I am proud to announce that my poem, Baudelaire, has been published today on Masticadores India. I want to thank Terveen Gill and her wonderful staff for publishing it. Please visit them and show them your support. Thank you!
(NOTE: Some laws may have changed since I wrote this in 2017.)
Euthanasia and Healthcare Ethics: An Ethical Dilemma
by Dawn Pisturino
Abstract
Healthcare ethics deal with life and death situations which involve every member of the healthcare team. But the patient is at the heart of healthcare ethics, and the rights, safety, and well-being of the patient must come first in all healthcare decisions. It is not up to healthcare personnel to decide who will live and who will die.
Euthanasia and Healthcare Ethics: An Ethical Dilemma
Every discipline has a code of ethics to follow when it comes to making ethical decisions, and healthcare is no exception. Ethics in healthcare is so important, in fact, that most organizations have a process through which tough ethical decisions, such as end-of-life decisions, can be made.
The Hippocratic Oath and Modern Healthcare Ethics
The origin of healthcare ethics dates back to the Hippocratic School of 200 B.C. (Geppert & Roberts, 2008). Hippocrates devised the Oath of the Hippocratic School, which includes confidentiality, nonmaleficence, and beneficence (Geppert & Roberts, 2008). Since then, technology has forced changes in healthcare ethics, adding principles of autonomy, respect for persons, compassion, privacy, and honesty (Geppert & Roberts, 2008). Most of these principles can be applied to end-of-life issues.
The End-of-Life Debate
The end-of-life debate has been fueled by the preponderance of chronic disease in modern society, quality of life issues, and the soaring cost of healthcare. In most countries around the world, euthanasia and patient-assisted suicide are illegal. Hippocrates himself said, “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect” (Doukas, 1995).
Dr. Jack Kevorkian
In 1999, Dr. Jack Kevorkian was found guilty of second-degree murder by a Michigan jury in the death of Thomas Youk (Charatan, 1999). Dr. Kevorkian had administered a lethal dose of medication to Youk, who was suffering from ALS (amyotrophic lateral sclerosis). He could not prove that Youk had asked him to end his life.
The Hemlock Society, a proponent of physician-assisted suicide, condemned the verdict (Charatan, 1999). But many organizations devoted to disability rights applauded Dr. Kevorkian’s conviction, claiming that euthanasia is a threat to people with disabilities (Charatan, 1999). The American Medical Association issued a statement by Dr. Nancy W. Dickey, who was president at the time: “Patients in America can be relieved that the guilty verdict against Dr. Jack Kevorkian helps protect them from those who would take their lives prematurely” (Charatan, 1999).
John Roberts, North American editor of the British Medical Journal, labeled Dr. Jack Kevorkian “a medical hero.” He considered Kevorkian an honest man who was acting according to his personal moral principles (Roberts & Kjellstrand, 1996). Still, most physicians want to be perceived by the public as healers – not death dealers (Doukas, 1995).
Dutch Euthanasia Act
In 2002, the Netherlands passed the Dutch Euthanasia Act, sparking a world-wide debate on end-of-life issues (Van der Heide, 2007).
Euthanasia, as defined in the Netherlands, is “death resulting from medication that is administered by a physician with the explicit request of the patient” (Van der Heide, 2007). In physician-assisted suicide, the physician prescribes the medication and the patient administers it himself, leading to death. In both cases, the physician is legally protected by the Dutch Euthanasia Act for ending life “at the request of a patient who was suffering unbearably without hope of relief” (Van der Heide, 2007).
Before making a decision, physicians are required to discuss euthanasia and physician-assisted suicide with the terminally-ill patient and his relatives. If there is any question about the ethical nature of the decision, physicians may discuss the matter with colleagues. In 2005, in the Netherlands, 73.9% of all patient-requested deaths were the result of neuromuscular relaxants or barbituates; 16.2% were the result of opioids (Van der Heide, 2007).
Ethical Dilemma Case Example
Physicians are not the only healthcare workers faced with ethical dilemmas. Nurses also find themselves in situations where they must apply ethical principles.
The Charge Nurse at a local hospital wanted to open up a patient bed in order to admit a patient from the emergency room. She asked this author – the patient’s nurse – to give a dose of intravenous morphine to a patient who was dying of end-stage kidney disease. Legally, the patient was a “Do Not Resuscitate.” The family was at the bedside.
“Ethical dilemmas often provoke powerful emotions and strong personal opinions; however, emotions and opinions alone are not a satisfactory way of resolving ethical dilemmas” (Lo, 2013). Faced with an ethical dilemma of tantamount importance, this nurse had only a short time in which to make the right decision.
The first thing to consider was the law and the legal ramifications of any decision made in this situation (Pojman & Fieser, 2017). How would the decision affect the Charge Nurse and the patient’s nurse? Would we be held legally liable if the patient died after receiving an extra dose of morphine? Would we lose our nursing licenses? Would the family sue? Would we lose our jobs? Euthanasia in Arizona is against the law.
Secondly, would the patient want to be given an extra dose of morphine? A “Do Not Resuscitate” status merely indicates that the patient does not want to be revived if the heart stops beating or respirations cease. It is not a request for euthanasia. Would it violate the patient’s personal or religious beliefs to administer an extra dose of morphine? Would it violate her core ethics? Would it take away her right of self-determination and autonomy (Pojman & Fieser, 2017)?
Thirdly, to go into the patient’s room and administer an injection of morphine without just cause would violate the culture and ethics of the hospital, the doctor, and most of the nursing staff (Pojman & Fieser, 2017). It would look suspicious to the family. They would question what this nurse was doing. It would place this nurse in an uncomfortable situation.
The ethical dilemma posed here is this: should the patient’s nurse do what the Charge Nurse requested or refuse? In order to make a rational and ethical decision, the patient’s nurse must first analyze the situation. According to Pojman and Fieser, “most ethical analysis falls into one or more of the following domains: (1) action, (2) consequences, (3) character traits, and (4) motives.”
Action
Giving the patient an extra dose of morphine would be the right action if the patient was in pain and wanted the medication. It would be the right action if the patient seemed uncomfortable and the patient’s family requested it. It would not be an obligatory act if it was too soon to give the medication or if the patient did not need it at that time. It would be considered an optional act, based on the nurse’s professional judgment and opinion. On the other hand, it would be a wrong action to give the morphine if the patient did not need it or the patient’s family did not want it given. If euthanasia were legal and the physician was at the bedside and requested the patient’s nurse to draw up the medication, it would be considered a supererogatory act if the physician administered it to the patient. He would be ending the patient’s suffering. The nurse would be involved in a legal and compassionate act.
Consequences
If the patient was in pain and needed the medication, giving the morphine would be the right action because it eased the patient’s pain. If the patient died as a result, there would be no legal or professional consequences because there is no way to predict if that particular injection will cause the patient to stop breathing. The morphine was given according to medical guidelines ordered by the physician. If the patient was not in pain and the extra injection of morphine caused the patient to stop breathing, it could raise ethical and legal issues for the nurse who administered the medication. Those issues would most likely be raised by the family, if they were concerned.
Character Traits
The Charge Nurse was more concerned about opening up a patient bed than respecting the rights of the patient who was dying. It seems callous, malevolent, and unfeeling. The patient’s nurse must examine her own feelings and attitudes and decide if the Charge Nurse was right or wrong in her request.
Motive
The motive of the Charge Nurse was clearly to give in to pressure from the emergency room to admit a patient. She showed no concern whatsoever for the patient who was dying. She had no respect for the patient’s rights and autonomy – or for the patient’s family.
The nurse’s motive should be to protect the rights and safety of her patient. She is the patient’s advocate. If she gives in to pressure from the Charge Nurse, she will fail in her duty to her patient. Even if she believes that euthanasia is a moral act, neither she nor the physician has informed consent from the patient or the family.
What Happened
The patient’s nurse evaluated the motives of the Charge Nurse, felt disgusted, and went into the patient’s room to check on her condition. She was resting quietly with her eyes closed, and the nurse saw no evidence of pain or discomfort. When the nurse asked the patient’s family if they wanted the patient to receive a morphine injection for pain, they agreed with the nurse that the patient was resting quietly and did not need it. Relieved, the patient’s nurse reported all of this to the Charge Nurse. As a parting shot she added, “And I’m not Dr. Kevorkian!”
Conclusion
Patients and their families have the final say in what happens to terminally-ill patients. It is not up to healthcare personnel to make decisions about end-of-life care for a patient. This will be particularly true if euthanasia and patient-assisted suicide ever become legal on a widespread scale. The medical community, in line with its own ethical principles, must respect the right of self-determination and autonomy of terminally-ill patients.
References
Charatan, Fred. (1999). Dr. Kevorkian found guilty of second degree murder. British medical
Doukas, D.J., Waterhouse, D., Gorenflo, D.W., Seid, J. (1995). Attitudes and behaviors on
physician-assisted death: A study of Michigan oncologists. Journal of Clinical Oncology,
13(5), 1055-1061
Geppert, M.A., & Roberts, L.W. (Ed.) (2008). Book of ethics. Center City, MN: Hazelden
Foundation
Lo, Bernard. (2013). Resolving ethical dilemmas: A guide for clinicians. Philadelphia, PA:
Lippincott, Williams and Wilkins
Pojman, L.P., & Fieser, J. (2017). Ethics: Discovering right and wrong. Boston, MA:
Cengage Learning
Roberts, J., & Kjellstrand, C. (1996). Jack Kevorkian: a medical hero. BMJ: British
Medical Journal, 312(7044), 1434
Van der Heide, A., Onwuteaka-Philipsen, B.D., Rurup, M.L., Buitina, H.M., van Delden, J.M.,
Hanssen-de Wolf, J.E., . . . van der Wal, G. (2007). End-of-life practices in the Netherlands
under the euthanasia act. New England Journal of Medicine, 356 (19), 1957-1965.
~
UPDATE:
Where is assisted dying legal in Europe?
Assisted dying refers to both voluntary active euthanasia and physician-assisted death, when a patient’s life is ended at their request.
Only three countries in Europe approve of assisted dying as a whole: Belgium, the Netherlands, and Luxembourg.
The first two even recognise requests from minors under strict circumstances, while Luxembourg excludes them from the legislation.
Germany, Switzerland, Germany, Finland, and Austria allow physician-assisted death under specific circumstances.
Countries such as Spain, Sweden, England, Italy, Hungary, and Norway allow passive euthanasia under strict circumstances. Passive euthanasia is when a patient suffering from an incurable disease dies because doctors stops doing something necessary to keep them alive.
Sources: Euronews
~
Dawn Pisturino
Philosophy 151
May 2, 2017; November 2, 2022
Copyright 2022 Dawn Pisturino. All Rights Reserved.
(Portrait of Queen Elizabeth II by Mary Eastman, 1953)
Today, we mourn the death of Queen Elizabeth II of England. Whatever people may think of monarchy, royalty, and the ruling classes, one thing is certain: Queen Elizabeth was a strong, stable, and enduring presence on the international stage. She was a remarkable woman who helped to guide the British nation through World War II as a war-time princess and the economic struggles of the aftermath as its Queen. For decades, she has been a beloved symbol of British strength and determination. She WAS Great Britain, and her passing begs the question: what happens now?
The Queen will not be forgotten. She will live on in the hearts and minds of her people. She will continue to be a symbol of strength and endurance as Great Britain continues to evolve as an independent nation and her people grapple with ongoing issues.
O God, give rest to this beloved soul, this strong woman, who dedicated her life to her beloved nation and her beloved people. May you richly reward her for her service to You and to others on this earth. Amen.
(Personal Note:I will not be posting on Monday because my husband is having knee surgery.Thanks!)
Dawn Pisturino
September 9, 2022
Copyright 2022 Dawn Pisturino. All Rights Reserved.
February 20, 2009: When our fourteen-year-old Siamese-calico cat was peeing on the rug and having occasional bowel movements in dark corners, my husband and I couldn’t wait until she died. Peace at last, we thought. No more litter boxes, no more cat whining, no more scrubbing the carpet. But as the time drew nearer, she seemed to sense that her days were winding down. She suddenly became very affectionate and wanted to sit on my lap for hours at a time. She wanted to be petted and cuddled and to stay near me all the time. She laid with my husband on the couch, hung out with him in the computer room, and slept on top of us at night, even in the heat of summer. But she was losing weight and going downhill fast. I held her in my lap and cried, finally realizing that we were going to lose her one of these days. In spite of her annoying, constant meowing and soiling the carpet, no matter what I did to stop it, I was going to miss her.
It all happened very fast. One day, she could barely walk, and she cried when she tried to stand up. She was sleeping more and more. I didn’t want to accept it, but we finally had to make a difficult decision.
We took her to the vet to have her put down. I held her in a towel in my arms, crying my eyes out. The vet was extremely busy, and it was obviously an inconvenient time for her, but she patiently explained the procedure, agreeing that it was probably the best thing to do. We stayed with our cat throughout the whole procedure, telling her how much we loved her. I hope she understood from the tone of our voices that we truly cared about her. I had lost my temper so many times when she soiled the carpet, I wanted to make sure she knew that we loved her, in spite of the problems between us.
Instead of earning our freedom from litter boxes and gaining peace of mind, we sat in front of the TV set listening for the cat. The house was just too darned quiet. Something had died inside of us, and life seemed very dull. We suddenly realized just how important she was and how much she had dominated our life for the last fourteen years.
After a couple of months, we happened to take our dog to the vet and fell in love with every cat and kitten we saw. Was it time to take the plunge and get another cat? We discussed it thoroughly and ran into the vet’s the next day to adopt an adorable tortoise shell kitten who was obviously the runt of the litter. She was in a cage with a larger black male kitten, and they were cuddled up together like the best of friends. We didn’t have the heart to part them, so we took both kittens.
Were we crazy? We started out with no cats and ended up with two kittens! After a few days, we were in love. How did we ever think we could live without a cat — let alone, two?
After a hard day at work, my favorite way to relieve stress is to curl up in the easy chair with one or two kittens on my lap. My stress just melts away.
Our cats are loving, sweet, funny, and unpredictable. They bring life into the house. And yes, we still have to clean out the litter box. But somehow, we don’t seem to mind so much.
April 26, 2022: After 12 years, we finally had to put our black cat down. He was dying of liver cancer. It was one of the most difficult things I’ve ever had to do. He was my baby, my special boy, my therapy cat. I thought I was going to die, it was so painful. Even though it’s been a year now, I still cry when I think of him. The interesting thing is that our little tortoise shell cat, who has been hell on wheels, has taken his place in so many ways! She now lets me cuddle her, something she never would allow before. We’ve grown very close. We also have an older cat who is attached to my husband. She always viewed me as competition for my husband’s affection. But, since my little black cat has been gone, she has become much more loving and friendly and sits near me in the computer room and watches me while I’m using the computer. She’s 16 years old, and I always thought she would be the first one to go. But life doesn’t always turn out the way we expect.
Dawn Pisturino, RN February 20, 2009; April 26, 2022
Copyright 2009-2022 Dawn Pisturino. All Rights Reserved.
Gaia was the Greek goddess of the Earth who was born out of Chaos at the beginning of creation. Through her mating with Uranus, the celestial gods were born. Her dalliance with Pontos brought forth the sea gods. Through Tartaros, she birthed the giants. All humans and animals were created from her material being.
The Greeks viewed the Earth as a flat disk surrounded by a river. Overhead, the Earth was protected by a heavenly dome. Underneath, a deep pit formed the dome of the Underworld. Gaia was the Mother who nourished and nurtured the Earth and everything on it. The seas and mountains anchored securely on her great and abundant breasts.
Humans are not separate from nature. We are as dependent on Mother Earth for our sustenance as any other creature. But the human ego, pumped up by advanced technology, has deceived us into believing that we are above it all. We are so powerful, intelligent, and all-knowing, that we can control nature, the weather, and all aspects of the natural order. We are the Masters of the Universe, ready to hop onto the next spaceship to another planet. The problem is that we will take all of our problems and our egos with us.
In the 1970s, scientists claimed that the Earth was headed for another Ice Age and had all the data to back it up. So far, it hasn’t happened. They claimed that the Earth would run out of petroleum in 25 years. It never happened. They claimed that the Earth was going to be so over-populated in the future that famine would be widespread. Except for the political manipulation of politicians, this has not happened.
In the 1990s, we began to see books like The Coming Plague (1994) and The Coming Global Superstorm (1999) which predicted widespread existential threats like devastating disease and severe weather patterns that would wipe out the human race. No natural event has ever occurred in the history of mankind which had the capability to wipe out the entire human race. (Please note that I’m not talking about the dinosaurs here.) COVID was never virulent enough to rise to that occasion, as inconvenient and life-changing as it has been. (And there is no evidence that COVID originated from climate change, as some people are claiming. It could just as likely have originated from a lab, as some evidence suggests, or arisen naturally as a result of mutation, which is the most logical conclusion.) And, the wildfires, hurricanes, and tornados we have experienced have been contained as local events.
When scientists first labeled climate change as “global warming,” they neglected to explain to the general public how that actually works, and people were confused by what they actually experienced; so they re-labeled it as “climate change” to make it easier to understand. Essentially, it means that when one part of the planet grows warmer and changes the local environment, other changes occur in other parts of the planet – but NOT NECESSARILY THE SAME CHANGES. For example, record heat in one part of the planet may be accompanied by record cold in another part, even if the overall temperature of the planet has increased. Increased drought in one area may be accompanied by increased precipitation in another. Climate (long-term conditions) and weather (short-term conditions) involve much more than just temperature. Wind and ocean currents play a big part. An extreme event would be a sudden and unstoppable shift in climate. This scenario was touched upon in the movie The Day After Tomorrow (2004), where North America was suddenly covered with ice, and people were forced to migrate south to Mexico. (This movie, by the way, is based on the book, The Coming Global Superstorm.)
Our Mother Earth also has mechanisms in place to control population (disease, infertility, old age, predation, and natural death). The human ego is so out of control that we have come to a point where we believe that nobody should ever get sick and nobody should ever die. This attitude has been clearly evident during the COVID pandemic. One of the most important things I learned as a registered nurse and healthcare worker is that you can’t save everybody, and in fact, you shouldn’t save everybody. This sounds cold-hearted, but it’s a fact of life. The world is out of balance because of human interference in the natural order.
On Earth Day and everyday, remember and love your Mother – she who nourishes and sustains your very existence. But please don’t spread the seeds of hysteria, fear, panic, and anxiety. When Rep. Alexandria Ocasio-Cortez and others began telling young people that we were all going to die in 12 years because of climate change, we began receiving young people into our inpatient mental health unit who were so distraught and eaten up with anxiety, paranoia, and fear that some of them were on the verge of suicide. Deliberately spreading this kind of fear-mongering rhetoric is irresponsible, cruel, and unacceptable. It’s pollution of a different sort.
Recycle what you can, plant trees, pick up litter, and keep your environment clean and free from as many toxins as possible. Work to help endangered species and places to thrive. Help clean up our oceans, rivers, and lakes. Conserve water! Reduce your use of plastic. Use energy-efficient vehicles, appliances, and lighting. Drive electric vehicles, if that’s your style, but remember that those batteries create toxic waste (ALL BATTERIES create toxic waste). Electronic computers, cellphones, and other devices also create toxic waste and use elements like lithium that have to be mined from the earth. Mining leads to erosion and deforestation. Convert to solar, wind, and all-electric, if you want. But remember that even these technologies have their environmental downside. For example, the breakdown of energy sources used to generate electricity is as follows, according to the U.S. Energy Information Administration: natural gas 40%, nuclear energy 20%, renewable energy 20%, coal 19%, petroleum 1%. Using electricity does not eliminate fossil fuels and nuclear energy from the equation. Anybody who tells you otherwise (including politicians and climate activists) has not done their homework. Furthermore, humans and animals are carbon-based entities. Plants depend on CO2 to produce oxygen. We could never live in a carbon-free world because that, in itself, would be an existential threat.
On April 22, we honor our planet. Happy Earth Day!
Dawn Pisturino
April 21, 2022
Copyright 2022 Dawn Pisturino. All Rights Reserved.
Here in my heart Is a tiny prayer That the world would Grow in kindness and love, That the pain of a million Voices would cease, And laughter run wild Over all the world.
I closed my mind and heart Because I could not bear To hear the tears Or feel the pain around me. I lived in a void For many years, But nothing changed. The world remained the same, Even when I was not.
I lived in the safe world Of grocery stores and J.C. Penney, Counting my money, And learning how to spend it. I bore my child And adored my loving husband. They became for me My fixtures, my sanity, The sum total of my life. But life does not end With safety and happiness, For while you are safe, Others are in danger. While you are happy, Others suffer. And it is not right, No, it is not right To shut the door behind you.
A heart in anguish Is a heart which feels The pain of a million suffering people And knows that death is near. A heart in anguish Touches the open wound, Binds the broken limb, Tastes the salty tears, And does it lovingly, Reverently, without fear. The heart in anguish knows life And death and suffering, But lives ultimately, and dies happy.
Dawn Pisturino 1985; March 9, 2022 Copyright 1985-2022 Dawn Pisturino. All Rights Reserved.
(A portrait of English poet, John Keats, by William Hilton, 1822)
Before his early death at 25 from tuberculosis on February 23, 1821, English poet John Keats despaired that “I have left no immortal work behind me . . . If I had time, I would have made myself remembered.” Suffering from ill health and mocked by critics, he could not imagine the fame and adulation that has preserved his memory for two hundred years. Buried in the Protestant Cemetery in Rome, his immortal words still echo in the hearts of young poets, and visitors still flock to see his simple grave.
(Photo by Vova Pomortzeff)
I can’t help thinking what a tragedy it was that such a brilliant young poet was not recognized in his own lifetime, however short. Keats died believing he was a failure. But this has happened to so many writers and artists! Why does it take the dark hand of Death to bring a great person’s talents to life? Are we all too blind and selfish to recognize them while they’re still alive? Or, must all great writers and artists pass the test of Time?
When I Have Fears That I May Cease to Be
by John Keats
When I have fears that I may cease to be
Before my pen has glean’d my teeming brain,
Before high-piled books, in charactery,
Hold like rich garners the full ripen’d grain;
When I behold, upon the night’s starr’d face,
Huge cloudy symbols of a high romance,
And think that I may never live to trace
Their shadows, with the magic hand of chance;
And when I feel, fair creature of an hour,
That I shall never look upon thee more,
Never have relish in the faery power
Of unreflecting love; — then on the shore
Of the wide world I stand alone, and think
Till love and fame to nothingness do sink.
Dawn Pisturino
February 17, 2022
Copyright 2022 Dawn Pisturino. All Rights Reserved.
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