Euthanasia and Mental Health in Old Age: Ethical and Legal Challenges

This report discusses the challenges related to euthanasia and mental health in old age. It evaluates the ethical and legal factors affecting euthanasia, the challenges relating to legalising euthanasia, and the perspective of registered nurses. The report also discusses the Mental Health (Compulsory Assessment and Treatment) Act 1992 in New Zealand and the ethical concerns relating to taking another person's life even with their consent.

Mental Health in Old Age
Euthanasia

Table of Contents
Introduction...............................................................................................................................2
Euthanasia..................................................................................................................................2
Mental illness and Euthanasia...................................................................................................4
Ethical and legal factors affecting euthanasia...........................................................................5
Challenges relating to legalising euthanasia..............................................................................6
Perspective of Nurses.................................................................................................................8
Recommendation.......................................................................................................................8
Conclusion..................................................................................................................................9
References................................................................................................................................10
Page 1

Introduction
Mental health illnesses are serious issues which affect a large number of people
across the globe. In the case of older people, it becomes difficult for them to deal with these
issues which are hard for them and their families. In New Zealand, the government has
implemented many laws which are focused on providing facilities to older people who are
suffering from mental health issues such as Mental Health (Compulsory Assessment and
Treatment) Act 1992 (Health, 2012). However, these policies are not enough to properly
address the ethical issues faced by older mental patients. Euthanasia is a key ethico-legal
issue relating to older adult mental health which affects many people which include
registered nurses providing support to people at home. Euthanasia is referred to the
practice of ending a person’s life intentionally in order to relive the person from pain and
suffering. Euthanasia is illegal in New Zealand, and no legislation is enacted by the
government to provide provisions for people who want to die as per their will. Nurses have
to deal with older patients who are in pain and suffering who did not want anything but to
die peacefully (Fletcher, 2015). The family members of the patient also face difficulties since
they cannot do anything in such situation. There are various ethical and legal factors related
to euthanasia which affects the parties involved in this scenario. This report will focus on the
ethico-legal issue of euthanasia relating to older adult mental health and how it affects the
patients and their family members. This report will evaluate various legislation and policies
which create issues for implementing of euthanasia procedure in New Zealand. The
perspective of registered nurses will be evaluated in the report to understand the ethical
dilemma and legal issues which they face while discharging their duties relating to older
mentally ill patients.
Euthanasia
Euthanasia is referred to the deliberate action of ending a person’s life with the
intention to relieve the persistent suffering of the patient. In the case of most countries,
euthanasia is considered as illegal, and against the law and in many cases it may carry a jail
sentence for committing murder. However, it is a controversial and emotive topic of
discussion because many people argue that relieving someone from pain is a noble act
Page 2

especially when the person gives his/her own consent (Keown, 2018). In the case of New
Zealand, euthanasia is illegal, and the two attempts which were made to make it lead were
failed. In the case of euthanasia, the doctor is allowed to end a person’s life through a
painless means as long as the patient and his /her family members give their acceptance
(Carrick, 2012). In the case of assisted suicide, the doctor assists the patient to commit
suicide as per his/her request.
However, the legal issue with euthanasia is that it is the act of killing another person
which is considered illegal. Although the motive of the parties in euthanasia is to relive the
person from the pain, however, it is still killing another person that is wrong. In case the
patient is unable to give his/her consent, for instance, he/she is in coma or mentally
unstable to give a valid consent, then it becomes difficult for the doctor to use euthanasia to
relive his/her pain (Chambaere, Vander Stichele, Mortier, Cohen & Deliens, 2015).
Euthanasia is classified into two categories which include voluntary and involuntary.
Voluntary euthanasia is conducted by the parties with consent. In this case, the patient and
his/her family members give their consent to relive the person from the pain. Currently,
voluntary euthanasia is legal in Switzerland, Belgium, the Netherlands, Luxembourg, and
Oregon and Washington states in the United States. Involuntary euthanasia is conducted
without the consent; in this case, the decision of euthanasia is made by another person
rather than the patient because the patient is unable to make the decision.
Furthermore, there are two procedures which classify euthanasia which include
passive and active euthanasia. In the case of passive euthanasia, the life-sustaining
treatments are withheld by the doctors. In the case of active euthanasia, the life of the
patient is taken by someone by using lethal substances or forcing in order to end the
patient’s life (Emanuel, Onwuteaka-Philipsen, Urwin & Cohen, 2016). Many people believe
that euthanasia is importance in the case of mentally ill patients who are old. They are
unable to understand their actions, and they suffer substantial pain as well. Through
euthanasia, their pain can be eliminated by the doctors along with their family members
who suffer with them as well. In countries where euthanasia is illegal, nurses providing
support to people at home deal with various ethical dilemmas because the family members
of the patients request them to relive the patient from his/her pain, however, they can face
legal charges for the same (Steck, Egger, Maessen, Reisch & Zwahlen, 2013). Older patients
Page 3

who are mentally ill are not able to feed themselves, and they suffer pain as well. The nurses
who provide them care at home have to face the ethical dilemma regarding whether to
relieve them from their pain or continually watch them suffer each day of their life.
Mental illness and Euthanasia
Generally, people think of severe and crippling depression among patients who are
mentally ill as the candidates for assisted suicide or euthanasia. Many famous doctors who
support right to die or euthanasia practice such as Dr Philip Nitschke argue that the people
who are suffering from depression and suicidal should be assisted by the medical
professionals to die if they decide for it (Life, 2018). They should have the option to end
their pain through humane medical treatment with the assistance of medical professionals.
The people who suffer from suicidal tendencies or depression are trapped, and they only
have the option to kill themselves through most inhumane ways in which they suffer most
pain such as shooting, jumping off building, cutting wrists, hanging and others. These people
should have the option to conduct euthanasia or assisted suicide through a medical
professional in which they die without any traumatic and painful way. The governments
should accept the ‘right to die’ right for people who are mentally ill which would create a
legal presumption of sanity for those individuals who commit suicide or request for
euthanasia (Steck, Egger, Maessen, Reisch & Zwahlen, 2013). The pain which is suffered by a
person suffering from depression is unbearable, and they have to live with such pain daily.
In the case of older people, they are unable to live their life because they require
assistance of others to perform their day to day operations. The family of older patients also
suffer due to their depression and suicidal tendencies because it affects the young people in
the family. They have to put the older mentally ill patients in health care homes which are
highly expensive, thus, it is not the option for low-income families which makes it easy for
the older people to commit suicide by painful methods (Nett et al., 2015). Many times the
mentally ill patients can or try to harm the children in the family due to which they can face
trauma as well for the rest of their lives. Many times families abandon older people who
suffer from mental disorders which makes it hard for them to live their life. They are unable
to protect themselves in the world due to their mental illness, and they can also cause harm
to other parties as well (Malpas, Mitchell & Koschwanez, 2015). The nurses who provide
Page 4

support to the older people at their home also face many challenges because they see these
patients in pain and trauma due to their mental illness, however, the nurses are bound by
legal policies to take any actions against them. It would have ethical for them to conduct
euthanasia to remove the patients from their pain; however, they are unable to take any
actions due to legal boundaries.
Even when the patients and the family members gave their acceptance for
euthanasia, the nurses and even doctors are unable to do anything, and the patients
continued to suffer pain, and the family also has to suffer the financial expenses for
medicines and hospital bills. Thus, legalising euthanasia will be considered as an ethical or
moral move by the government to ensure that older people who have mental illness have
the option to end their pain and suffering by relying on the option of euthanasia (Hewitt,
2013). The mental patients who are unable to take the decision by themselves, however,
who are facing substantial pain should also be set free from their pain through euthanasia in
which their family members can take the decision for them while consulting with their
doctor. By accepting and legalising the right to suicide, it would create a legal presumption
of sanity which would assist in the prevention of appropriate mental health treatment (Kim,
De Vries & Peteet, 2016). After the legalising of euthanasia, the number of suicide
committed by older people who are suffering from mental illnesses will be decreased.
However, there are various ethical concerns relating to euthanasia as well because people
could misuse this option which could lead to disastrous results.
Ethical and legal factors affecting euthanasia
One of the key issue with euthanasia is that it is an act of murdering someone;
although intention is a key part which is considered by the court while determining whether
the person is liable for the murder or not (mens rea), however, the person is most likely to
face jail time who conduct euthanasia in the country which it is illegal. In New Zealand,
euthanasia is illegal under section 179 of the New Zealand Crimes Act 1961 (Legislation,
2018). The key legal factor which affects the implementation of euthanasia policies is that
murder is considered as illegal in the country. It is wrong for a person to kill another person
due to which doctors and nurses did not kill the patient on the request of the family
members because they knew that they could be prosecuted for murdering the patient. The
Page 5

person who commits or try to commit murder can face a maximum penalty of life
imprisonment. Thus, the person who conducts euthanasia also faces the risk of life
imprisonment even if the patient was begging the person to relive him from the pain. In the
case of nurses who are giving services at the home, this issue increases because they spend
more time with the patients than compared to the doctor (Goldney, 2012). The nurses have
to deal with the patient who is continuously suffering from pain and the family members of
the patients who have to pay heavy medical bills even when they know that there is no
chance that the treatment will save the patients.
The government has provided various rights to people with a mental health
condition in New Zealand under the Mental Health (Compulsory Assessment and
Treatment) Act 1992. These rights are received by a person who made an application or
another person who made an application on behalf of the patient to prove that the patient
has a mental disorder (McCormack, Clifford & Conroy, 2012). Many times older people
suffer from mental illnesses which make them dangerous for themselves or their family.
These patients harm themselves badly, and all they want is to get a painless death. The
doctors also know that there is nothing that they can do to save the patient or cure his
mental illness. All they do is keep the patient in a stable stage where he/she is neither dead
nor alive to ensure that he/she did not harm himself or others. The family members have to
pay significant fees to the hospital to keep the patient alive who wants do not want to live.
Thus, the legal restraints imposed on the government to prohibit euthanasia have created
many problems for the patients and his/her family members (Keown, 2018). These
challenges are faced by nurses as well who have to deal with the patient and his/her family
members. Therefore, there are various ethical and legal factors which are related to
euthanasia which affects the older people who are suffering from mental health issues and
their family members.
Challenges relating to legalising euthanasia
Following are various ethical and legal challenges which people and the government
faces relating to legalising euthanasia in New Zealand.
 Illegal process
Page 6

Suicide is a major issue in New Zealand which has been decriminalised by the
government, however, people who assist another person in committing suicide can be held
liable by the court and a penalty of five years of imprisonment can be imposed on the
person. This shows that helping another person takes his own life even when the person has
given his/her consent is considered illegal in New Zealand (Ten Have & Welie, 2014).
Similarly, in euthanasia, the doctors assist the patient in taking his/her own life which is
considered illegal. In the case of older people who are mentally ill, the doctors wanted to
help them by relieving them from their pain; however, they cannot help them because a
legal procedure for euthanasia has not been established in New Zealand.
 Ethically wrong
There are various ethical issues relating to taking another person’s life even when the
person has given his/her consent. The deontology ethical theory judges the morality of a
situation based on the fact whether the parties involved in the situation have violated their
duties or not. In this situation, it is wrong for people to kill another person because they are
violating their duties to relive another person from pain. Although the consequences of this
action could be positive, however, the duties are violated by the parties which are
considered as ethically wrong (Fletcher, 2015). Therefore, even reliving older mentally ill
patients from their pain is considered wrong from an ethical perspective.
 Religious factors
Many people argue that from a religious perspective, legalising euthanasia is considered
wrong. No religion gives permission to take another person’ life even it is to relive them
from pain. It is believed that humans are created by the god, and they did not have the
power to take another person’s life (Danyliv & O’Neill, 2015). This power is only available to
the god and killing someone is considered as one of the biggest religious based crime. Thus,
it has become difficult to legalise euthanasia in New Zealand.
 Inhumane behaviour
Many people argue that euthanasia is considered as inhuman behaviour even if the
objective is to relive the person from pain. Especially, in the case of older people who are
mentally ill and who are unable to give consent for euthanasia which raises the issue of
Page 7

informed consent. Due to their mental inabilities, it becomes difficult for older people to
give informed consent for euthanasia; therefore, their family members take this decision for
them (Keown, 2018). Therefore, it is considered as inhumane behaviour because euthanasia
is conducted without the valid permission of the person who might want to keep living
which is considered as inhumane behaviour.
Perspective of Nurses
The registered nurses play a crucial role in assisting older people who are suffering
from mental illness in reducing their pain and making their life simpler. They are the ones
who directly deal with the patients and their family members. The doctor and nurses also
knew that the older person who is suffering from mental illness is less likely to be cured and
the only action which they can take is to ensure that the person is alive. The nurses who are
providing their services at home of the patient also face various ethical issues because many
times the family ask them to relive the patient from their pain; however, the nurses are
bound by legal rules (Kranidiotis, Ropa, Mprianas, Kyprianou & Nanas, 2015). Many times it
becomes difficult for doctors and nurses to ask the family members to choose the option of
euthanasia when they knew that the patient would continue to suffer from pain and also die
painfully. Since euthanasia is illegal in New Zealand, it becomes difficult for nurses to do
their job by reducing the pain of the patient and the family members.
Recommendation
Euthanasia should become legal in New Zealand because it will assist older people
who are suffering from mental illness to end their pain by taking help from medical
professionals. The government should implement a legal framework which addresses the
challenges faced by older people who did not have any other options but to continue to
suffer pain. Legalisation of euthanasia will reduce the number of suicides by older people
who are suffering from mental problems, and the only option which they have is to take
their life through pain ways. Legalisation of euthanasia will also assist the doctors and
nurses since they will be able to assist the patient in eliminating pain and it will help
terminate the pain of family members as well.
Page 8

Conclusion
Based on the above observations, it can be concluded that euthanasia is a key
ethico-legal issue relating to older people who are mentally ill. The objective of euthanasia is
to relive the older person who is ill and in immense pain to relive his/her pain by given a
painless death. Many people considered it a noble act because they are saving the person
from the suffering of pain. However, there are various ethical and legal issues relating to the
same. Firstly, it is illegal in New Zealand to kill a person or help them in taking their life.
There are various laws which provide rights to older people who are suffering from mental
illnesses. From an ethical perspective, euthanasia is considered as wrong as well. No religion
gives the permission to take the life of another persona, and many ethical theories
considered it as immoral as well. Another issue is that older people who are suffering from
mental illnesses are not able to take their decisions by themselves and someone else takes
the decision of euthanasia for them which is considered as ethically wrong. However,
euthanasia should be legalised because it will reduce the number of suicide committed by
older people who suffer from mental illnesses. It will also assist those older people to end
their pain who cannot give their consent due to their mental illness. Doctors and nurses play
a key part in euthanasia, and they should be consulted before accepting the application for
euthanasia.
Page 9

References
Carrick, P. (2012). Medical ethics in antiquity: philosophical perspectives on abortion and
euthanasia. Berlin: Springer Science & Business Media.
Chambaere, K., Vander Stichele, R., Mortier, F., Cohen, J., & Deliens, L. (2015). Recent trends
in euthanasia and other end-of-life practices in Belgium. New England Journal of
Medicine, 372(12), 1179-1181.
Danyliv, A., & O'Neill, C. (2015). Attitudes towards legalising physician provided euthanasia
in Britain: The role of religion over time. Social Science & Medicine, 128, 52-56.
Emanuel, E. J., Onwuteaka-Philipsen, B. D., Urwin, J. W., & Cohen, J. (2016). Attitudes and
practices of euthanasia and physician-assisted suicide in the United States, Canada,
and Europe. Jama, 316(1), 79-90.
Fletcher, J. F. (2015). Morals and Medicine: the moral problems of the patient's right to
know the truth, contraception, artificial insemination, sterilization, euthanasia. New
Jersey: Princeton University Press.
Goldney, R. D. (2012). Neither euthanasia nor suicide, but rather assisted death. Australian
& New Zealand Journal of Psychiatry, 46(3), 185-187.
Health. (2012). Guidelines to the Mental Health (Compulsory Assessment and Treatment) Act
1992. Retrieved from
https://www.health.govt.nz/system/files/documents/publications/guide-to-mental-
health-act.pdf
Hewitt, J. (2013). Why are people with mental illness excluded from the rational suicide
debate?. International journal of law and psychiatry, 36(5-6), 358-365.
Keown, J. (2018). Euthanasia, ethics and public policy: an argument against legalisation.
Cambridge: Cambridge University Press.
Page 10

Kim, S. Y., De Vries, R. G., & Peteet, J. R. (2016). Euthanasia and assisted suicide of patients
with psychiatric disorders in the Netherlands 2011 to 2014. JAMA Psychiatry, 73(4),
362-368.
Kranidiotis, G., Ropa, J., Mprianas, J., Kyprianou, T., & Nanas, S. (2015). Attitudes towards
euthanasia among Greek intensive care unit physicians and nurses. Heart & Lung:
The Journal of Acute and Critical Care, 44(3), 260-263.
Legislation. (2018). Crimes Act 1961. Retrieved from
http://www.legislation.govt.nz/act/public/1961/0043/137.0/DLM329347.html
Life. (2018). Mental Illness and Euthanasia. Retrieved from
http://www.life.org.nz/euthanasia/abouteuthanasia/abouteuthanasia2/
Malpas, P., Mitchell, K., & Koschwanez, H. (2015). End-of-life medical decision making in
general practice in New Zealand-13 years on. New Zealand Medical
Journal, 128(1418), 27-39.
McCormack, R., Clifford, M., & Conroy, M. (2012). Attitudes of UK doctors towards
euthanasia and physician-assisted suicide: a systematic literature review. Palliative
Medicine, 26(1), 23-33.
Nett, R. J., Witte, T. K., Holzbauer, S. M., Elchos, B. L., Campagnolo, E. R., Musgrave, K. J., ...
& Pride, K. R. (2015). Risk factors for suicide, attitudes toward mental illness, and
practice-related stressors among US veterinarians. Journal of the American
Veterinary Medical Association, 247(8), 945-955.
Steck, N., Egger, M., Maessen, M., Reisch, T., & Zwahlen, M. (2013). Euthanasia and assisted
suicide in selected European countries and US states: systematic literature
review. Medical care, 51(10), 938-944.
Ten Have, H., & Welie, J. V. (2014). Palliative sedation versus euthanasia: an ethical
assessment. Journal of pain and symptom management, 47(1), 123-136.
Page 11