holland, there has been
poor palliative and hospice care
whereas in the countries where
euthanasia is forbidden, they have
developed hospice care for the
patients who are suffering badly.
The issue of euthanasia has been
raised in recent years in Islamic
countries due to the debate over
specic cases in which specic
patients or their families have asked
health care professionals, judges
and religious people for a patient’s
right to die with dignity in a number
of different ways (Bernard, 2000).
In reality the issue did not enter
into open public debate as it has in
the USA and European countries.
Despite this, the concept of
euthanasia has mainly concentrated
on physicians due to the nature of
their roles.
Turkey, as an Islamic country forbids
euthanasia strictly and considers
such actions as a crime by the
Criminal Law of Turkey (Karadeniz,
Yanikkerem, Pirincci, Erdem, Esen,
and Kitapcioglu, 2008). In Jordan
euthanasia is illegal even if informed
consent is taken from the patient
or his family, thus it is considered a
crime against human life and the one
who commits euthanasia whether
actively or passively will be punished
by the law as being an intentional
act.
Discussion
Regarding Patient Suffering
Many patients experience pain
and suffering when they are dying,
that is true, and during my clinical
experience I have seen many
dying patients who at their end
stage illness were in pain, and they
may be treated without dignity, or
experiencing spiritual disorders.
But, we think this is an individual
experience.This is supposed not
to happen, but it is still happening
and people are using this factor to
convince people for the legalization
of euthanasia. We must do better
and look for better solutions. There
is another option, which explains
why euthanasia is increasingly
unnecessary.
In the Greek Orthodox Church
euthanasia is not accepted in every
type, and there is no legal legislation
or any action that helps patients to
be allowed euthanasia (Voultsos,
Njau, and Vlachou, 2010). Keown,
(2005) reported Buddhists’ point of
view and found that there are many
different opinions about euthanasia
and they justify it as to end the
sufferings of a patient. However,
there is no justication whatsoever to
end the life of a human being under
any circumstances.
Moreover, in the teachings of the
Catholic Roman Church euthanasia
is a crime against life and God. On
the other hand, Evangelical churches
and the Roman Catholics have the
same attitudes towards euthanasia
which says that life is sacred.
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According to the Hindu views,
there are two points of view. One
considers euthanasia as a good
action; the other considers it as
disturbing the cycle of death and
rebirth. Also, why are churches that
established the rst hospices in the
19thcentury and medical and nursing
students now receiving training in
pain control, because they believe
that different types of pain respond
to different treatments and this will
help in caring of the dying.
In general, suffering is not only
a medical problem but also an
existential problem that extends
beyond physical pain. It is
inuenced by many factors such as
psychological, cultural and spiritual
factors and we can deal with
physical symptoms but the suffering
may remain.
Islam forbids all forms of self-
killing whatever the reason is for
life and death is in the hands of
Allah and nobody has the right to
end this life bestowed by Allah and
it is considered as a suicide. This
means that Islam is totally against
euthanasia whether active or passive
and considers it a type of killing if it
is committed by a different person
and a suicide if it is committed by
the same person and both of them
should be punished and sent to
hell in the other life. Thus Islam
has a clear cut attitude towards
euthanasia which is strictly forbidden
by all means because Islam and the
prophet (the messenger of Allah)
said that life belongs to Allah and
He is the only One who has the
right to give or take it away without
any exceptions. Accordingly, all the
Fatwa Councils in all the Arab and
Islamic countries do not pass any
law (Fatwa) considering it as legal
under any circumstances.
In addition, the Islamic Code of
Medical Ethics, 1986 mentions that
the concept of a life not worthy
of living does not exist in Islam.
Justication of taking life to escape
suffering is not acceptable in Islam.
Prophet Mohammad taught: “There
was a man in older times that had
an iniction that taxed his patience,
so he took a knife, cut his wrist
and bled to death. Upon this God
said: My subject hastened his end,
I deny him paradise.” (Translation
of Sahih Muslim, Book 35). Yusuf
al-Qaradawi, the chairman of the
International Union for Muslim
Scholars (IUMS) mentioned that we
can say that the Islamic perspective
is that life belongs to Allah. It is He
who gives and takes away life. No
human can give or take it. Muslims
are against euthanasia. They believe
that all human life is sacred because
it is given by Allah, and that Allah
chooses how long each person will
live (Fatwah Bank. 1996).
Moreover, the religious community
in Islamic countries has discussed
some sensitive medical issues such
as denition of death, withholding
and withdrawing life sustaining
measures, and its legality as early
as 1983. The Permanent Committee
for Research and Fatwa issued
a statement (Riyadh No. 6619;
1983) that advanced life support
measures can be stopped if the
medical team afrms that brain
function has irreversibly ceased
(Albar, 2004). The Islamic FIqh
(comprehension) Academy; 3rd
session, 1986, Amman, Jordan,
Resolution No. 5 concluded that a
person can be declared dead in one
of two conditions: (1) complete and
irreversible cardiopulmonary arrest
afrmed by physicians. (2) Cessation
of brain activity and afrmation by
physicians that this cessation is
irreversible and that the brain has
entered the state of decomposition
(OIC, 2003; Albar, 2004).
Physician and Protection of Life
One aspect of the euthanasia debate
that is often ignored is that it expects
doctors to perform euthanasia. One
of the main roles of physicians is to
gain a patient’s trust and therapeutic
relationship, and how does one
maintain this goal if the patient’s
perception will change toward the
physician who participates in killing
patients (murder) instead of being a
protector of life! Euthanasia violates
codes of medical ethics which
prohibits doctors from helping their
patients die.
Perspectives of those who
Oppose Euthanasia
There are people who are against
euthanasia because they consider
it a murder. Those who rejected
euthanasia fear it may become
a means of health care cost
containment, and become non-
voluntary and against the rights
and value of human life. Those
people defend their opinions through
emphasizing the respect of human
dignity through searching for
solutions for cost containment, not
through killing patients because of
their suffering, and should identify
the reasons that make a patient’s
request for euthanasia and nd
solutions to enhance their quality of
life (Voultsos, Njau, and Vlachou,
2010). This means that it is not the
choice of the physician to decide
about killing patients even if they
have signed an agreement and this
is not a violation of their human
rights.
Euthanasia is a social, legal, and
ethical dilemma although many feel
euthanasia is an unethical practice,
one of the biggest arguments against
this process is belief about the
casual nature with which it will be
approached in the future.
If euthanasia is permitted without the
necessity to abide by government
regulations and laws, people will
use it as a means to get out of even
simpler troubles.
Moreover, there may be ways in
which pressure may be put on
individuals to die or end their lives
because they may seem as ‘burdens’
to the family. They may also use it as
a method of avoiding heavy medical
expenditures that may be needed
in cases that are complicated.
Religious views suggest that only
God has the right to take life, and it
is something human beings should
not meddle with. Furthermore,
they believe that life is a precious
gift that has been bestowed upon
us by the Almighty, and giving it
up due to some pain is no way to
value it. Political views suggest that
euthanasia will have an effect on
society, no matter how personal a
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decision it is. As a society that
survives on following the footsteps
of others, deciding to request death
will cause other individuals (in less
deplorable situations) to follow these
methods too.
These are simply some thoughts on
the ongoing debate that is a cause
for concern all over the world. From
the humanitarian point of view, the
right to die with dignity, respect,
comfort, and peace belongs to
every individual, and this cannot
be ignored no matter how many
arguments are put forth against this
practice.
Though several facts may be
presented to you to persuade or
dissuade you about this practice,
it is ultimately your belief that will
allow you to think whether or not
such a practice should be legalized.
It is a good idea to remember that
death and dying is inevitable and
an ultimate eventuality. In effect,
the legalization of euthanasia under
the strict governing of laws and
regulations will allow those who wish
to avail of this right, to do so with
dignity. It is a process that will take
a while, while the pros and cons of
euthanasia are considered, and till
all human beings are convinced that
it may be a boon from Allah when
viewed from the perspective of the
right to life.
Human rights give everyone the
right to take the best medical
management to face different
diseases and their signs and
symptoms that affect all quality of life
domains; therefore, from the British
physicians’ point of view, the majority
of them do not support legalizing
assisted dying, neither in the form of
euthanasia nor physician-assisted
dying. (Seale, 2009)
Euthanasia is complex, and there
are ethical, legal, social, and moral
arguments. The fear of euthanasia
is that it will become a broad area
for cost saving for health care
institutions and toward health
care providers in order to allow
euthanasia to terminate life of
patients under many circumstances;
and that condoning voluntary
euthanasia is a slippery slope
towards allowing involuntary assisted
killing (Rietjens et al. 2009).
The perspective of university
students about euthanasia was
studied in Pakistan. Students who
opposed legalization (74.4%) cited
impediments to future medical
research as the most common
reason, followed by the risk of
misuse by physicians or family
members. Only 8.9% of students
cited religious beliefs as a reason
against legalization of euthanasia.
(Shaikhand & Kamal, 2011)
Perspectives of those who
Support Euthanasia
This is one of the broad arguments
for euthanasia. Supporters of
euthanasia should know there is a
social, ethical and legal impact on
society, patients, and their families.
Socrates, an ancient philosopher of
Greece chose to kill himself instead
of being exiled. The debate concerns
one question: is euthanasia
ethical? The case rests on one
main fundamental moral principle:
mercy. There are many even within
the medical eld who believe that
euthanasia is far more ethical to
those who have suffered terribly in
terminal illnesses.
There are a many good reasons
to accept euthanasia as the best
option; it helps the patient, the
patient’s family, and the family’s
economy. It is a choice and
alternative for a patient’s decision
which should be respected in order
to alleviate suffering. There are
many countries where euthanasia is
allowed in order to give the right for
everybody to end his life and help
in health care cost containment.
Patients in chronic prognosis do
not have a choice to live. They can
request euthanasia to stop suffering.
Patients in terminal stages of
disease and suffering from
uncontrolled severe pain, poor
wound healing, poor social
interaction, and poor emotional and
economic status tend to request
euthanasia. Euthanasia allows
patients to terminate their perpetual
state of suffering and die with
dignity, respect, comfort, peace,
and free of pain, when the patients
cannot perform physical, emotional,
and social tasks.
Advocates and supporters for
euthanasia ask about why such
a person should continue to live
in suffering. There will be guilt,
anger, frustration, and sadness
associated with the decision of
choosing euthanasia. In this way, it
is considered improper to demand
death, when feeling weak. Also, it is
believed that the person in question
has an obligation towards society,
where she/he simply cannot choose
to die because the life and death is
given from God only.
In Greece euthanasia is applicable
under legal documentation without
giving attention to ethical, or social
aspects of euthanasia (Voultsos,
Njau, and Vlachou, 2010). Also, in
Flemish hospitals all health policies
contain euthanasia procedures; that
involve caregivers, patients, and
relatives. Euthanasia policies go
beyond summarizing the euthanasia
law by addressing the importance
of the euthanasia care process; to
give the patients and their families
the rights to die in dignity as well
as when the patients arrive at a
critical prognosis which cannot be
controlled by medical management
(Lemiengre, Casterle , Denier,
Schotsmans,& Gastmans, 2008).
There is a substantial majority of
nurses supporting the practice
of euthanasia for patients with
a terminal illness with extreme
uncontrollable pain or other distress
and for their own involvement in
consultancy about euthanasia
requests. There is, however,
uncertainty about their proper role
in the performance of euthanasia.
Older nurses were more likely than
younger nurses to support life-
ending without the patient’s request
(Inghelbrecht, Bilsen, Mortier, &
Deliens, 2009).
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Some of the arguments favoring
the practice found in other studies
included the need to relieve severe
and incurable pain in the context of
terminal illness or extremely poor
quality of life, allowing patients to
exercise freedom of choice and
freeing up medical resources to help
others (Roubaix, 2008).
Pakistani student perspective
toward euthanasia was to relieve
patient’s suffering but only when a
committee of physicians agreed to
commit it. Only 25.6% of students
agreed that euthanasia should be
legalized in Pakistan to put an end
to the sufferings of the patients.
(Shaikhand & Kamal, 2011)
Perspectives of the Researcher
Death is considered the inevitable
end of a human’s life; it is the
Creator who gives and takes away
the human’s life. We believe that
euthanasia is not legal, ethical, and
religious in all forms or names. It is
strange in the twenty-rst century
to nd supporters for euthanasia
not exploiting the scientic, medical
and technological advances in
nding new medical methods to
prevent or relieve the disease or
its symptoms. The second reason
we understand that euthanasia is
opposed to palliative care, supposed
to be encouraged not neglected. In
Jordan, for example, palliative care
is started at King Hussein Cancer
Center (KHCC) and does not appear
in other health care institutions.
Moreover, Catholic hospitals have
rigidity in using the concept of
euthanasia and give support and
availability of palliative care and a
multidisciplinary team to introduce
the best health management to
terminally ill patients to improve
quality of life for patients and their
families (Lemiengre, Casterle,
Denie, Schotsmans, & Gastmans,
2008). Also, the major fear held by
the dying is not physical pain, but is
also the fear of being abandoned by
family, society, or both.
The World Health Organisation
(WHO) recommends that
governments devote more attention
to pain relief and palliative care
before considering laws to allow
euthanasia. Most patients who
request euthanasia change their
minds once satisfactory pain control
is established.
The third reason is the religious
sense toward caring of patients
in order to prevent euthanasia by
providing dignity, respect, and
freedom from suffering in the
end of the patients’ life. Catholic
nurses also agreed more often
than non-religious nurses to
prevent euthanasia requests by
comprehensive palliative care and to
overcome signs and symptoms that
make patients request euthanasia
(Inghelbrecht, Bilsen, Mortier, &
Deliens, 2009). On the other hand,
palliative care is not only limited to
patients but also to their families.
Family members are an important
part of a patients care, to give
patients more rapport, support, and
security.
It is common for family members
to become overwhelmed by the
additional responsibilities placed
upon them when they nd one of
their members suffers from chronic
disease such as cancer. Palliative
care can help patients, families, and
friends to cope with this disease and
give them the support they need. It
gives holistic care that consists of
physical, spiritual, emotional, and
coping care.
We consider euthanasia as an act of
murder. Our Quran emphasizes this
“He who created death and life that
he might try you as to which of you
is better dead, he is the mightiest,
the most forgiving” (Qur’an- 67:2).
Also taking one’s life in Islam is only
required for the sake of abolishing
crime, ensuring peace, tranquility
and security in the human society.
Also, Islam does not believe in
prolonging life as everyone has been
created for a life span. Scientists
are to assist but not replace Allah in
the creation of death “ Allah gives
life and death and Allah sees well all
that you do” (Qur’an 3:156).
There is no doubt that the nancial
cost of maintaining critical illness is a
factor. However the question is when
the human becomes ill and cost
becomes a nancial burden on the
society, should allow death naturally
and the cost is the responsibility of
the society and they should change
their priorities and divert funds from
administrative and recreational areas
to compensate the nancial burden.
The suffering which one undergoes
as a result of illness does not
takeover one’s dignity rather in
fact benets him spirituality by
removing his/her sins as described
by Prophet Mohammad.”Any Muslim
is affected with harm because of
sickness or some inconvenience,
Allah will remove his sins for him as
a tree sheds its leaves” (Sahih Al-
bukhari: Kitab Ultibb, 153). Thus, our
responsibility is to seek treatment
rather than mercy killing or suicide.
Prophet Mohammad emphasized
this when he said “O Muslims, seek
cure, since Allah has not created
any illness without creating a cure”
(Ibne Majah, Abu Daw’od) thus, if we
do not know the cure, it is now our
responsibility to search for the cure
not instead to start killing patients to
end their sufferings.
Statement of Argumentation
The rst statement for euthanasia
argument is a merciful response
that alleviates the suffering of
patients which ia sometimes
wrongly perceived to be otherwise
unbearable. The second statement
for euthanasia debate is the
autonomy in which the patient has
the right to make his own choices.
The third statement for euthanasia
argument is legal, social, ethical,
and religious aspects of euthanasia.
The last statement is the regulation
and legislation of existing practices
of euthanasia to protect health care
providers and patients.
Recommendations
Relieving pain, restoring dignity,
improving quality of life and giving
people back control over their lives is
far better than fatal injections. Most
people are visibly relieved when they
are told euthanasia is not an option.
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MIDDLE EAST JOURN AL OF NURSING VOLUME 7 ISSUE 5 OCTOBER 2013
When symptoms are properly
controlled, fears dealt with,
appropriate practical, emotional and
spiritual help is provided and people
feel safe, it is very rare for people to
ask again for death by euthanasia.
Euthanasia is a complex issue
from a global perspective. Different
cultures, traditions, religions and
laws make the issue too simple for
quick explanation. Therefore the
recommendation for euthanasia is
stated in four axes that consist of
legal, governmental, social, and
education axes. Legally, there must
be strict laws preventing euthanasia
and even those helping to do it.
There should also be legislation
against this act and punishment of
those who do it or even help to do
it. Socially, local governmental and
non-governmental institutions should
also be against euthanasia and they
should do their best to prevent it by
all means and to establish groups
and charities to help patients and
their families socially, spiritually and
nancially.
Educationally, all academic
institutions (universities and
colleges) teaching medical programs
should teach medical ethics courses
as part of their programs to enable
the students to understand the
ethical bases to deal with patients
and their families based on ethical
backgrounds.
Furthermore, governmental and
private health sector should pay
more attention to establishing a
palliative care unit in hospital to
cover all chronic diseases. In Jordan
since 2004 when the Palliative Care
Jordanian Society was established
to give the right for the patients not
to feel pain, loneliness and suffering
in various stages of their illness is
considered a duty of health care
providers and the medical institutions
to take into consideration the
psychological, social and spiritual
aspects when dealing with patients
who complain of chronic diseases,
and allow the patients to die with
respect, dignify, peace, comfort, and
without any social isolation.
Summary and Conclusion
Euthanasia has been a hot topic of
debate for a while now. While some
believe it is only humane to enable
a human being to end his suffering
by means of assisted suicide, others
believe that all pain and suffering
endured by human beings is God’s
will, and should be accepted as
it has been given by God. In this
heated debate religious, political,
ethical, legal and personal views
are also included. Among all these,
those who desperately want to end
their lives because they simply
cannot go on in any way are the
ones who suffer. Every individual
or group has a different viewpoint
regarding euthanasia.
Euthanasia is considered a practical,
emotional, and religious debate.
There is also a deep and broad
history of euthanasia, which cannot
be ignored when having a debate
regarding this subject. Based on
this history, beliefs, and viewpoints,
certain arguments for and against
euthanasia have been put forward.
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Appendix A
Appendix A
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EDUCATION AND TRAINING
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To study the reported medical practice of euthanasia in Belgium since implementation of the euthanasia law. Analysis of the anonymous database of all euthanasia cases reported to the Federal Control and Evaluation Committee Euthanasia. All euthanasia cases reported by physicians for review between implementation of the euthanasia law on September 22nd, 2002 and December 31, 2007 (n = 1917). Frequency of reported euthanasia cases, characteristics of patients and the decision for euthanasia, drugs used in euthanasia cases, and trends in reported cases over time. The number of reported euthanasia cases increased every year from 0.23% of all deaths in 2002 to 0.49% in 2007. Compared with all deaths in the population, patients who died by euthanasia were more often younger (82.1% of patients who received euthanasia compared with 49.8% of all deaths were younger than 80, P < 0.001), men (52.7% vs. 49.5%, P = 0.005), cancer patients (82.5% vs. 23.5%, P < 0.001), and more often died at home (42.2% vs. 22.4%, P < 0.001). Euthanasia was most often performed with a barbiturate, sometimes in combination with neuromuscular relaxants (92.4%) and seldom with morphine (0.9%). In almost all patients, unbearable physical (95.6%) and/or psychological suffering (68%) were reported. A small minority of cases (6.6%) concerned nonterminal patients, mainly suffering from neuromuscular diseases. The frequency of reported euthanasia cases has increased every year since legalization. Euthanasia is most often chosen as a last resort at the end of life by younger patients, patients with cancer, and seldom by nonterminal patients.
Article
Nurses have an important role in caring for terminally ill patients. They are also often involved in euthanasia. However, little is known about their attitudes towards it. To investigate on a nationwide level nurses' attitudes towards euthanasia and towards their role in euthanasia, and the possible relation with their socio-demographic and work-related characteristics. A cross-sectional design was used. In 2007, a questionnaire was mailed to a random sample of 6000 of the registered nurses in Flanders, Belgium. Response rate was 62.5% and after exclusion of nurses who had no experiences in patient care, a sample of 3321 nurses remained. Attitudes were attained by means of statements. Logistic regression models were fitted for each statement to determine the relation between socio-demographic and work-related characteristics and nurses' attitudes. Ninety-two percent of nurses accepted euthanasia for terminally ill patients with extreme uncontrollable pain or other distress, 57% accepted using lethal drugs for patients who suffer unbearably and are not capable of making decisions. Seventy percent believed that euthanasia requests would be avoided by the use of optimal palliative care. Ninety percent of nurses thought nurses should be involved in euthanasia decision-making. Although 61% did not agree that administering lethal drugs could be a task nurses are allowed to perform, 43% would be prepared to do so. Religious nurses were less accepting of euthanasia than non-religious nurses. Older nurses believed more in palliative care preventing euthanasia requests and in putting the patient into a coma until death as an alternative to euthanasia. Female and home care nurses were less inclined than male and hospital and nursing home nurses to administer lethal drugs. There is broad support among nurses for euthanasia for terminally ill patients and for their involvement in consultancy in case of euthanasia requests. There is, however, uncertainty about their role in the performance of euthanasia. Guidelines could help to make their role more transparent, taking into account the differences between health care settings.
Article
I discuss the significance of respect for personal autonomy in bioethics with reference to its practical expression: rational informed patient choice. The question is whether, given the apparent practical limitations to this notion, bioethical autonomy should be seen as an absolute. After a historical review of informed consent and its development, I discuss the requirements for informed consent. Some inherent tensions are evaluated, as is the applicability of the notion that in order to be legitimate, autonomy should do some ethical work. Limits to the notion of informed consent are explored with reference to six examples: the right of women to reproductive autonomy; the autonomy of legally minor Jehovah's Witnesses; autonomy in cosmetic surgery; inappropriate treatment; autonomy and human medical research, and euthanasia and other end-of-life options. The discussion is within a South African framework with reference to other jurisdictions and decisions where appropriate. I conclude that whilst some unusual instances of limitation of bioethical informed consent might be ethically justifiable, the arguments presented point to the opposite: the unfounded limitation of informed consent.