Euthanasia is “a concept used in the medical field which means easy death or gentle death, and is defined as the deliberate speeding up of the death of an individual based on terminal medical conditions” (Jonsen, et al. 2015). Euthanasia reflects one of the current debate issues health professionals encounter when caring for the end of life patients who are choosing between speeding up their death or living the rest of their life in pain. In the fields of laws and regulations related to human health there is still a controversy over the concept of a peaceful death. This ethical dilemma has health care providers making a decision to choose between two difficult options and are obligated to use moral reasoning to solve these legal and ethical risks. Euthanasia’s legal and ethical aspects are still debated in many countries in the world. Withholding or withdrawing treatment of any patient has been never easy and is unable to be generalized (Naga, et al. 2013). There are two classes of euthanasia, Active and passive. Active euthanasia is “the ending of life by deliberate administration of drugs” (Farlex Partner, 2012). Active euthanasia is then split into two sub categories, in-voluntary (patient does not give permission to the medical provider) and voluntary (patient gives permission to the medical provider). Passive euthanasia is “the ending of life by the deliberate withholding of drugs or other life-sustaining treatment” (Mosby’s, 2009). Many patients experience pain and suffering well experienced their terminal conditions. Suffering is not only a medical problem but also extends past physical pain. It is influenced by psychological, cultural and spiritual factors. Therefor under certain irreversible conditions euthanasia should be acceptable for those who have reflected the consequences and have given written or oral consent under their request.
In the case study “Respirator Removal” (Mackinnon, et al. 2014) Jim is a forty-four year old lawyer who was diagnosed with a tumor in his right lung. The surgery was routine and he returned to a normal life. Four years later, Jim was diagnosed with another tumor in his left lung, he knows he has a month to live. He has been put on a respirator which is extremely uncomfortable and hinders his ability to talk. Jim decided that he does not want to live out his last few weeks under this condition and would rather the respirator to be removed (Mackinnon, et al. 2014). Removing a respirator or a feeding tube are examples of passive euthanasia. The physician would stop his treatment of life support. “Withdrawal of life support in the intensive care setting is increasing in frequency. More than half a million deaths a year, or 20-25% of all deaths in the United States, occur in ICU” (Chen, 2015). People are considered to be autonomous, they have the power to decide when and how to end their lives. Immanuel Kant ‘s principle of autonomy “justifies the claim that a human must never be used a mere means to another’s end. Kant’s principle of autonomy is particularly useful and pertinent to all bioethical issues, especially euthanasia” (Rohlf, 2016). Ventilator termination is a complex process and is now considered as ethically and morally acceptable as “legal precedents and enthusiasts have deemed that if the quality of life is unacceptable to the patient, removing a ventilator from an awake patient is ethically equivalent to removing a ventilator from a patient who is unaware. One benefit is that the provider can be confident of the patient’s actual wishes. However, one must ensure durability of the patient’s desire and an absence of reversible reasons for desire to hasten death, such as clinical depression, concerns of being a burden to family, or uncontrolled pain” (Chen, 2015). Critical care providers should be comfortable and familiar with this topic.
The ethical framework for arguing for or against euthanasia is a complex system because death is typically seen as “bad” in society. When looking at euthanasia, it is important to remove associated emotions that are involved, deontology allows us to do so. The “action is based on whether or not the action itself is wrong under a series of rules, rather than based on the consequences of the actions” (Webster’s, 2014). The ability to act morally, one must follow one’s moral duties (Mackinnon, et al. 2014). Patient centered deontology is specific to euthanasia as it is dependent upon patient’s consent. Jim desires the removal of the ventilator to avoid pain and discomfort. Although Kant would believe that euthanasia is morally impermissible, autonomy is used for arguing that euthanasia is morally permissible when the patient has consented. No one forced Jim into this decision, he exercised his rights to acting as a free rational being. Jim is acting on voluntary active euthanasia, he is giving consent and has acknowledged all the legal implications. Refusal of a patient’s wishes would deprecate a patient’s autonomy by impeding them from acting as an end in themselves as well as belittling them as a person.
Overall, euthanasia is a debatable and difficult issue patients have to deal with to express their autonomic rights. There are multiple factors correlated with each individual case. An individual with a terminal illness with no cure should be able to consent to the ability to end their life on their own means. “Patient centered deontology is the best ethical framework for evaluating the moral permissibility of euthanasia. It allows Patient autonomy and making judgments based on the act and agent themselves rather than the consequences” (Nathan, 2015). There is no difference in active and passive euthanasia, they are morally permissible, and that the distinction between active and passive euthanasia, in itself, actually diminishes the autonomy of the patient because this deems the agent as external in contrast to the patient acting as the agent.