Research Paper on Medical Assistance in Dying: Right to a Dignified Death

Introduction

Medical Assistance in Dying or Euthanasia as popularly referred is understood today as the free decision to take one's life if the following conditions exist: intense pain or suffering, irreversible illness close to death and lack of any alternative (Downie, 2004). The debate on dignified death caught public attention in early 2015 when a judicial decision of the Supreme Court recognized the right to a dignified and voluntary death of all patients who so request. According to a new government report, more than 1% of all deaths in 2018 in Canada were the result of euthanasia. The Fourth Interim Report on Medical Assistance to Die in Canada revealed that from January to October 2018 a total of 2,613 people in the country received "medical assistance to die," which represented 1.12% of all deaths in the period (Government of Canada, 2019). According to the report, only one person self-administered the lethal drug in assisted suicide. In all other cases, the patient died after a lethal dose deliberately administered by a doctor or nurse at the request of the patient. This paper argues that the conditions given for euthanasia are not comprehensively reliable and should, therefore, not be used as the basis to end the life of elderly adults in Canada.

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Analysis and Critique

In June 2016, the Canadian Parliament passed Bill C-14 that legalized physician-assisted suicide and euthanasia administered by a physician throughout the country. Since then, more than 6,700 Canadians have died as a result of medically assisted deaths (Kim & Lemmens, 2016). The vast majority of physician-induced deaths in the first ten months of 2018 took place in a hospital or at the patient's home. About 5% occurred in a nursing home or a care center, and another 4% were in a hospice. Only 7% of those who received medical assistance to die were between 18 and 55 years old. The average age of the deceased was 72 years. About six out of ten people who chose health care to die had some cancer. The 16% who opted for this practice suffered from circulatory and respiratory problems. Neurodegenerative diseases, such as ALS, accounted for 11% of deaths with medical assistance (Government of Canada, 2019).

Euthanasia can be considered a primitive practice that goes against the moral and ethical values of professional practice. In Greek culture, which was centered on the beautiful and healthy, Plato said that "who is not able to live performing the functions that are his own, should not receive care, for being a useless person both for himself and the society. The primitive people practiced different means to help them die, for example, the auction of the wounded to death in the war. Since then, a fundamental part of medical ethics is the Oath of Hippocrates, where the denial of active euthanasia and the help of suicide is evident with the principle: "I will not give anyone a remedy that could cause death, nor will I give advice in that direction."

Euthanasia has the potential of being misused as a shortcut to removing the burden for both doctors and the relatives of the old patient (Landry, Foreman & Kekewich, 2015). The Fourth Interim Report shows that very few people who requested medically assisted death were denied their applications. Still, controversial issues affecting society tend to be founded based on morality rather than reason with the former garnering more support. For instance, the publication of the report came shortly before the 22nd National March for Life held in Ottawa on May 9, another controversial issue which has been legal in Canada for 50 years, when then-Prime Minister Pierre Trudeau decriminalized the procedure in 1969. Trudeau's son, Justin Trudeau, is the current prime minister. Justin Trudeau's government sparked a controversy in the summer of 2018 when he enacted a new policy that required pro-life organizations not to be eligible to receive funds from the Canadian Summer Jobs program, even if the organization did not do any pro-life work. This requirement was finally eliminated after a public protest. The likelihood of eliminating medical assistance in dying is also likely to face the same fate. The current trends, such as increased controversy and pressure from the civil societies and activists to criminalize euthanasia is a testament to lack of support for the practice.

The legality surrounding consent as a condition for euthanasia is also a matter of debate. Patient consent as dictated by the law lacks the efficacy to transform the transgression into a licit one, since the right to life is a personal right that cannot be delegated, cannot be deferred and cannot be renounced; (The same can be said on slavery: the state cannot allow someone to give up their freedom and sell themselves as a slave) (Emanuel, Onwuteaka-Philipsen, Urwin & Cohen, 2016). Also, the consent of a patient in such a situation, affected psychologically, cannot be considered valid but vitiated in his will. The capacity of the elder patient to make sound decisions in cases of pain and anguish cannot be justified. The supplications of the very grave patients who sometimes invoke death should not be understood as an expression of a sincere will to euthanize; these are almost always anguished requests for assistance and affection. Even many times, the patient can be induced to ask for euthanasia because of the environment that surrounds them and makes them feel like a useless burden to their family. In a moment of lucidity, before the trance, doubts would subsist as they could repent and find themselves unable to manifest it when they fell ill.

Another condition given for practicing euthanasia is the incurability of the disease for the elder patient. This should not be used as a reason to engage in euthanasia, especially because medical discoveries have since discovered a cure for previously incurable diseases (Tepehan, Ozkara & Yavuz, 2009). Concerning the compassion of those who practice euthanasia, it is difficult to verify the motive, since it can conceal diverse and non-altruistic motives, such as the desire to inherit, to get rid of an annoying burden, to avoid larger expenditures, etc. In the case of the doctor, there may also be a desire to disregard professional responsibility, have free beds, conduct experiments, reduce health expenses, etc. Euthanasia can generate mistrust towards health professionals because it is understood that its application would not be indifferent to the economy of a health institution. This would destroy the doctor-patient relationship. This doctor-patient relationship is much more than a contractual link; it is a human relationship based on trust; the patient goes to the professional with the hope that he will cure him of his illness. The legalization of euthanasia causes situations of fear and mistrust, especially for the elders with terminal conditions who may think that once diagnosed with an incurable disease, the caretakers may want to eliminate them to avoid expensive treatment and uncertain results. In this regard, the noble profession of health professionals should be to save lives or to calm suffering, when it is not possible to save a life; but never put an end to its existence.

The Role of the Nurse

The principles of basic ethics are general criteria that serve as the basis for the rules of action of a social or professional group such as nursing practice. Throughout history, the essence of professional practice has been continuously adapted to new realities. We must not forget the fact that we are living a particular moment in history characterized by the evolution of knowledge and culture.

The promotion of euthanasia, so intense in some areas, is usually based on the consideration of particular border situations. As healthcare professionals, it is necessary to demarcate what can be the analysis of specific cases, of what must be a fundamental principle: nobody has the right to provoke the death of a seriously ill person, neither by action nor by omission. A society that accepts the termination of the lives of some people, due to the precariousness of their health and the actions of third parties, inflicts on themselves the offense that is considered unworthy of the lives of some sick or severely disabled people. We should strive for a breakthrough in science that promotes more and better treatments that could reach sick people without engaging in life-ending practices.

Conclusion

As a future nursing professional, I think it is essential to reflect on euthanasia and therapeutic limitation since throughout our career we will face many ethical dilemmas whose resolution will depend in no small extent on how clear and strong our values and principles are as a person and as health professionals. Our role is to take care, protect our patients above all, and although life has an insurmountable limit, its end should be naturally induced. In this regard, euthanasia should not be encouraged.

References

Downie, J. G. (2004). Dying justice: A case for decriminalizing euthanasia and assisted suicide in Canada. University of Toronto Press.

Emanuel, E. J., Onwuteaka-Philipsen, B. D., Urwin, J. W., & Cohen, J. (2016). Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe. Jama, 316(1), 79-90. Retrieved from < https://preview.thenewsmarket.com/Previews/JOUR/DocumentAssets/440789.pdf>

Government of Canada (2019).The Fourth Interim Report on Medical Assistance to Die in Canada. Retrieved from < https://www.canada.ca/en/health-canada/services/publications/health-system-services/medical-assistance-dying-interim-report-april-2019.html>

Kim, S. Y., & Lemmens, T. (2016). Should assisted dying for psychiatric disorders be legalized in Canada?. CMAJ, 188(14), E337-E339. Retrieved from < https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047832/>

Landry, J. T., Foreman, T., & Kekewich, M. (2015). Ethical considerations in the regulation of euthanasia and physician-assisted death in Canada. Health policy, 119(11), 1490-1498. Retrieved from < https://doi.org/10.1016/j.healthpol.2015.10.002>

Tepehan, S., Ozkara, E., & Yavuz, M. F. (2009). Attitudes to euthanasia in ICUs and other hospital departments. Nursing ethics, 16(3), 319-327.