Rio Salado Community College Voluntary Euthanasia Discussion

Respond to the following individual’s discussion posts. There need to be at least 2 paragraphs per question with a minimum of 7 sentences per paragraph.

APA 7th Edition

Vonna

• Voluntary euthanasia is basically the decease of a patient’s life with their physician personally involved. For example, removing a vegetative patient’s feeding tube or respirator (Niles, 2019). The difference between euthanasia and physician-assisted suicide is the physician’s involvement, which is almost nonexistent in physician-assisted suicide. During physician-assisted suicide, physicians will only provide the medication used to on set the death, it is the patient who injects themselves.
  • Physician’s ethical dilemmas with voluntary euthanasia involves:
    • Beneficence and Nonmalfeasance: Some physicians feel like they are ending a patient’s pain and suffering. Opposing physicians believe that they should not be directly involved with taking a life, only prolonging it.
    • Autonomy: Physicians that believe in euthanasia feels it provides the patient with the opportunity to determine when and how they die. Opposing physicians’ states that it provides the patient/families and insurance companies the chance to avoid healthcare bills.
    • Dignity: Physicians for euthanasia states that it allows the patient to be free from an unsatisfactory life. Opposing physicians believe that it “devalues the concept of life” (Niles, 2019).
• I do believe a law should be established. Not to ban voluntary euthanasia, but to set boundaries for roles and outlines a process that is beneficial for the patient. It is their right, ultimately, to decide what happens to their life, including if and when it deceases. The Oregon Death with Dignity Act upholds all ethical values, allowing autonomy and ensuring beneficence and nonmalfeasance, along with promoting justice and dignity. The act mandates two different physicians to assess and evaluate a patient for life-ending circumstances, a mental health professional to intervene in the case the patient is not in a fit mental state, and multiple requests from the patient for the procedure to take place, verbally and written. Physicians are also required to give their patient additional information regarding other care options such as hospice and palliative care. Personally, I don’t want to have a painful death nor do I want to grow old and not be able to take care of myself, I’d rather go peacefully after living a fulfilled life. I do suffer from a chronic disease that causes unbearable pain and humility, and the immediate relief that is currently available is utterly barbaric. Sometimes I find myself begging for God to just end my life so I wouldn’t have to endure so much just trying to live for my loved ones, who are also forced to watch me suffer. Although my disease is not life-threatening, I do think that euthanasia, no matter how tough of a pill it is to swallow, is another aspect of “quality” healthcare that is missing.
• Defensive medicine is the result of increasing patient-initiated lawsuits and medical malpractice premium expenses for physicians who does not provide standard care or treatment to a patient that ends with them injured, something damaged, or at a loss. In turn, physicians began fighting back by developing defensive medicine technicians: extra ordered tests and unnecessary services provided to patients to reduce their errors and prevent malpractice liabilities. One question brought about by this practice is if it is efficient for the patient’s healthcare or a physician’s way of showing that they expended every care option. Current studies shows that physicians that do practice defensive medicine are associated with fewer malpractice claims, yet, there is still no correlation between extra tests and high quality of care (Miller Jake, 2015). Evidence only shows that defensive medicine adds additional costs to the U.S. yearly healthcare spending rate.
  • I do believe that this is a current practice that physicians enforce. I work in an emergency laboratory for both adult and children, and the main lab for the entire hospital. I have witnessed physicians ordering tests that had nothing to do with the patient’s ailments and I’ve overheard nurses speaking on similar situations with other nurses; furthermore, I’ve witnessed them also enabling the situation by drawing as much blood as they to keep up with the extensive ordering.
• Workplace bullying was initially defined as, “an ongoing harassing workplace behavior between employees, which results in negative health outcomes for the targeted employees,” by Andrea Adams in 1992 (Niles, 2019). However, The Joint Commission redefined it as, “intimidating and disruptive behaviors in the workplace because they realized workplace bullying had more severe outcomes than the first definition acknowledged (Niles, 2019). I do consider this behavior unethical. It is a right to have a positive work environment and treated with dignity and respect according to OSHA (Occupational Safety and Health Act of 1970) and the Civil Rights Act (Title VII of Civil Rights Act). Infringement upon an individual’s rights is wrong, which makes workplace bullying and unethical and criminal act. I have witnessed physicians’ talk down to nurses. I have had nurses talk to me disrespectfully. We were able to read an email sent to a superior administrator that cost them their jobs. We also were able to witness the resignation of the hospital Vice President due to sexual harassment in the workplace.

References:

Miller, Jake. (2015, November 4). Does Defensive Medicine ‘Work’?. Harvard Medical School.

Does Defensive Medicine ‘Work’? | Harvard Medical School (Links to an external site.)

Niles, N. J. (2019). Basics of the U.S. healthcare system. (4th ed.). Jones & Bartlett Learning.‌

Ashley

1. Voluntary euthanasia is intentionally ending the life of a patient at their request (Niles, 2021). This can occur in several different ways but the healthcare provider is the one who takes the action with the intention of a patient’s death. This differs from assisted suicide, which is where a patient completes the action of killing oneself, but the healthcare provider has provided the means to do so (Niles, 2021). This is often done by a doctor prescribing medication that a patient later takes. The difference between the two is the person taking the action in order to ultimately end the life of a patient. There are several ethical dilemmas involved in voluntary euthanasia. There are five principals of ethics that all healthcare workers must abide by, and in direct competition with one another surrounding this issue are the issues of autonomy and nonmalfeasance. Autonomy is a principal that ensures that healthcare workers allow patients to be active participants in their healthcare plans (Niles, 2021). In acting with autonomy we comply with a patients wishes for their healthcare, even if it’s not what we believe is in their best interest (Niles, 2021). We do this because the patient is in the driving seat of this relationship, they know their values, and they know themselves better than we do. A patient asking for their life to be ended, based solely on the principle of autonomy would be ethical. We would be doing what the patient wished and ending their life. When nonmalfeasance comes into play we end up with a problem. Nonmalfeasance means doing no harm to a patient, and only doing good (Niles, 2021). Death, and causing the death of a patient is the exact opposite of what we, in healthcare, consider to be “good”, and goes against the entire reason many of us chose this profession. Acting in a manner that causes a patients death is unethical from the perspective of nonmalfeasance alone.

I am personally of the belief that this issue should have laws, or at least guidelines that protect both the patient and provider. If a provider is comfortable doing so, and the patient is deemed to be of sound mind and able to make a decision on their own, then I do believe a patient’s choice should carry much more weight than a provider acting to avoid nonmalfeasance. If a provider is uncomfortable performing euthanasia I believe that is a perfectly reasonable line to draw, and the patient can seek another provider. As I said before, many of us chose this profession to do the opposite of euthanize people, and I feel that needs to be respected, as well.

1. Defensive medicine is when a provider does more than what they believe, using their best judgement, is required for a patients care and wellbeing, in order to avoid future consequences (Niles, 2021). These consequences are generally those of malpractice or other lawsuits. I absolutely think that physicians do this. I oftentimes can’t blame them. I cannot imagine spending so much of my income protecting myself from lawsuits and knowing constantly that my entire career could be ruined if I missed one thing on the wrong patient. That’s a tremendous amount of pressure to work under, and if ordering a few extra labs and images removes that doubt and anxiety I can reasonably justify that as an empathetic person. Is it the right thing to do? Absolutely not. We’re costing patients, and the healthcare system an obscene amount of money, and subjecting people to testing, and additional stresses they more than likely don’t need, but as our society currently sits I can understand it.

In doing a bit of research around defensive medicine I found a scholarly article that brought up a very interesting “flipside” to defensive medicine. The idea of both “positive” and “negative” defensive medicine (Shenoy et al., 2022). Positive defensive medicine is what we have spoken about in class – ordering extras, providing unnecessary “mores” for a patient as a way of covering oneself, where negative defensive medicine is a means of avoiding a patient by “getting rid of” patients that provide a higher level of liability (Shenoy et al., 2022). Finding a reason to transfer or move a patient, referring them out, etc. due to fears surrounding potential consequences are all examples of negative defensive medicine. Negative defensive medicine is absolutely heartbreaking, and probably leads to the patients who most need care (high risk) being passed over due to fear.

1. Workplace bullying is essentially harassment at work (Niles, 2021). Unfortunately I have witnessed this several times in my current career. I work in operations for a large national company that has a zero tolerance policy for any sort of harassment and bullying in the work place, thankfully, but it often becomes my job to manage and handle things such as workplace bullying when they do pop up on my own team. I consider this behavior to be completely unethical, not just from a healthcare standpoint but from a “being a decent human” standpoint. The entire purpose surrounding bullying is to put others down, threaten, and harass them. There is not a single good reason to do that. Focusing solely on healthcare one of the main principles of ethics in healthcare is beneficence – which is the doing of good for a patient and a person (Niles, 2021). It does no one any good to feel unsafe and unappreciated in their place of work, and it does no one any good to be the kind of person who makes others feel that way.

References:

Niles, N. (2021). Healthcare Ethics. Basics of the U.S. Health Care System. (4th ed.). (pp. 305-320).

Jones & Bartlett Learning.

Niles, N. (2021). Healthcare Law. Basics of the U.S. Health Care System. (4th ed.). (pp. 273-289).

Jones & Bartlett Learning.

Shenoy et al. (2022, February 17). Patient safety assurance in the age of defensive medicine:

a review. Patient Safety in Surgery – Bio Med Central. https://pssjournal.biomedcentral.com/

articles/10.1186/s13037-022-003198