Euthanasia: Ethical Issues and Principles in End-of-Life Care

This article discusses the ethical issues and principles surrounding euthanasia in end-of-life care. It covers different forms of euthanasia, the role of healthcare professionals, and the principles of nonmaleficence, patient autonomy, double effect, justice, and beneficence. The article also includes a case study and discusses the legality of euthanasia in Australia.

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Euthanasia
Giving good care for dying individuals requires that the health experts have known about
ethical issues pertinent to end-of-life care. Patient autonomy can be assured by effective advance
planning at the end of life when the victim has lost the capacity to make a decision (Shah, 2018).
Health experts caring for terminally sick patients receive requests for medic-assisted suicide. The
practitioner must establish the basis for the request and work with the health care personnel to
give support and comfort the patient. Medics need to incorporate spiritual situations into the
management of patients at the end of life (Shah, 2018). Euthanasia refers to the killing of a
person for the sake of mercy to relieve great suffering. Health practitioners must be convinced
that request is voluntary, well considered and the victim has unremitting pain (Keown, 2018).
There are many forms euthanasia that includes passive euthanasia, active euthanasia,
voluntary and non-voluntary euthanasia. Passive euthanasia refers to authorizing the individual
to die by withholding treatment or by discontinuing such treatment once begun. Active
euthanasia is taking a positive step to end life like the administering a toxic substance or the
injection of an air bubble into the bloodstream (Shah, 2018). There are at least two experiences
where cessation is not the same as euthanasia: the refusal of treatment right and when continued
treatment brings more discomfort and has minimal chance of survival. The non-voluntary
euthanasia is ethically controversial and involuntary euthanasia happens when an individual
might well be able to provide informed consent, however, they might be unable to give consent if
asked and in those situations terminating a life through the actions of others happens (Shah,
2018).
Doctors are constrained directly or indirectly by the laws in the sphere of politics in the
treatment and care of individuals who might be near to terminate their lives. There is a key

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current problem concerns the availability and the success of palliative medicine and palliative
care in the social policy (Keown, 2018). Withholding or withdrawing of ineffective medication
is permissible even if it shortens life foreseeably. Moreover, a good medical treatment at the life
termination that motivates practice and that kind of medication is oriented to make sure that the
individual dies with dignity and in comfort. As much as the benefits of medication must
outweigh the disadvantages, this kind of treatment should not involve termination of the patients
deliberately(Shah, 2018).
For instance, there was a 66-year-old female victim who was a divorcee and a mother of
one daughter. The victim lives with her 21-year-old daughter. She was a mathematics teacher
and he was healthy and actively involved in various activities until five months ago when she
started complaining about generalized pain and loss of weight, multiple seizure episodes and
severe headache. She as then diagnosed with metastasis brain tumor stage IV. She got two cycles
of chemotherapy and she refused to receive radiotherapy. She later developed hypoxic damage to
her brain cells that left her paralyzed and blind. Furthermore, she lied in her bed and depressed,
she had no contact in the outside world. Her daughter feeds her religiously and sincerely. She
then asked her daughter to die in peace and signed an agreement consent form with the witness
of her daughter because she was suffering from an intolerant pain. Her doctor gave her a high
dose of morphine and ended her life immediately.
The cases raise an ethical issue since it's a controversial subject involving life and death
decision. According to Sahni & Jain, Euthanasia implies that's most individuals that are
incurably sick will not choose to end their own life or ask for assistance from other people to
activate their death. For this reason, they may suffer pain physically from a long health decline
which is stressful both for the woman and the daughter. Therefore if the woman could not access

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euthanasia she would have a cruel choice concerning end her own life using various means
(possibly painful, violent and ineffective means) (O'Neill, 2013). For example, an Ethical
problem in the case especially religious wise is that God gives lives and therefore he should be
the one to end it. Making euthanasia legal will make others misuse the opportunity by killing
even when it's not necessary (O'Neill, 2013). The case represented an ethical issue since the
reason behind the treatment of pain-relief is to relieve the pain, therefore, the primary intention
should not be killing but relieve pain. It is unethical to help anyone kill themselves.
In Australia, euthanasia is seen as a controversial problem. There are many different
legislations in Australia associated with euthanasia, however, most states consider it illegal.
Suffering is also an existential issue which extends beyond physical pain because it is influenced
by many elements like cultural, spiritual and psychological elements and we can deal with the
symptoms that are physical but the suffering may remain (Shah, 2018). One of the major
responsibilities for me as a medic is to gain the trust of the victim and the therapeutic
relationship. Euthanasia violates the codes of medical ethics that prohibit doctors from assisting
their sufferers to die (Keown, 2018). The patient who was diagnosed with metastasis brain tumor
stage IV was in great pain. She made her own decisions to die peacefully and her daughter was
the witness. Relieving the pain by injecting the morphine was the necessary action as the patient
could have died eventually after some time. The patient died with dignity because of her ability
to make a decision. She was also relieved from pain because she had control over her life.
Although many individuals are relieved when they are told that euthanasia is not an option, this
morphine injection was the right thing to do because the patient was suffering from intolerable
pain (Keown, 2018).

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Ethical Understanding
There was no need to continue with the treatment is there is no difference between letting
one die and killing so long as the reciprocal consent of the parties involved is obtained.
Additionally, euthanasia is morally right since it brings greatest happiness balance over the
unhappy woman brought about by mercy killing. Therefore in this case killing is morally right.
The social and cultural settings keep on changing, thus new changes concerning
euthanasia should be developed. The same way people the right to live in dignity is the same way
they have the right to die in dignity. In the case of the 66 female the condition was simply painful
and prolonging it was unnecessarily, the illness robbed the woman most of her dignity. Therefore
volunteer euthanasia was necessary (Gastmans, 2013). Additionally, the science of medicine and
practice is presently adept of extraordinary human life prolongation. It can either be a
continuation that often excessively results in a concomitant prolongation of suffering that is
pointless and unnecessary (Keown, 2018). As a medic terminal illness puts a lot of pressure to
the family members ( the daughter of the 66 years old woman) and also to the medical
practitioners to spend time and resources that are costly on the sick person that has minimal
chance of recovery or no chance at all and thus they are irretrievably predestined to die. Such
patients, therefore, should then be assisted to end their life to end the suffering. As a medical
practitioner, the most important task is to relieve suffering and not to prolong life and health
promotion. Individuals have the right to die with dignity and the practitioners have a duty to
assist in the regard (Gastmans, 2013).
Euthanasia should not be considered immoral, for the woman to choose to end her life
does not necessarily mean that she is violating moral laws (Gastmans, 2013). Most people
against euthanasia argue that euthanasia proponents are immoral because it is necessary to

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protect and preserve life. However, life preservation is subject to the choice of self-determination
of a person and no physician choice. For example if the woman had not asked for the doctors
help to die and the doctor decides to kill her then that could be considered as immoral,
nonetheless, she decided it on her own. Accordingly, killing invades on the right of the
individual to live by grabbing away the choice element in the death of an individual.
Nonetheless, if the person chooses how to die then no infringement is done (Keown, 2018).
Accordingly, a practitioner is seen to be forcing an individual to live a life without what
they think or consider is self-worth by denying the individual her dying right when she is
experiencing suffering and pain that is intense (patients that are critically sick) (Gastmans, 2013)
Even though anti-euthanasia intentions are good, it is wrong to demand a person to live a life full
of suffering (this is immoral since it deems them the right of choice). Mercy killing accelerates
making of the choice, in this case, the choice of compassionate and sympathetic to the dignity of
the sick individual.
Principles and Values
The principle of voluntary euthanasia dictates that every being has the right to implement
plans in case they want to end their life so that their death can be peaceful, consistent and at the
time they choose (O'Neill, 2013). For example, I would advocate low dose pain medication in
fear of the patient becoming an addict since excess dosage will harm the patient which is against
medical ethics which is to ensure that the patient is in good condition (avoiding harm to the
patient) (Keown, 2018).
Sufficient pain relief, especially during euthanasia, is an ethical obligation that is primarily based
upon the nonmaleficence, patent autonomy, double effect, and justice and beneficence principle.

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Managing pain involves an assessment that is complete (considering total pain components)
(O'Neill, 2013). Most pain relief drugs are administered depending on the total pain of the
patient. Therefore they should be prescribed depending on the severity of patient pain. However,
this raises ethical dilemmas since the prescription should also consider psychological and
functional significance. For example, if the drug is administered in high dose it may cause
psychological harm and if administered in low dose it may not relieve the pain, thus initiating
suffering of the patient (Nelson, & Nelson, 2014). Nonetheless, it is important to consider the
patient choice of ending the pain, In this case, the full dosage would be necessary to end the pain
of the distressed patient, and however, it may cause other harms. Although this signifies respect
of individuals' right since low dosage implies that the pain will still be there thus the patient will
continue to suffer, even though it may lower chances of addiction. This misunderstanding poses
a great barrier in terms of management of pain that is effective (Holmes, 2016).
The principle of nonmaleficence, patient autonomy, double effect, justice, and
beneficence involves balancing the benefits and risks to ensure that the patient is not harmed. For
example, beneficence involves the duty to improve the condition of the patient, putting in mind
what's good for the patient including his or her desires this principle is aligned closely with the
nonmaleficence which is the duty to not injure the patient (Nelson, & Nelson, 2014). Thus is
principles combine to create the basis for balancing the goal of the patient for the ease with the
safety of the patient. The principle of justice involves acknowledging the right of a person in
dues time. In this case, the patient has the right to be treated in a different manner depending on
his or her condition. For example, individuals who have the same diagnosis should be treated
similarly and those with different diagnosis should be treated differently (Holmes, 2016). The
principle is helpful in pain relieving since the patient pain medication on another patient does not

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have to be the same on the other patient. Patient autonomy demands medical practitioners to
respect the demand of the patient and allow them to make their own decisions concerning their
own health. This is relevant since the patient has freedom over his or her physical body,
therefore, practitioners should acknowledge the principle of autonomy (Keown, 2018).
Opioids for example in life-limiting illness are surrounded with several errors, which is
they are highly addictive, and that depending on it and tolerating it is a form of addiction. Even
though the drug may cause addiction which is unethical, my greatest duty is to save the patient
from days of torture since pain is a terrible thing that can happen to humans than death itself.
Every patient cannot be cured, however, mortality can be delayed. Pain relief and suffering are
always on our hands as medical practitioners. as physicians, it is our role to take good care f the
patient, with other needs coming second since pain relief is a basic human right (Keown, 2018).
Pain relief serves various benefits to the patient, by easing his or her condition of distress and
suffering since it improves the condition of the patient, by putting in mind what's good for the
patient including his or her desires (Holmes, 2016).
As physicians, we need to ensure that the pain of a patient is managed and assessed
properly. Chronic diseases might necessitate prescribing pain relievers like opioids. However
relieving pain has to equal in weigh not to expose the patient in addition, additionally, it should
not create the patient diversion on drugs and addiction to others. The ethical principles provide a
framework to help medical practitioners to make decisions that are ethically appropriate when
prescribing a pain reliever. As pain relieving is the obligation of the medical professions
In conclusion, euthanasia is seen as a controversial issue (since it raises ethical concerns) others
making it illegal and others legal. However, the patient should be given the opportunity to decide

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over his or her own life since individuals have the right to die with dignity and the practitioners
have a duty to assist in the regard.

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Reference
Gastmans, C. (2013). Dignity-enhancing nursing care: a foundational ethical framework.
Nursing ethics, 20(2), 142-149.
Holmes, D. (2016). Critical interventions in the ethics of healthcare: Challenging the principle
of autonomy in bioethics. Routledge.
Keown, J. (2018). Euthanasia, ethics and public policy: an argument against legalisation.
Cambridge University Press.
Nelson, H. L., & Nelson, J. L. (2014). The patient in the family: An ethics of medicine and
families. Routledge.
O'Neill, O. (2013). Acting on principle: An essay on Kantian ethics. Cambridge University Press.
Sahni, S. P., & Jain, G. Right to Life Includes Right to Die a Dignified Death: Public Opinion
About Euthansia In India. Klaus Günther 2 Klemen Jaklic 3 Hans Lindahl 3 Cristina
Traina 4, 25.
Shah, D. R. (2018). Euthansia & personal autonomy rights for the terminally ill.