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In current clinical practice, there are a lot of painful and controversial issues. Among them, there is a question of what point life begins, and death occurs. The limits on life support of a terminally ill person are actively debated involving the aspects of both the patients and providers rights. For example, a patient, whose further course of treatment is considered, can be said that he or she can decide whether to life a longer life while experiencing chronic acute pain or accept a voluntary death without the pain and suffering. It should be decided by the patients themselves if it is possible. Health professionals making the choice often hesitate what decision should be taken to the patient. A decision is no longer a simple choice between a longer life with chronic pain or death. The problem of determining the moment of death is an important bioethical problem.
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Example of Bio-Ethical Dilemma (Personal Experience)
An ethical dilemma is a form of argument in which two premises lead to the conclusion that, as a rule, involves a nasty alternative that is a choice, unacceptable from an ethical point of view. The patient or the representative of medical care may be in a position in which it is necessary to choose the lesser of two evils. This is why unpleasant alternatives require reflection, debate, discussion and, finally, actions. Often the nurse finds a way to avoid the need to choose between two evils, resolving, and then making a recommendation or an offer allowing carrying out morally acceptable concrete action and avoiding the extreme, unpleasant alternatives that arose in the beginning.
To illustrate such controversial issue, the following observation can be provided. A cardiologist was called for consultation to the house of the patient. P., 67 years old, suffering from chronic heart failure of III stage occurred after a series of myocardial infarction. After examination of the patient and appointing appropriate treatment, one of the relatives followed a consultant to the car. He asked whether there is a need in all of these droppers, tablets and injections. He also asked not think that the family does not want to treat the patient and wish him death, but they only wanted to cease his suffering. To this, the consultant said that any patient should be treated until the last breath, without losing hope of recovery or improvement. After some time, the patient's condition worsened and he was transferred to the hospital. After losing hope for his recovery, the euthanasia was performed at the request of the patient.
Implications in the Profession of Nursing
Euthanasia could be performed at patients request. However, health professionals are involved in dyadic relationships since the one and the other party is responsible for the patient's health. Recent advances in resuscitation sometimes come into conflict with the moral and ethical criteria that complicates the doctor position in the performance of medical duty. With the help of controlled breathing and cardiopulmonary bypass, it is possible for unlimited time (sometimes years) to keep the life of a man while in the brain there are deep irreversible changes to the destruction of human personality. Doctors are aware of the futility of assistance under such conditions, however, euthanasia, that is offensive to promote the patient's death based only on own decision. Thus, euthanasia has quite complicated implications in the profession of nursing.
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The Patients Rights
In several countries, a law has passed giving the patients the right to terminate treatment aimed at prolonging life. For this, it is necessary that the patient is mentally sane and experienced pain and repeatedly demanded euthanasia and his doctor consulted with another doctor about his condition. Thus, for the patient, the right to die is legalized.
Patient rights are enshrined in various right regulations, the Code of medical ethics. They suggest the following: respectful and humane attitude of the medical workers; free choice of doctor, receiving full information about their health status, survey methods, the treatment and its effects, qualification of medical professionals involved in the delivery of health care; relief of pain associated with the disease and medical intervention by accessible ways and means; consent or refusal of medical care and hospitalization; saving of medical confidentiality by medical workers; spiritual support of cleric.
The Providers Rights
Lawyers make some clarification regarding the providers rights within the issue of euthanasia. Anyone who voluntarily take on the role of the killer, even if it is guided by charity and compassion, wishing to save the person from unnecessary suffering, shall be punished. Such situations have led to a revision of the criteria for determining the moment of death. In addition to the traditional criteria - irreversible cessation of breathing and (or) circulation, which can now be maintained artificially, - the criterion of brain death has been applied. Brain death means that the patient has lost the ability to think and feel, he or she can not think and understand, cry, rejoice.
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To help not only today's patients but also participants in the dilemma to participate in critical decisions that eventually emerge from formulating and analyzing their bioethical dilemmas, medical professionals turned to documents and doctrines that addressed, albeit briefly, the need to respect the dignity of all people, especially vulnerable ones. They can be, for example, persons with reduced mental ability to the decision regarding medical care. Respect for the dignity and independence of all people as the most important of these doctrines includes obtaining the consent of the informed person.
The emergence of effective life-supporting technologies (such as ALV) has found a problem: how long to extend the life of the patient, especially if his mind is irrevocably lost. This situation may give rise to a conflict of interest between doctors (who have diagnosed the brain death) and the patient's family, who consider him a living. For example, representatives of the patient may insist on the continuation of life-sustaining treatment, which, according to doctors, is useless; or, on the contrary, patients (or their representatives) may require the termination of medical procedures, which they consider degrading dying. Thus, the extremely complicated dilemma is formed. However, decisions about their lives and their bodies should be taken only by the person himself or his family.
Quality of Life Judgment
Nowadays, advances in medical technology and clinical pharmacology expanded border zone between life and death. However, the qualified medical aid with the use of modern medical technology and pharmaceuticals require a lot of material costs. Yet successful treatment does not exclude the request of the patient for euthanasia in the particularly difficult and hopeless cases. The right to death suggests the fear of such a vegetable existence which diminishes the human dignity. Not death but this existence is regarded as the worst thing that can happen to a man - the loss of self, loss of self-esteem. Keeping a person's life against his will, when the meaning of life is lost for him and he is forced to languish in a state of slow agony is senseless cruelty. Regulations on the sanctity of human life should be compared with such categories as freedom, human dignity, and compassion.
Social Obligation of the Professional Advanced Practice Nursing
The complicity of the given bioethical dilemma makes most people agree on the need for mutual respect between each a professional physician and his patient. This means that the nurse gives an advice and assist their medical staff and patients or deal with complaints about procedures and possible violations of their rights. Also, the nurse takes specific measures in the organization of meetings on these issues to protect and assert the rights of patients, as well as their responsibilities. Social obligations consist also in negotiations with the family members of dying person and consulting them regarding the possible outcomes.
Method of Decision-Making
The decision making should be based on the principle of dual investigation. Within the context of given case, this principle of bioethics can be applied to the actions that have two or more effects, among which there are one bad or undesirable, and the other is relatively good. To a certain extent, this principle justifies the possibility of indirect murder. However, it but should not be forgotten that moral evil as the result of such action is justified. The decision making requires four conditions to justify an action or deed:
- An act in itself should be good (or indifferent);
- The intention of the person carried out this act is directed only to a good result, while the worst consequence is tolerated or allowed;
- A bad consequence is not a meant to achieve a good corollary;
- There should be appropriate proportionality between the good and the bad consequence of the result.
A person's life carries many contradictions, and it is not surprising that his death is their strong knot. The question whether it is ethical and legal for health professional to be involved in interrupting the life of another person remains open. Euthanasia is not a significant resolution of these contradictions since it only forcibly removes them. This is not consistent either with the dialectic nor with our understanding of medical humanism. If there is some positive value, it is increasingly expanding the discussion on euthanasia and heightened attention to scientific medicine, and of truly humane doctors to the dying man.