Analysis of an Ethical Dilemma

The infamous “Terri Schaivo case” was one of ethical vs. medical consideration, and how those decisions made impacted how human euthanasia is currently viewed. From a healthcare provider’s perspective, we will be reviewing this topic and its related ethical implications, laws regarding this topic, and the stakeholders involved in the case. While the Schaivo case is reviewed here, we will also discuss the impact it has had on social values, morals, norms, and nursing practice as we attempt to explore the impact this trial has had on the healthcare system as a whole. Finally, we will examine how ethical theories and principals could play a role in defining ethical topics and how they could have been avoided or reduced within the daily practice of medicine.

The Terri Schaivo Case
“The Terri Schaivo case was a legal struggle, involving prolonged life support and the question of euthanasia” (Wikipedia, 2014). Terri Schaivo entered a vegetative state in early 1990. Both her private doctors and those that were court appointed believed that there was no hope of rehabilitation. Terri’s husband, Michael Schiavo, wished to follow his wife’s request for no mechanical means of extending her life however, Terri’s parents disputed the removal of support. The Schaivo case was heard more than twenty times in Florida courts and in each instance the courts ruled in the husband’s favor. Eventually politicians inserted themselves into the case which became the catalyst for “Terri’s Law”, giving Governor Jeb Bush the authority to have Schaivo’s feeding tube re-inserted when a court ruled it removed. The U.S. Congress became involved shortly after “Terri’s Law” and passed legislation allowing federal courts to intervene. Terri Schaivo’s feeding tube was finally removed on March 18, 2005, and she passed away 13 days later. Upon autopsy, her brain was half the weight of a healthy human brain. The medical examiner was quoted as saying “The damage was irreversible. No amount of therapy or treatment would have regenerated the massive loss of neurons” (Goodnough, 2005).

Obligations of the Nursing Professional
Euthanasia has a wide reaching effect on the ill (patients) and their families, but also on healthcare practitioners, insurance companies, religious groups, and government. Various statements about euthanasia have been written into medical codes of conduct. The American Nurses Association (ANA) prohibits nurses’ participation in assisted suicide and euthanasia; these acts are in direct violation of the Code of Ethics for Nurses, the ethical traditions and goals of the profession, and its covenant with society. Nurses have an obligation to provide humane, comprehensive and compassionate care that respects the rights of patients but upholds the standards of the profession in the presence of chronic, debilitating illness and at the end-of-life (American Nurses Association, 2013).

The ANA’s stance on Euthanasia and assisted suicide states that nurses are not to administer medication which could lead to the end of a patient’s life. It is very important for nurses to maintain competencies for providing palliative care and to stay up to date on legislation in regards to assisted suicide/euthanasia. Legally, if a nurse participates in an act of assisted suicide and then that nurse puts him/herself at risk for civil and criminal prosecution, loss of license, as well as imprisonment. Four states have legalized Physician-Assisted Suicide: Oregon, Vermont, Washington, Montana (Procon.org, 2014). The federal government prohibits euthanasia under general homicide laws and does not have laws regarding assisted suicide.

Summary of Impact
Euthanasia and assisted suicide are hugely debatable concepts in health care. Nurses have the ethical responsibility to provide their patients with requested information on assisted suicide as well as provide patients with palliative care. However, the act of participating in assisted suicide in any form is a direct violation of the Code of Ethics for Nurses (American Nurses Association, 2013). Nurses are passionate about being positive advocates for their patients. In the event of a patient requesting assisted suicide, it is okay for nurses to understand the patient’s point of view as well as honor the patient’s right, values, and dignity. It is then up to the nurse to provide the patient with comfort care by alleviating symptoms, as well as mental, emotional, and spiritual care (American Nurses Association, 2013).

At times it may be difficult to determine a balance between the preservation of life and enabling a dignified death. In dealing with a situation such as this, it is important to have an in-depth understanding of the ethical principles in health care. Non-maleficence, justice, veracity, and autonomy are important to remember when discussing assisted suicide with your patients and family members (Grand Canyon University, 2011). Nurses are the backbone to providing compassionate and humane care whether it is end-of life care or life preservation care. However, being knowledgeable of the ethical principles in nursing will better prepare the nurse for the challenges faced in patient care.

Ethical Theory
Consulting ethical theories and/or principles may help when confronting an ethical dilemma. The removal of Terri Schiavo’s PEG tube went against the non-malfeasance principle. The ethical principle of non-malfeasance is the avoidance of harm on a patient (ANA, n.d.). “Judges who would not halt the removal of Schiavo’s PEG tube were ‘guilty not only of judicial malfeasance — but of the cold-blooded, cold-hearted extermination of an innocent human life’” (Bishop, 2008). The same could be said about the healthcare provider that removed the PEG tube. Physicians and nurses take oaths and pledges that state they will do no harm to patients in their care. When the PEG tube was removed it took away her means of hydration. The symptoms of extreme dehydration are extremely painful. The other side of the ethical dilemma could be that the family wanted to end her suffering. Although by doing so wouldn’t that open the doors to ending people’s lives in the future that are cognitively disabled being euthanized in the same manner?

Works Cited
American Nurses Association. (2013). ANA Position Statement: Euthanasia,
Assisted Suicide, and Aid in Dying. Retrieved August 14, 2014, from Nursingworld: http://www.nursingworld.org/MainMenuCatagories/EthicsStandards/Ethics-Position-Statements/Euthanasia-Assisted-Suicide-and-Aid-in-Dying.pdf

American Nurses Association (n.d.). Short Definitions of Ethical Principles and Theories Familiar words, what do they mean? http://www.nursingworld.org/mainmenucategories/ethicsstandards/resources/ethics-definitions.pdf

Bishop, J. (2008). Biopolitics, terri schiavo, and the sovereign subject of death. Journal of Medicine & Philosophy, 33(6), 538-557

Goodnough, A. (2005, June 16). Schaivo Autopsy Says Brain, Withered, Was Untreatable”. The New York Times .

Grand Canyon University. (2011). Ethical Theories and Principles in Health Care. Ethical principles in Health care. Retrieved from: http://lc-ugrad1.gcu.edu/learningPlatform/user/users.html?operation=loggedIn#/learningPlatfor m/loudBooks/loudbooks.html?viewPage=past&operation=innerPage&topicMaterialId=5 32034c7-a8a0-46fc-9f81-4b2f1e2df2a7&contentId=01279a3d-65b6-433d-b83f- 4fadd4984b47

Procon.org. (2014). State-by-State Guide to Physician-Assisted Suicide – Euthanasia. Retrieved August 14, 2014, from http://euthanasia.progon.org/view.resource.php?resourceID=000132

Wikipedia. (2014, August 20). Terri Schaivo Case. Retrieved August 22, 2014, from Wikipedia, The Free Encyclopedia: http://en.wikipedia.org/wiki/Terri_Schaivo_case