Euthanasia and prolongation of life Suicide is the direct and willful destruction of

one’s own life. It is direct insofar as the primary

Etymologically euthanasia means “easy death”
object
from the Greek words eu which means easy and
of thee act is the killing of oneself; it is willful
Thanatos which means death. More strictly it
insofar as it is deliberate, voluntary and
means painless and peaceful death: it is
intentional.
deliberate putting to death in an easy, painless
And it is destructive insofar as the means of
way, of an individual suffering from an incurable
terminating one’s own life is, more often than not,
and agonizing disease.
violent, brutal or very harsh. In some respects,
Cases of euthanasia may be grouped into self-
the concept of active voluntary euthanasia and
administered and other administered. The self
suicide overlap, but there are several differences,
administered may be either active (positive)
people who resort to euthanasia do so for the
euthanasia in which the terminally ill patient will
medical reasons, hence, it is referred to as an
deliberately, directly terminate his/her life by
easy and painless death.
employing painless methods- it is an act of
Suicide, on the contrary, is usually the
commission as it is voluntary and deliberate.
destructive and violent termination of one’s life.
Passive (negative) euthanasia in which one
As a rule,
allows
suicide presupposes incurable ailment or
oneself to die without taking any medications or
terminal condition. Hence, the former is a sudden
by refusing medical treatment it is an act of
interruption or destruction of the life process,
omission as one simply refuses to take anything
while the latter is an easy, painless, and quiet
to sustain life.
acceleration of imminent or certain death for one
Classification of euthanasia to rid of prolonged suffering. Furthermore the
1. Active and voluntary euthanasia- is one individual who commits suicide for non-medical
reasons is solely responsible for his or her death.
in which either a physician, a spouse or a friend
of a patient will terminate the patient’s life upon Application of Ethical Theories
his/her request. It is voluntary as it is requested Natural law ethics, with its principle of
by the patient and active as some positive stewardship, considers suicide as self-murder.
means is used to terminate the patient’s life. An individual
2. Passive and voluntary euthanasia- is one has no right to murder himself/herself as he/she
has no right to murder someone else. Life is a
in which the terminally ill patients is simply gift
allowed to dies by the physician, spouse or an of God, A person is only a steward, a caretaker
immediate relative upon the patient’s request. It at most.
is passive as no positive method is employed; The utilitarian’s principle of utility seems to be in
the patient is permitted to pass away. It is keeping with the argument that an individual may
voluntary as this is done upon the patient’s deliberately terminate his/her own life if and
request. when suffering becomes too much to bear.
3. Active and non-voluntary euthanasia- Besides,
occurs when it is the physician, spouse, friend or whenever one has become a financial burden
relative who decides that the life of the terminally and a liability due to a prolonged, incurable
ill patient should be terminated. It is active as disease,
some positive method is utilized to terminate the then an appeal to the greatest happiness for the
patient’s life it is non voluntary as the termination greatest number principle becomes justifiable.
of the patient’s life is decided by an individual This is arguable, however.
other than the patient Kant’s ethics, within the context of the
categorical imperative’s not using oneself only as
4. Passive and non-voluntary euthanasia-
a means
is one in which a terminally ill patient is simply but always as an end. May be taken as a
allowed to die, as requested to immediate family rejection or prohibition of suicide. On the other
members or the attending physician. It is passive hand,
in as much as no positive means is employed to advocates of the principle of autonomy and self-
end the patient’s life; it is non voluntary as other regulating will to support and justify their
person make the moral decision to terminate the argument
patient’s life. that an individual not only has a duty to preserve
his/her life, but also to die with dignity if and
Suicide when
the situation warrants such a moral decision. intended or postponed. It merely happens. It is
Dysthanasia bad death» and is considered an event, part of the temporal life of every human
being. Hence, allowing to die is anti-euthanasia,
a common fault of modern medicine. which unethically anticipates death, and anti
The timeline of humanity shows us evolution in dysthanasia, which unduly postpones it.
almost every field of arts and science. In science, ALLOWING TO DIE: POSSIBILITIES
the advances have come through the knowledge
Allowing to die includes, in particular, three
and technology, which is itself the result of
possibilities.
applied knowledge.
First possibility: when the treatment to prolong
In medicine, the aftermath of this evolution has
life is useless or futile for the patient, and
contributed, together with social improvement of
therefore
many societies, to a progressive and sustained
ought not to be given. We remember the world of
increase in life expectancy.
the poet: For man to want to live when God
The increase in life expectancy owes much of its
wants him to die is madness.
accomplishments, so far as Medicine is
Second possibility for letting die: when the
concerned, to the technological achievements
prolongation of life or the postponement of death
which can directly influence the natural history of
is
end of life.
unduly burdensome in the first place for the
In terms of concept, the end of life or death has
patient – also for the family. On this point,
two moments: The process of death and the
the Catechism of the Catholic Church
moments of death. While the latter is the moment
summarizes the traditional teaching of the
of irreversibility, the former―the process of
magisterium:
death―can be swayed in either way; in
“Discontinuing medical procedures that are
fastening―euthanasia or in
burdensome, dangerous, extraordinary, or
retarding―dysthanasia.Dysthanasia from Greek,
disproportionate to the expected outcome can be
dysthanatos, turning death difficult. In a broad
legitimate; it is the refusal of ‘over-zealous’
sense it can be
treatment. Here one does not will to cause death;
understood as medical stubbornness or a futile
one’s inability to impede it is merely accepted”
treatment. In good medical practice the treatment
(CCC, 2278).
should be proportional to the expected prognosis.
Third possibility for allowing to die: when the
If the treatment provided clearly overcomes the
patient needs painkillers or medical sedation,
expected prognosis retarding the process of
which
dying and prolonging the agony and suffering of
does not intend the death of the patient. These
the
painkillers directly mitigate suffering and
patient, than it seems clear that it is a case of
indirectly
dysthanasia.
may shorten life. Physicians and significant
Orthothanasia is death in its natural and others are committed to relieve pain and
inevitable process, respecting the person's suffering,
right to die with dignity, supported by palliative which is their professional commitment, or moral
care. duty limited only by the prohibition against direct
The word orthothanasia was used for the first killing. Summing up the traditional teaching of the
time in the 1950s. It means correct dying, or Church, the Catechism states: “The use of
allowing painkillers to alleviate the sufferings of the dying,
to die or letting die. even at the risk of shortening their days, can be
It is vital to note the difference between allowing morally in conformity with human dignity if death
death to occur and intending death to happen. is not willed as either an end or a means, but
While in euthanasia the death of the patient is only
directly intended and caused, in allowing to die foreseen and tolerated as inevitable”
his death is directly caused by a grave pathology: Administration of drugs to the dying
the morphine administered to the patient in pain In medicine, specifically in end of life care,
directly causes the relief of his pain and indirectly palliative sedation is the practice of relieving
and unintendedly may perhaps advance his distress in
death, which is merely foreseen and tolerated. a terminally ill person in the last hours or days of
Let us underline that in the case of letting die, the dying patient’s life, usually by means of a
what is directly intended is the relief of the acute continuous intravenous or subcutaneous infusion
pain of the patient. In allowing to or letting die, of a sedative drug, or by means of a specialized
therefore, death is neither directly caused nor
catheter designed to provide comfortable and  Make decision and guide doctors about life
discreet administration of ongoing medications sustaining procedures in the event of terminal
via condition, persistent vegetative state and end
rectal route. Palliative sedation is an option of stage condition i.e DNR, Pain management,
last resort for patients whose symptoms cannot Organ Donation, Euthanasia.
be ADVANCE DIRECTIVES : FORMS.
controlled by any other means. It is not a form of
euthanasia, as the goal of palliative sedation is to 1. Living will (Health-care directives)
control symptoms, rather than to shorten the  A living will is a more restricted type of advance
patient’s life. directive because you only make decisions
about life sustaining procedure in the event that
your death from a terminal conditions is
Advance Directives impending.
An advance decision (or Advance Directive, a  This is a living document that allows a person
Living Will, or Healthcare Directive) allows an to state whether he or she wants his or her
individual to provide instructions for future life artificially prolonged under certain conditions.
medical care and treatment while still capable of The Health-Care Directive would only be
making followed if the patient is diagnosed in writing by
decisions for themselves and provides an the attending physician to be in a terminal
opportunity for an individual to discuss treatment condition or in a permanent unconscious
opportunities with healthcare professionals, situation by two doctors, and where the
including medical staff as well, as to discuss and application
resolve difficult issues with family and friends. of life-sustaining treatments would serve only to
Some medical conditions permit the extension of artificially prolong the process of dying.
life for many years through artificial means. But  The Health-Care Directive must be signed by
many patients and their families question the the patient and witnessed by two persons.
significance of doing so where there is little hope The witnesses cannot be related to the patient or
of expect to inherit anything from the patient
recovery. and they cannot be hospital employees, staff,
The value of life during and after recovery from attending doctors or employees of the
an illness is often an essential issue. Consider attending doctor.
quality-of-life issues in making decisions about
2. Health care proxy
accepting, rejecting, or stopping medical
treatment. Is a document (legal instrument) with which a
Advance directives were created in response to patient appoints an agent to legally make health
the increasing complexity and prevalence of care
medical technology. Numerous studies have decisions on behalf of the patient, when he or she
documented critical discrepancies in the medical is incapable of making and executing healthcare
care decisions stipulated in the proxy.
of the dying; it has been found to be
 This is a legal document in which an individual
unnecessarily sustained, painful, expensive, and
designates another person to make health
emotionally
care decisions if he or she is rendered incapable
burdensome to both patients and their families.
of making their wishes known. The health
Advance directives care proxy has, in essence, the same rights to
Is a legal document in which a person specifies request or refuse treatment that the
what actions should be taken for their health if individual would have if capable of making and
they are no longer able to make decisions for communicating decisions.
themselves because of illness or incapacity.  Most people pick a spouse, partner, or child as
Advance directives are written, legally- their health care proxy. Obviously, you want
recognized documents that state your choices someone who knows you and your preferences
about health well.
care treatment or name someone to make such 3. Power of attorney
choices for you if you are not able to do so
(Reyes,  Written authorization to represent or act on
2010). another ‘s behalf if private affairs, business, or
some other legal matter, sometimes against the
Purpose of Advance directives wishes of the other.
 Appointment of health care proxy
 Not limited to healthcare but also other matters, 6. Protect the confidentiality of the patient who chooses
such as finance medical aid in dying.

ADVANCE DIRECTIVES: ADVANTAGE 7. Remain objective and protect the confidentiality of health
 unnecessarily prolonged painful hospitalization care professionals who are present during the aid
 Prevents unnecessary prolonged comatose or in dying process, as well as the confidentiality of those
vegetative state who choose not to be present.
8. Be involved in end-of-life policy discussions and
 Prevents burden of rising Medical costs
development
 Releases responsibility of love ones of difficult
decisions
ADVANCE DIRECTIVES : DISADVANTAGE
Advance directives
 Family or loved ones may disagree with your
- Is a legal document in which a person specifies what actions
medical decisions. should be taken for their health if they are no longer able to
 Difficulty in predicting what treatments will be make decisions for themselves because of illness or
available and preferred in a “future” crisis. incapacity.
 Uncertainty over who can/shou Advance directives are written, legally-recognized documents
that state your choices about health- care treatment or name
Cardio-Pulmonary Resuscitation someone to make such choices for you if you are not able to
Resuscitation efforts are used to reverse the clinical sign of do so
death (loss of spontaneousrespiration, loss of cardiac
function & unconsciousness) Ethical Decision Making Process
When to stop CPR? Problem Analysis
• Futile/Hopeless Problem is a discrepancy between the current situation and a
• More than 30 minutes in desired state.
adults/15 minutes in newborn Before you can begin to solve a problem, you must be able to
• Advance directives/Living will identify and categorize it
Moral Uncertainty
Ethico-Moral Responsibility of Nurses: Euthanasia occurs when we sense that there is a moral problem, but are
Hallmarks of end-of-life care include respect for patient self- not sure of the morally correct action
determination, nonjudgmental support for patients’ end-of- Moral/ethical dilemma
life. is a problem that requires a choice between two options that
Preferences and values and prevention and alleviation of. are equally unfavorable and mutually exclusive
suffering
Pattern of decision making
2 options of end-of-life Recognizing a problem
1. Medical aid in dying – patient with terminal illness, self- Gathering data
determination, voluntary choice and informed request to Comparing options/action implies uncertainty
self-administer medication to hasten death Making a choice/implemented decision
2. Euthanasia- occurs when someone other than the patient
administers medication in any form with the intention of Attributes of an Effective Ethical Decision Maker
hastening the patient’s death 1. Moral integrity. Moral integrity binds all of a person’s
moral virtues into a coherent package—it creates a
Recommendations wholeness and stability of character that leads to
It is the shared responsibility of professional nursing trustworthiness
organizations to speak for nurses collectively in shaping 2. Sensitivity, compassion, and caring
health care hence the American Nurses Association supports - they hear what patients say and understand the
recommendations that nurses: meaning
1. Remain objective when discussing end-of-life options with 3. Responsibility. - has a sense of duty to the patient, an
patients who are exploring medical aid in dying. obligation to do whatever is necessary, within reason, to care
2. Have an ethical duty to be knowledgeable about this for the patient or solve a problem
evolving issue. 4. Empowerment - suggests that a person has self-confidence
3. Be aware of their personal values regarding medical aid in that he or she can effect change
dying and how these values might affect the patient- 5. Patience and willingness to deliberate
nurse relationship.
4. Have the right to conscientiously object to being involved Principles of Ethics and Research
in the aid in dying process. 1. Nuremberg code of 1947
5. Never “abandon or refuse to provide comfort and safety Ethics principles for human experimentation resulting from
measures to the patient” who has chosen medical aid in Nazi
dying Focus on human rights and welfare
 Nursing consideration: Do not resuscitate
(DNR) orders
Although it is generally considered the domain of
the physician to write a DNR order, nurses need
to be aware of parameters surrounding such
orders. In some states, persons with serious
medical conditions keep a special medical order
form documenting end-of-life wishes posted in a
prominent place at home (or in the chart if the
person is in a long-term care facility). This form
specifies endof-life wishes (including DNR
orders), is readily available to emergency
Declaration of Helsinki
personnel, and travels with the person to the
Statement of ethical principles for medical research involving hospital or other treatment facility
human participants, including identifiable human material
and data; doctors doing medical research on patients Problem Analysis
For all involved in medical research
Basis for Good Clinical Practice (GCP) A problem is a discrepancy between the current
situation and a desired state. Problems are
Belmont Report 1976 usually unplanned and often unexpected. They
The Belmont Report is a report created by the National may be simple or complex, routine or moral.
Commission for the Protection of Human Subjects of
Biomedical and Behavioral Research
summarizes ethical principles and guidelines for research Moral Uncertainty
involving human subjects Moral uncertainty occurs when we sense that
Evidence-base practice is a systematic inter connecting there is a moral problem, but are not sure of the
scientifically generated evidence with the tacit knowledge of morally correct action; when we are unsure
the expert practitioner which moral principles or values apply; or when
we are unable to define the moral problems
Ethical issues involved in EBP (Jameton, 1984). This happens to us when we
1. Status of evidence have a sense that something is not quite right.
2. Client Autonomy
3. Conflict of interest
Moral/ethical dilemma
The NCCS Documentation Standard A dilemma is a problem that requires a choice
- Documents are permanent legal records that
between two options that are equally unfavorable
provide a comprehensive sequential description of relevant
facts, data, and information about the patient’s health status.
and mutually exclusive. A dilemma seems to
Documentation of nursing actions done to a patient is critical defy a satisfactory solution.
to determine if the expected standard of care was rendered
to a particular patient. An ethical dilemma occurs when options
include conflicting moral claims. Ethical
Ethico-Moral Responsibility of Nurses: dilemmas present in at least two ways.
Euthanasia
1.Moral integrity. Moral integrity binds all of a
The delivery of high-quality, compassionate, person’s moral virtues into a coherent
holistic and patient-centered care, including end- package—it creates a wholeness and stability of
of-life care, is central to nursing practice. character that leads to trustworthiness.
Hallmarks of end-of-life care include respect for Beauchamp and Childress describe integrity as
patient selfdetermination, nonjudgmental support “soundness, reliability, wholeness, and
for patients’ end-of-life preferences and values, integration of moral character” (2001, p. 35). It is
and prevention and alleviation of suffering. In a “coherent integration of aspects of the
states where medical aid in dying is legal, patient self—emotions, aspirations, knowledge and so
selfdetermination extends to include a terminally on—so that each complements the others”
ill patient’s autonomous, voluntary choice and We believe that moral integrity is integral to
informed request to self-administer medication to effective ethical decision making. The person
hasten death.
with moral integrity does not hold stubbornly to conclusions from the discernment to develop
one position, but rather encourages a convictions.
climate of mutual respect and reasoned  Four Principles of Moral
discourse. However, the person with moral Discernment/Judgment
integrity will not compromise beyond a certain  Principle of formal cooperation
point.  Principle of Material cooperation
 Principle of lessser evil
2. Sensitivity, compassion, and caring. Sensitive,  Principle of double effect
compassionate, and caring nurses work
intimately with patients—they hear what patients
say and understand the meaning. They Principle of well-formed conscience
perceive the circumstances, attitudes, and
 Informed consent to medical treatment is
feelings of others. They intimately know about
fundamental in both ethics and law.
suffering—from touch, sight, smell, and sound.
 Patients have the right to receive information
Interests of patients become their own.
and ask questions about recommended
treatments so that they can make well-
3. Responsibility. The nurse with responsibility
considered decisions about care.
has a sense of duty to the patient, an obligation
to do whatever is necessary, within reason, to  Successful communication in the patient-
care for the patient or solve a problem. A physician relationship fosters trust and supports
nurse with responsibility, sensitivity, compassion, shared decision making
and caring will recognize moral problems,
understand them from a human perspective, and Strategies of Moral Decision-Making
accept a duty to work actively toward their
solution. Responsibility also includes a duty to Process
understand ethics in a way that informs
Ethical Dilemma
consistent and fair application of ethics at the
bedside.  is a problem in the decision-making process
between two possible options, neither of which
4. Empowerment. Empowerment is the capacity is absolutely acceptable from an ethical
of people to be active participants in matters perspective;
that affect them. Empowerment suggests that a  Approaches to solve an ethical dilemma were
person has self-confidence that he or she deduced:
can effect change. It includes courage and an
exercise of power. Empowerment is an  Refute the paradox (dilemma): The situation
essential attribute for those making ethical must be carefully analyzed. In some
decisions. It creates positive action flowing from cases, the existence of the dilemma can be
sensitivity, compassion, caring, and responsibility. logically refuted.
 Value theory approach: Choose the
5. Patience and willingness to deliberate. During alternative that offers the greater good or the
a crisis, people struggle to understand the lesser evil.
situation and their feelings. They work to clarify  Find alternative solutions: In some cases, the
and articulate their views and relate them to problem can be reconsidered, and
a framework of values. The nurse must listen new alternative solutions may arise.
and be patient and able to live with
vagueness, confusion, uncertainty, and paradox.
The nurse should provide a safe PROCESS OF ETHICAL DECISION
environment and gently assist patients, families, MAKING
and colleagues as they work through the
 Gather data and identify conflicting moral
ethical decision-making process.
claims
 Identify key participants
Principle of Moral Discernment
 Determine moral perspective and phase of
Olson (2002) refers to the ability to discern what moral development of key participants
is morally right from morally wrong that  Determine desired outcomes
requires moral reflectiveness on the meaning of  Identify options
good and bad. It refers to ability to draw  Act on the choice
 Evaluate outcomes of actions
  What alternatives are unacceptable to one or
all involved?
Gather data and identify conflicting moral  How are alternatives weighted, ranked, and
claims prioritized?
 What makes this situation an ethical problem?
Are there conflicting obligations, duties, Act on the choice
principles, rights, loyalties, values or beliefs?
 Be empowered to make a difficult decision
 What are the issues?
 Give yourself permission to set aside less
 What facts seem most important?
acceptable alternatives
 What emotions have an impact?
 Be attentive to the emotions involved in this
 What are the gaps in information at this time?
process.
Evaluate outcomes of action
Identify key participants  Has the ethical dilemma been resolved?
 Who is legitimately empowered to make this  Have other dilemmas emerged related to the
decision? action?
 Who is affected and how?  How was the process affected those involved?
 What is the level of competence of the person  Are further actions required?
most affected in relation to the decision to be
made? Cost-effective
 What are the rights, duties, authority, context, limited resources for health should be allocated
and capabilities of participants? to maximize the health benefits for the
population served. A cost-effectiveness analysis
(CEA) of alternative health interventions
Determine moral perspective and phase of
measures their respective costs and benefits to
moral development of key participants determine their relative efficiency in the
 Do participants think in terms of duties and production of health.
rights?
 Do the parties involved exhibit similar or Equity
different moral perspectives? Is concerned with the distribution of benefits and
 Where is the common ground? The difference? costs to distinct individuals or groups. The
 What principles are important to each person maximization of benefits, which is associated
involved? with the general philosophical moral theory of
 What emotions are evident within the utilitarianism or consequentialism, however, is
interaction and with each person involved? routinely criticized for ignoring those
 What is the level of moral development of the considerations (Rawls 1971). E
participants?
Issues involving access to care
 Access to Quality Care - Patients want to be
Determine desired outcomes
able to access their healthcare when they want
 How does each party describe the and need it.
circumstances of the outcome?  Geographic and Manpower Shortage
 What are the consequences of the desired  Limited education
outcomes?  Poor infrastructures
 What outcomes are unacceptable to one or all  Cost
involved?
 Scientific evidence vs Cultural Practice

Identify options BENEFITS AND CHALLENGES OF

 What options emerge through the assessment TECHNOLOGY
process?
 Reducing healthcare costs.
 How do the alternatives fit the lifestyle and
values of the person(s) affected?
 Predicting epidemics.
 What are legal considerations of the various  Avoiding preventable deaths.
options?  Improving quality of life/quality care
 Reducing healthcare waste. 2. Compliance with the by-laws of the accredited
 Improving mobility/access professional organization (PNA),and other
 Developing new drugs and treatments. professional organizations of which the
 Security e.g. data hacking/phishing Registered Nurse is a member is a lofty duty.
3. Commitment to continual learning and active
 Volume of data in iCloud participation in the development and growth
 Dangers with AI central data point of the profession are commendable obligations.
 Impersonal patient-healthcare provider 4. Contribution to the improvement of the socio-
relationships economic conditions and general welfare of
 Connectivity nurses through appropriate legislation is a
 Cost practice and a visionary mission.
 Fast and numerous changes
Current technology: Issues and dilemma
 Security
 Portability Nurses and Practice
 Cost Ethical Principles
 Real-time events 1. Human life is inviolable.
 Equity 2. Quality and excellence in the care of the
 Justice patients are the goals of nursing practice.
3. Accurate documentation of actions and
outcomes of delivered care is the hallmark of
Lobbying/Advocating fort Ethical Issues nursing accountability
Related to Health Care
 Since the ethical foundation of lobbying is the Nurses and Co-workers
vigorous public debate necessary for Ethical Principles
informed decision making, ethical dilemmas 1. The Registered Nurse is in solidarity with other
related to lobbying tend to arise when various members of the healthcare team in
behaviors by lobbyists and lawmakers working for the patient’s best interest.
undermine the fairness and transparency of that 2. The Registered Nurse maintains collegial and
process and do not contribute to the common collaborative working relationship with
good colleagues and other health care providers
 Ethical lobbyists embrace the rule of law and its
underlying principles. Avoid conflicts of
Nurses Society and Environment
interest: If a potential conflict arises, ethical
lobbyists disclose it immediately to both parties Ethical Principles
and recuse themselves until the matter is 1. The preservation of life, respect for human
resolved. rights, and promotion of healthy environment
shall be a commitment of a Registered Nurse.
2. The establishment of linkages with the public
Code of Ethics for the Filipino Nurses
in promoting local, national, and
Nurses and the People international efforts to meet health and social
1. Values, customs, and spiritual beliefs held by needs of the people as a contributing member
individuals shall be respected. of society is a noble concern of a Registered
2. Individual freedom to make rational and Nurse
unconstrained decisions shall be respected.
3. Personal information acquired in the process
of giving nursing care shall be held in strict
confidence.

Nurses and the Profession

Ethical Principles:
1. Maintainance of loyalty to the nursing
profession and preservation of its integrity are
ideal.