Nursing Ethics: Quality of Life, PAS, and Environmental Ethics

This nursing ethics assignment addresses several critical topics. Part one focuses on establishing standards for assessing the quality of life for terminally ill patients, discussing the necessary representation in a task force and the key elements to consider. Part two delves into the ethical considerations surrounding physician-assisted suicide (PAS), exploring the principles of beneficence and non-maleficence, the potential advantages and drawbacks of assisted dying clinics, and the application of utilitarianism in end-of-life decisions. The assignment also examines the legal and ethical accountability of physicians and patients' rights regarding treatment refusal. Part three shifts the focus to environmental ethics, exploring Aldo Leopold's land ethic, the concept of the Tragedy of the Commons, and the individual's responsibility towards environmental conservation. The assignment integrates these diverse ethical frameworks to provide a comprehensive analysis of complex issues in nursing practice and environmental stewardship.

Running head: NURSING ETHICS
NURSING ETHICS
Name of the Student
Name of the University
Author Note

NURSING ETHICS
Part one
Quality of life is an important outcome measure while caring for patients, who are
terminally ill. The measures that can be taken ranges for a complete assessment, includes
psychological, physical, spiritual and functional needs of elderly patients. Patients who are
seriously ill should be screened for pain, nausea, shortness of breath and constipation at the
time of the admission. Patients under hospice care should be thoroughly discussed about the
spiritual needs of the patient. A palliative care task force normally would need physicians as
well as non physician members. They should include pharmacist, social care workers, non-
hospitalist physicians and the spiritual care providers. Patients would require bereavement
counseling, housekeeping assistance and respite care1.
The topic of end of life gives rise to many ethical questions, including the quality of
life, beneficence and the accountability of the physicians towards their patients. The ethical
principle that justifies euthanasia is beneficence, which is the complement of non-
maleficence. Beneficence allows the doctors to promote well fare to the patients2. While it
can be asserted by few that doctors are accountable to preserve life of an individual under any
circumstances, while it can be argued by some that the doctors should act as per the best
interest of the patient. In case of patients who are terminally ill, they often suffer from pain
that is unbearable and wants it to end, which can only be done by ending his life. In such a
case the most merciful approach will be to end his life in a merciful manner3. In such a
1 Wang, Yin-Chih, and Chia-Chin Lin. "Spiritual well-being may reduce the negative impacts of cancer symptoms on the
quality of life and the desire for hastened death in terminally ill cancer patients." Cancer nursing 39, no. 4 (2016): E43-E50.
2 Gaertner, Jan, Waldemar Siemens, Joerg J. Meerpohl, Gerd Antes, Cornelia Meffert, Carola Xander, Stephanie Stock, Dirk
Mueller, Guido Schwarzer, and Gerhild Becker. "Effect of specialist palliative care services on quality of life in adults with
advanced incurable illness in hospital, hospice, or community settings: systematic review and meta-analysis." bmj 357
(2017): j2925.
3 Davis, Mellar P., Jennifer S. Temel, Tracy Balboni, and Paul Glare. "A review of the trials which examine early integration
of outpatient and home palliative care for patients with serious illnesses." Ann Palliat Med 4, no. 3 (2015): 99-121.

NURSING ETHICS
circumstances death is imminent and a doctor is only left with two choices. Ending the life of
the patient by a physician either assisted suicide or let the disease to take its course.
Part two
2. The principle of beneficence and non maleficence provides important perspective from
which the roles of the physician can be viewed in Euthanasia. It can be shown by the
physicians, how in certain cases ending a life can be the best thing that a doctor can do 4.
Although people might find the role of the doctor incompatible with mercy killing, one
justified reason for this feeling is that people perceive doctors as having pledged, only to
preserve life when they took the “Hippocratic oath”, but the Hippocratic Oath did not contain
any specific statements obliging the doctors to preserve life at every cost. The oath however
helps to provide the expression of both beneficence and non-maleficence. Keeping a
terminally ill patient under assisted living would only increase the suffering of the patient,
which is against the principle of autonomy and beneficence.
3. While assisted dying has been made legal in several countries, but there is a clinic in
Switzerland who provide assisted dying only after a thorough checkups and is only provided
to terminally ill patients, in order to alleviate their sufferings. While there are certain
advantages of an assisted dying clinic, there are many pitfalls that cannot be overlooked. The
supporters of PAS consider this practice to be a logical extension of the obligation of a
4 BANOVIĆ, Božidar, Veljko Turanjanin, and Anđela MILORADOVIĆ. "An ethical review of euthanasia and physician-
assisted suicide." Iranian journal of public health 46, no. 2 (2017): 173.

NURSING ETHICS
physician for respecting the autonomy of the elderly person, to relieve the suffering and
assisting the patient to get a peaceful death. However, it can be argued that patient autonomy
is not a total right and it is a matter of concern that the societal acceptance of the PAS, might
initiate a slow down the slippery slope towards the acceptance of involuntary Euthanasia5.
Furthermore, a question arises, that is a medicalized death good for the patient and alleviates
their sufferings or addresses the needs of the dying individual?
Practising euthanasia in clinics can be dangerous as well, because, the prediction of
the terminal illness might be wrong. Again, the legalization of the euthanasia would only
work if the doctor agreed to provide this option to the patient. There are times when the
doctor might not be willing to provide the option to the patient. Euthanasia medicines might
not deliver the promised result. The State of Oregon investigated the result of the patients
who took the lethal prescriptions as a part of Death with dignity act, but it has been noticed
that some of the people go consciousness even after taking the medicines. Again, a
Euthanasia clinic without proper registrations might be indulged in fowl play and
malpractice. Euthanasia could also allow people who qualify for Euthanasia and should not
allow people to choose death for some other reason other than terminal illness6. Hence, I
believe that is not necessary build a separate “assisted dying clinic” and can be provided in
the hospitals under the supervision of the doctors.
4. Utilitarianism can be referred to as a normative ethical theory that places the locus of the
right and wrong on the various outcomes of choosing one of the actions over the other
policies. The theory helps one to understand the fundamental role of the pain and pleasure in
5 Sulmasy, Lois Snyder, and Paul S. Mueller. "Ethics and the legalization of physician-assisted suicide: an American College
of Physicians position paper." Annals of internal medicine 167, no. 8 (2017): 576-578.
6 Colleran, Elizabeth, and C. A. Chico. "Death and Dying: The Blessing and Curse of Euthanasia."

NURSING ETHICS
human life and approves or disapproves an action on the basis of the pain and pleasure
brought about. John Stuart Mill’s theory on utilitarianism can be best applied to the concept
of Euthanasia7. As per Mill’s theory of ethics, if the actions are correct and in proper
proportions, then they can surely cause happiness and pleasure. The theory states that that an
individual should act in agreement with the rule that balances good over evil. The Act-
utilitarianism is sometimes termed as the type of situational ethics. Hence, voluntary
Euthanasia can be pleasurable for people who are under extreme pain and distress and there
are no other options left. The person suffering from distress will be relieved having a
permanent control over their life. It cannot be denied, that patients being satisfied in their last
life brings a sense of closure in their life and helps them to get a dignified death8.
Furthermore, voluntary Euthanasia can be permissible morally. The hospital resources that
are used for providing an assisted can be given to patients, who really need them.
Furthermore, the families have to incur huge medical expenses for continuing with the life
support system.
5. How we live the last days of our life is quite significant for me as a human being as well as
my families. Unsuitable or untimely treatment at the end of life can be detrimental and
draining for an individual both emotionally and physically for the patient as well as the
families. Some of the end of life care is beyond the practice of the scope of medicine and
needs to be addressed inn in some other ways. The medical ethics establishes the physicians,
the patients and the societies largely than the law6. Physicians are accountable towards the
7 Keown, John. Euthanasia, ethics and public policy: an argument against legalisation. Cambridge University Press, 2018.
8 Jordan, Madeline. "The Ethical Considerations of Physician-assisted Suicide." Dialogue & Nexus 4, no. 1 (2017): 12.

NURSING ETHICS
patients on the ethical doctrines of beneficence. Both law and medical ethics strongly support
the rights of the patient to refuse any treatment, including any life sustaining treatment. Death
occurs after the refusal of the treatment. It can be argued for the legalization of Euthanasia,
as it looks forward to the principle of autonomy and respect for the patient. It has been
viewed by the proponents, that PAS is actually a compassionate act that respects the choices
made by the patients and fulfils the obligation of non-abandonment. However, the opponents
of the concept of Euthanasia might argue that physician’s duty mainly emphasizes on care
and comfort and hence they should not take part in ending a patient’s life with intensions9.
According to the proponents of PAS, such practice has been found to reduce the
suicide rates. Southern Medical Association has conducted a study, where it was found that
the legalization of Physician assisted suicides have decreased the rate of suicides among the
elderly people suffering from terminal diseases10. On the other hand, it has been stated by the
opponents, that balancing the respect for the autonomy of the patient against the other ethical
principles is necessary. One might argue that if the physicians are made the arbitrars of
assisted suicide, and then it is one kind of paternalism and definitely not a power that
physicians should want11. The legalization of PAS, might empower the physicians but not the
patients. In spite of this, the benefits of Euthanasia outnumber the pitfalls associated to PAS.
9 Yang, Y. Tony, and Farr A. Curlin. "Why physicians should oppose assisted suicide." Jama 315, no. 3
(2016): 247-248.
10 Jones, David Albert, and David Paton. "How does legalization of physician assisted suicide affect rates of
suicide?." Southern medical journal 180, no. 10 (2015): 599-604.
11 Emanuel, Ezekiel J., Bregje D. Onwuteaka-Philipsen, John W. Urwin, and Joachim Cohen. "Attitudes and
practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe." Jama 316, no.
1 (2016): 79-90.

NURSING ETHICS
Part 3
Land ethics or environmental ethics was given a term by Leopold “in his land of the
pyramids, which is a text about environmental ethics. According to, Leopold, there is a strong
need of “new ethics” with the relation human to land and to the plants and the animals
growing above it. Environmental ethics can be termed as an escape from the human centered
thinking. It can be used as a tool for accommodating concerns about the non-humans.
Nowadays, it is being used as a legitimate tool for enquiring the environmental problems.
Leopold’s reading has raised awareness on the environment ethics for understanding the
moral foundation of a human towards the environment that they are living12. The
environmental ethics has tried to unify humans and ethics. The main purpose for this is to
reform the perception of science towards nature as value free. Aldo Leopold has pointed out
that the environmental problems are also philosophical13. This environmental ethics can be
applied to understand the environmental degradation. The alarming situation of the
environment is not concerned with the man alone, but with the entire species. Some of the
existential issues related to environmental ethics are pollution, extinction of the species,
pollution, deforestation and the loss of harmony between the natures. I believe that another
area that made a deep impact is on economics. All the developing models for the economy is
based as the concept that environment is a part of the economy. The economic progress can
only be brought about by restructuring the economy with the ecosystem of the earth.
12 Whyte, Kyle. "How Similar Are Indigenous North American and Leopoldian Environmental Ethics?." Available at SSRN
2022038 (2015).
13 Henning, Brian G. "Unearthing the Process Roots of Environment Ethics: Whitehead, Leopold, and the Land
Ethic." Balkan Journal of Philosophy 8, no. 1 (2016): 3-12.

NURSING ETHICS
Another important concept for understanding environmental ethics is the “Tragedy of
the Commons” by Garett Hardin. It is situation within a collective resource system where
individual consumers acting autonomously for their own interest, act in a manner that is not
in compliance with the common good of all the users by depleting or spoiling the shared
resource via collective action 14. This common concept can be applied in out every day’s life.
For example, when asked man about the pollution that is due to the excessive generation of
waste, they give excuses of their own share of waste production to be very less in comparison
to the actual ill effects on the environment15. They are unable to understand that summative
effect of every individual’s exploitation of the earthly resources earth is actually contributing
to the ill effects of pollution.
Individuals might find that the share of the cost of his wastes, he discharges in to the
environment is less than the cost of purifying the wastes before releasing them in to the
environment. This is just an example, and I strongly believe that each one of us is trapped in
to the system of spoiling our own nest. Thus, it can be said that these two readings are
appropriate for understanding the environmental ethics.
14 Hardin, Garrett. "The tragedy of the commons." Food Ethics (2016): 54.
15 Schmidtz, David. "Tragedy of the Commons." International Encyclopedia of Ethics (2013).

NURSING ETHICS
References
BANOVIĆ, Božidar, Veljko Turanjanin, and Anđela MILORADOVIĆ. "An ethical review
of euthanasia and physician-assisted suicide." Iranian journal of public health 46, no. 2
(2017): 173.
Colleran, Elizabeth, and C. A. Chico. "Death and Dying: The Blessing and Curse of
Euthanasia."
Davis, Mellar P., Jennifer S. Temel, Tracy Balboni, and Paul Glare. "A review of the trials
which examine early integration of outpatient and home palliative care for patients with
serious illnesses." Ann Palliat Med 4, no. 3 (2015): 99-121.
Emanuel, Ezekiel J., Bregje D. Onwuteaka-Philipsen, John W. Urwin, and Joachim Cohen.
"Attitudes and practices of euthanasia and physician-assisted suicide in the United States,
Canada, and Europe." Jama 316, no. 1 (2016): 79-90.
Gaertner, Jan, Waldemar Siemens, Joerg J. Meerpohl, Gerd Antes, Cornelia Meffert, Carola
Xander, Stephanie Stock, Dirk Mueller, Guido Schwarzer, and Gerhild Becker. "Effect of
specialist palliative care services on quality of life in adults with advanced incurable illness in
hospital, hospice, or community settings: systematic review and meta-analysis." bmj 357
(2017): j2925.
Hardin, Garrett. "The tragedy of the commons." Food Ethics (2016): 54.
Henning, Brian G. "Unearthing the Process Roots of Environment Ethics: Whitehead,
Leopold, and the Land Ethic." Balkan Journal of Philosophy 8, no. 1 (2016): 3-12.

NURSING ETHICS
Jones, David Albert, and David Paton. "How does legalization of physician assisted suicide
affect rates of suicide?." Southern medical journal 180, no. 10 (2015): 599-604.
Jordan, Madeline. "The Ethical Considerations of Physician-assisted Suicide." Dialogue &
Nexus 4, no. 1 (2017): 12.
Keown, John. Euthanasia, ethics and public policy: an argument against legalisation.
Cambridge University Press, 2018.
Schmidtz, David. "Tragedy of the Commons." International Encyclopedia of Ethics (2013).
Sulmasy, Lois Snyder, and Paul S. Mueller. "Ethics and the legalization of physician-assisted
suicide: an American College of Physicians position paper." Annals of internal medicine 167,
no. 8 (2017): 576-578.
Wang, Yin-Chih, and Chia-Chin Lin. "Spiritual well-being may reduce the negative impacts
of cancer symptoms on the quality of life and the desire for hastened death in terminally ill
cancer patients." Cancer nursing 39, no. 4 (2016): E43-E50.
Whyte, Kyle. "How Similar Are Indigenous North American and Leopoldian Environmental
Ethics?." Available at SSRN 2022038 (2015).
Yang, Y. Tony, and Farr A. Curlin. "Why physicians should oppose assisted
suicide." Jama 315, no. 3 (2016): 247-248.