Lecture Seventeen: Ethics and the end of life

Question 1

What is NURSING ETHICS?

Answer 1

“the examination of ethical and bioethical issues from the perspective of nursing theory and practice that, in turn, rest on the agreed core concepts of nursing, namely: person, culture, care, health, healing, environment and nursing itself…”

Question 2

Why do nurses need a moral compass?

Answer 2

e.g. we have technology, but what action is right in THIS situation? We have ventilators etc- but does it mean it is right?

Question 3

What are Personal values?

Answer 3

My beliefs and ideals e.g., ‘all life is sacred’ versus ‘suffering is intolerable’

Question 4

What are Professional values?

Answer 4

Guide our interactions
e.g., nurse as patient advocate

Question 5

What is moral agency?

Answer 5

ethics in action
i.e. how choices are made

Question 6

What is Values clarification?

Answer 6

Understanding another’s values and wishes

Question 7

Why is a code of ethics important?

Answer 7

provides a reference -
Set of values, principles or expectations that guide nurses in reflection and decision-making

Question 8

What is a Principle based approach?

Answer 8

Applying ethical principles to practice:

Autonomy
Non-maleficence
Beneficence
Justice
Fidelity
Veracity

Question 9

What is an example of autonomy?

Answer 9

Self determination: Risks and benefits of a procedure explained and understood when obtaining informed consent.

The right or condition of self-government.

Question 10

What is an example of Non-maleficence?

Answer 10

Doing no harm when performing an intervention

Question 11

What is an example of Beneficence?

Answer 11

Promoting the benefit of the patient.
Strong connotation of doing good to others including moral obligation

Question 12

What is an example of Justice

Answer 12

Act fairly

Sharing time evenly across patients (equal access)

Question 13

What is an example of Fidelity

Answer 13

Being faithful to a patient’s request, such as NOT to share their diagnosis with family

Principle that pertains to trustworthiness

Question 14

What is an example of Veracity?

Answer 14

Telling only what you know to be the facts

Conformity with truth or fact

Question 15

How do we respond to ethical dilemmas?

Answer 15

Assess the situation (gather data)

Identify the actual ethical issue

Identify options

Think it through to reach a decision

Implement the plan

Evaluate it

Question 16

What is euthanasia ?

Answer 16

Deliberately bringing about the
death of a person to end what is
considered an intolerable existence

Question 17

What are the six kinds of euthanasia?

Answer 17

Voluntary passive
Voluntary active
Involuntary passive
Involuntary Active
Non Voluntary passive
Non Voluntary Active

Question 18

What is passive euthanasia?

Answer 18

Just kind of occurs. Maybe by not giving food and fluid

Question 19

What is active euthanasia?

Answer 19

Intervening and doing something to specifically end their life

Question 20

What is Voluntary euthanasia?

Answer 20

Competent person asks to die

Question 21

What is Involuntary euthanasia?

Answer 21

Person doesn’t have the opportunity to consent to die. Some of the killing that happened in WW2

Question 22

What is Non voluntary euthanasia?

Answer 22

Person does not consent or deny to consent. There isn’t the opportunity. If someone was a baby, or not legally competent.

Question 23

What are the 5 conditions to euthanasia?

Answer 23

1) Intentionality
2) Evidence of suffering
3) Motivated by beneficence
4) Painlessness
5) Non-fetal humanity

Question 24

What are points for and against euthanasia?

Answer 24

Against- It was morally wrong. Slippery slope argument. How to tell if someone was competence. Emotionally charged. There was a time frame (6 months terminal). Risk of abuse. Clinical uncertainty

For- Autonomy. What would stop someone from ending their own life by themselves? Reduce suffering

Question 25

What are some NZ law landmarks for euthanasia?

Answer 25

1995 ‘Death with dignity’ bill fails 61:29 votes (Michael Laws)

2012 ‘End of life choice’ bill presented (David Seymour)- 69/5. Passed. Proposed act

2020- ‘NZ Euthanasia Referendum’ at General Election to legislate the ‘End of life choice Act 2019’

Question 26

What was the END OF LIFE CHOICE Act 2019

Answer 26

Has passed into law.

To give individuals with a terminal illness (who meet certain criteria) a lawful option of requesting medication to end their life

Aims to ‘promote compassion and the preservation of dignity’

Nursing lacks a universal position on euthanasia – it is a matter of conscience – we may opt out

Question 27

How can we be sure that it is the person’s own decision, fully informed and free from coercion?

Answer 27

Ideal safeguards
- USA State senator Claire Ayer

Must ensure –
* Person has capacity
* Diagnosis is correct
* Cooling off period
* Clinical depression ruled out
* No discrimination against minority
groups
* Palliative care / hospice options
explained

Question 28

What happens if a health practitioner opts out of assisting euthanasia?

Answer 28

A health practitioner is NOT under obligation to assist a person who wishes to receive assisted dying (conscientious objection)

SCENZ - The ’Support and Consultation for End of Life in New Zealand’ holds the list of Doctors, Nurse Practitioners and Psychiatrists who are willing to be involved

A conscientious objector MUST inform the patient that they have a conscientious objection and tell them of their right to ask the SCENZ group for the contact details of a replacement medical practitioner

Question 29

What is the eligibility criteria for assisted dying?

Answer 29

Person must meet all of the criteria-
- Ages 18 or over
- A citizen or permanent NZ resident
- Suffering of a terminal illness that is likely to end their life within the next 6 months
- in an advanced state of irreversible in physical capability
- Experiencing unbearable suffering that cannot be relived in a manner that the person considered tolerable
- competent to make an informed decision about dying

Question 30

What are some key points to the assisted dying act?

Answer 30

A health practitioner cannot raise discussion around ‘assisted dying’

• Must determine competence to make an informed decision (understand, use and weigh information) and can communicate that decision in some way
• A person can change their mind at any time
• Must encourage discussion with family, friends and counsellors
• Must ensure decision is free from pressure by talking with:
  other health practitioners who are in regular contact
  members of the person’s family approved by the person

Question 31

What are some decisions a patient can make if they are going to be euthanised?

Answer 31

Date and time of medication administration

• May delay this date for up to 6 months
• Where they want to die e.g. hospital or home
• Whānau or others present ?
• Method of medication administration (ingestion or IV)
• Self-administration or administration by a Doctor / NP