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Analysis of an Ethical Dilemma Part 2

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Analysis of an Ethical Dilemma Part 2
Gary Bigge, Diana Hanakahi, Jennifer Lockwood, Sheryl Murray, Alex Warkenthien
Grand Canyon University
Ethics
NRS 437V
Linnette Nolte
March 3, 2013

Analysis of an Ethical Dilemma Part 2 As a continuation of a previous study, the Grand Canyon University Team White Ethics Committee further examines the dilemma of euthanasia. Four individual personal interviews were conducted and the results are included below. The Team White Ethics Committee has been tasked with the challenge of comparing similarities and differences between the cases we have studied and making a recommendation on each case based on our interviews and personal beliefs. The first case was Dax (Busada, 2011) and the second case was Terry Schiavo (Springs, 2009).
Interview #1
To receive a spiritual leader’s perspective about euthanasia, Pastor Sandy Ash of Harbor Chapel Community Church in Moss Landing, California was interviewed. The interview started by giving Pastor Ash a brief background regarding both the Dax and Terry Schiavo stories. When asked about her view on euthanasia, Pastor Ash stated, “If it’s a person who doesn’t want to live then there’s still hope and they shouldn’t give up since there is no machine keeping them alive. There’s a lot to live for” (Ash, 2013). Pastor Ash also added, “It depends on what stage. If there’s a machine then the person should let them go if they want to go, if that’s their wish” (Ash, 2013). With Terry’s case, she was young and did not have anything on paper stating her wishes should she become incompetent of making medical decisions. When asked about her thoughts on Terry’s case, Pastor Ash reported, “All I knew about was that I thought she was on a ventilator and I think he [Terry’s husband] should be charged with manslaughter or neglect for allowing her to die” (Ash, 2013). Pastor Ash added, “In our current society, you want to give every opportunity you can to recover and do the best you can to make them comfortable, and if you ask me I would encourage them to try” (Ash, 2013). Pastor Ash believes the medical community would and possibly could extend their boundaries with regards to euthanasia. In the interview, Pastor Ash points out, “it would be a grey line instead of black or white and we need to keep our place where no one steps over that line. I don’t think euthanasia should be used as a convenience to their family” (Ash, 2013). Pastor Ash concluded the interview stating, “We need to keep our boundaries so there are no grey areas, where we shouldn’t decide life should end or continue because that’s God’s job. He’s planned that for us before we were born and for man to decide, would be wrong” (Ash, 2013).
Interview #2 On February 27, 2013, friend and neighbor, Mr. Terry Lee, age 63 was interviewed in person at his residence in Spring Valley, California (Terrance, 2013). The topic of the interview was euthanasia. Mr. Lee was briefly given an overview of the two scenarios that were examined by our school group, Team White. Naturally, Mr. Lee had questions as he was being filled in on the stories. He wanted to know for example, if Mrs. Terri Schiavo had previously expressed verbally her ideas of what quality of life she would want if there were to be a situation where these ideas would need to be considered. He said that often husband and wife pairs speak of such things, but seldom put them into writing. Mr. Lee had a vague recollection of the Schiavo case, but was not familiar with many of the details. After speaking with Mr. Lee for about 45 minutes, he came to a conclusion regarding the dilemma of whether or not to discontinue artificial hydration and nutrition for Mrs. Terry Schiavo. He recognized that with the lack of a written and legalized living will, that it became a legal matter since the family and Mr. Schiavo were on opposing sides of the dilemma. Mr. Lee felt that the right thing (right, in this case being “legal”) was to allow the courts to decide and find in favor of the husband. Mr. Lee felt that the sense of doing right was to follow the law and therefore Mr. Lee was expressing his belief in deontology. The husband had a stronger legal stance. However, Mr. Lee also appreciated the dilemma because he thought that if the Schiavo family were willing to take their daughter home and care for her, that morally, they should have been allowed that option. In regards to the Dax case, Mr. Lee was amazed that Dax had his wishes ignored for the entire time of his ordeal. Mr. Lee asked if Dax was mentally capable of making such a decision and was informed that multiple psychiatric evaluations revealed Dax was perfectly capable of making an informed and rational decision. Mr. Lee felt very strongly that Dax had every right to ask for and receive his denial of treatments. Mr. Lee speculated that perhaps Dax’s mother was being selfish by not allowing her son to die. Mr. Lee wondered if the mother was worried about regretting her possible decision to let Dax die. Additionally, Mr. Lee thinks that since Dax’s dad and the husband of his mother had died, that the mother could not bear the loss of another family member and therefore choose to keep Dax alive. Mr. Lee feels that Dax should have been allowed to have total autonomy in the matter of his healthcare and treatment. It seems that Mr. Lee supports utilitarianism theory in this case because he thinks the most important thing is that Dax gets to realize his autonomy, regardless of the fact that it may have been difficult for Dax’s mother to accept (Purtilo & Doherty, 2011).
Interview #3 To obtain the perspective of a healthcare colleague the writer interviewed Audrey Hoffman who is a registered nurse at Sanford University of San Diego Medical center. The writer reviewed both cases that were presented to the students for this project. The writer began the interview by asking Ms. Hoffman what her personal view was on euthanasia. Ms. Hoffman went into her views by saying that she viewed euthanasia as murder (Hoffman, 2013). She also stated that euthanasia should only be allowed if the patient was suffering and their condition was terminal (Hoffman, 2013). At the same time though, she believes that God will take us all when it is our time and no matter what the reason it is still considered suicide in her opinion (Hoffman, 2013). She goes on to say that she would not want any part in euthanasia with any of her patients (Hoffman, 2013). With Terry’s case she viewed Terry as being young and still having some quality of life and what happened to her should not have been allowed. She found that both cases would be very difficult situations to be in as both a nurse and as a person.
Interview #4
When in administration, there are many other views that have to be considered when looking at issues outside of patient care; the main things that are usually addressed are ethics, communication and the comfort of patients by the nurses. But with administration, their priority is financials, economics and utilization of resources. During an interview with the Director of Nurses, M. Duron, this senior nurse of many years has advanced from manger to administration, these differences were brought to a different view. She had three different opinions that were broken into perspective, economics and morality. Ms. Duron stated, “From an administrative point of view, I understand the obstacles the chronically ill patient puts on the healthcare system. (Duron, 2013). She continued to address that a large amount of resources and money is spent during the last part of life on people. But if euthanasia was an option there could be a better outcome and impact if these resources were made available for the patient. Her attention changed when asked about her moral view on euthanasia and discussed her nursing ethics of “to do no harm.” Duron’s moral opinion is that she does not believe that euthanasia will ever be available for chronically ill patients because “no one has the right to choose when one lives or dies.” (Duron, 2013). The authors in this paper feel that in the case of Dax, he should have had his wishes honored and been allowed to die in the manner of his choice. Death is a part of the whole process of life and a person has the right to self-determination, including the decision of ending one’s own life. An important component is that Dax was deemed competent to make decisions by more than one psychiatrist. In the Terry Shiavo case, the whole issue would have been less complex if she had a living will or other written documents in place prior to her change in condition. However, the reality is that the family, the husband, and ultimately the courts became involved in deciding what would be best for Terry Shiavo. The authors of this paper felt Terry Shiavo should have been allowed to go home and be cared for by her loving family. It seems they had the resources, the commitment, and the belief that they were doing the right thing (duty) in allowing her to live and see what the future may hold. Those who are against euthanasia say that it is morally and ethically wrong. Those who are against euthanasia say that it is unnecessary when there have been many advances on palliative care that focuses on pain, stress, and symptom relief (Bonin, 2012). They also say that if euthanasia was legalized, it may be hard to control it from getting out of hand. In the Netherlands, where euthanasia is legal, there have been cases in which euthanasia was used against the patient’s wishes or when the patient is unable to voice their choice (Bonin, 2012). The use of extensive laws and regulations would not help from this type of practice from being abused. Being alive is not equivalent to living: on this premise, both sides of the debate about euthanasia can agree; however, the right to decide when death trumps life is not man's decision to make (Bonin, 2012). Condensed to a conclusion, the Team White Ethics Committee members recognize that all individuals considered and interviewed in this paper operate from their own sense of what is right. It is this individual sense of what is right that guides us all to think and thus act as we do. It can be stated that all individuals that are considered in this body of work are, in some sense, using the theory of deontology. Everybody is acting or wanting to act according to their perception of “what is right, or what is their duty”. To examine the dilemma in closer detail is to see that the differences between the individuals are based on their fundamental morals as a part of our society. For example, what role religion plays in an individual’s life can have a dramatic influence on the outcome of a euthanasia case study. God is referenced as being the “deciding entity” over any human individual in some of our studies with this case. Should those individuals be allowed to make the decision of euthanasia for another person, it is fair to say the person would be kept alive as long as humanly possible. Conversely, there are people who feel that the choice of ending one’s life is solely the choice of that individual. Since we all seem to share a common bond of wanting to be able to do what we think is right, even though our opinions of what is right may vary, we feel individuals should be allowed to do what they think is right in the consideration of euthanasia for themselves. As for the dilemma of trying to decide for someone who cannot express their wishes, it is probably best that we error on the side of caution and make reasonable efforts to sustain life for the individual. The act of ending a human life should not be a hasty or reactionary action (American Nurses Association, 2010).

References
A. Hoffman, personal communication, February 26, 2013
American Nurses Association. (2010). Code of Ethics for Nurses, with interpretive statements.
Retrieved from http://nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf.
Bonin, A. (2012). Human Euthanasia, The Debate: The arguments for both sides.
Retrieved from http://www. examiner.com/article/human-euthanasia-the-debate-the-arguments-for-both-sides
Busada, Squisher. (2011, August 5). Dax Case 1. Retrieved from http://www.youtube.com/watch? V=IsxaaMbZMtA
Busada, Squisher. (2011, August 5). Dax Case 2. Retrieved from http://www.youtube.com/watch? V=VwCCfuOd5Q
Busada, Squisher. (2011, August 5). Dax Case 3. Retrieved from http://www.youtube.com/watch? V=GgF5GyKK7xU.
Busada, Squisher. (2011, August 5). Dax Case 4.
Retrieved from http://www.youtube.com/watch?V=gTzPekXM.
L. Terrance, personal communication, February 27, 2013
M, Duron, personal communication, February 28, 2013
Purtilo, R. B., & Doherty, R. F. (2011). Ethical Dimensions in the Health Professions (5th ed.). Retrieved from http://pageburstls.elsevier.com/books/978-1-4377-0896-7/Root/0
S. Ash, personal communication, February 27, 2013
Springs, Franklin. (January, 2009). The Terri Schiavo Story. Retrieved from http://www.youtube.com/watch?v=cki55BM42kw…...

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