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Euthanasia is derived from the Greek word euthanatos meaning easy death; the process of deliberately putting an end to life to relieve pain and suffering (Math & Chaturvedi, 2012). Euthanasia is practiced not only by those experiencing extreme pain but also for other causes such as improvements in the quality of life arising from traumatic physical injuries and psychological factors associated with incurable diseases.
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Voluntary euthanasia generally means that the doctor will act directly, for example, by offering a lethal injection, to put an end to the suffering of the patient (Math & Chaturvedi, 2012). Then there is the doctor-assisted dying, which refers to the physician providing the means of death, most often with a prescription (Math & Chaturvedi, 2012). At the end of the day, the patient, not the physician, will administer the lethal medication (Math & Chaturvedi, 2012).
There has been a great deal of public debate on euthanasia/assisted dying; the early end of life adds to the controversy over certain complicated and sensitive issues such as the legal, moral, human rights, medical, political, economical, religious, social, and cultural aspects of society today.
The paper will discuss religion as it is not stated in the Bible that euthanasia is forbidden, and will it become a moral decision? Culturally, many groups see life without meaning as one that is not worth living. When exploring the history of attitudes, it is discovered that part of the nature of nursing attitudes towards euthanasia is due to the needs of nurses at the level of clinical practice, interaction, desires, decision-making and ethics. Finally, a great deal has been written about the importance of human rights, the injustice of suffering, the ability of individuals to choose to die with dignity while suffering and the need to uphold the fundamental right of every person to live.
Religious relations and religious practice impact public attitudes and behavior towards voluntary assisted dying and voluntary euthanasia. As discussed by De Villiers (2016) the bible does not involve complete prevention against medically assisted dying and voluntary euthanasia. It would seem that it comes down to the beliefs in and about God and people’s attitude towards euthanasia (Sharp, 2018). Sharps (2018) research and analysis do not show strong claims to the beliefs between God and attitudes toward voluntary euthanasia. In the same way, Gielen, Van Den Branden and Broeckaert (2009) have stated in his research that religious views and euthanasia can be a positive relationship.
Nurses have an important role in caring for terminally ill patients and are regularly confronted with euthanasia and assisted dying. Pesut, Thorne, Greig, Fulton, Janke, and Vis-Dunbar, (2019) studies exhibit that nurses perform a centred role in identifying and negotiating the preliminary affected person queries regarding assisted dying. Nurses’ attitudes towards euthanasia allow them to focus on their values and beliefs. Pesut, et al. (2019) attracts attention to the nursing care of patients having openness, attentiveness, patience, trustworthiness and communication with both the family and health care team.
Pesut, et al. (2019) data signifies debate concerning autonomy in assisted dying, as patients are not making a truly autonomous decision as the system has not provided them with high-quality palliative care. Especially significant is the study of Berghs, Dierckx de Casterle and Gastmans (2005) which indicates the more need for education and knowledge of palliative care which may decrease and make euthanasia unnecessary. With this said, it is interesting that Bergh, et al. (2005) declares nurses who had everyday care with terminally ill patients were the most against euthanasia. Regardless of the nurse’s beliefs and thought processes Bergh, et al. (2005) found that nurses are willing to set aside their beliefs in the best interest of the patients.
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Gilbert and Boag, (2019) also show that at times palliative care is often reported to fail in relief of pain and suffering of terminally ill individuals. Nevertheless, it is almost universally accepted that doctors and nurses often end people’s lives, usually in the comfort of a patient’s home. Pain-relieving medications are given in doses that are more than likely to cause death (Berghs et al., 2005). It can be concluded by Berghs, et al. (2005) that pain relief can lead to the death of a person, which ensures that palliative sedation and pain relief will cover many of the cases of people seeking euthanasia. In comparison to Rufup, Rhodius, Borgsteede, Boddaert, Keijser, Pasman and Onwuteaka-Philipsen (2010) study of Dutch doctors in the Neverlands, there seems to be a lack of understanding in several areas, which can also be a barrier for proper pain management at the end of life. Improvement is needed in the type of pain management, palliative sedation, consequences of opioids and opioid rotation.
Patients right to die
Respect for independence is one of the key standards of euthanasia and assisted dying. Autonomy describes the right of capable adults to make informed preferences about their own medical care (Fontalis, Prousali, & Kulkarmi, 2018). Fontalis et al. (2018) also state that doctors respect for autonomy requires the acknowledgment and safety of the patient’s right to self-determination and the provision of the required guidelines that would require knowledgeable and independent choice, free from pressure.
It should be acknowledged that new assisted dying legislation in Victoria was passed in 2017, with Victoria being the first Australian state (Gilbert & Boag, 2019). Exposure to assisted dying programs gives people a stable legal framework, a sense of security and a sense of control over the conditions under which they choose the manner and timing of their death (Gilbert & Boag, 2019). Subsequently, White and Wilmott, (2018) suggest that people of Australia would like people living with a terminal illness to have the right and the ability to choose when and how they die, with dignity and less pain.
Whereas Garmondi, Pott and Payne (2013) suggest patients did not consider pain or symptom pressure to be the main reason to seek assisted suicide, emotional depression and fear of loss of control were the main factors. Patients discuss misunderstandings about the nature and purpose of palliative care, and the study showed that patients did not see the availability of palliative care services as having an impact on their decision-making (Garmondi et al., 2013).
While Roest, Trappenburg and Leget (2019) express patients request for euthanasia or assisted dying is determined by fear of suffering, dependency, uncertainties or strain on caregivers they had witnessed previously surrounding the deathbed of partners, parents or siblings. Roest et al. (2019) say many patients and their family, children or siblings explain how the desire for the assisted dying was part of a personal outlook which formed together well before becoming ill. The application for assisted dying can emerge from family-related factors, which tend to serve daunting roles and responsibilities in assisted dying decision-making with varying experience (Roest et al., 2019).
Euthanasia has been a long, controversial and sensitive issue in many countries. The legislation must protect the right to life of all, the right to life is a fundamental human right. This literature review intended to analyse the religious views, nurse’s attitudes and the patient’s right to die, although only a few topics, all very important topics when talking about euthanasia and assisted dying. It can be perceived that the views of nurses in clinical practice on topics such as palliative care, religious beliefs, cultural diversity and ethics will form the basis of much-needed further research. Support for euthanasia or assisted dying may also be motivated by principles such as empathy that are also part of religious ethics.
Furthermore, palliative care is said to be able to effectively relieve the suffering of 95% of all terminally ill patients (De Villiers, 2016). In fact, from a moral point of view, finding and receiving successful and sufficient relief from pain is desirable to attempting medically assisted suicide or euthanasia. This should, therefore, be the first and preferred choice for terminally ill patients.
The research also shows that concerns regarding family members and the social context tend to have a great deal of weight for both patients and clinicians when evaluating an application for assisted dying. The analysis also reveals that the active participation of family members in assisted dying can contribute to indecisive feelings and experiences.
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