CHAPTER I
INTRODUCTION
1.1. BackgroundOne of the most controversial debates is whether or not Euthanasia should be legalized and whether or not it is humane. A lot of people think that euthanasia or assisted suicide is needed so patients won’t be forced to remain alive by being "hooked up" to machines. But the law in some country already permits patients or their family to withhold or withdraw unwanted medical treatment even if that increases the likelihood that the patient will die. Therefore, no one needs to be hooked up to machines against their will. Neither the law nor medical ethics requires that "everything be done" to keep a person alive. To insist, against the patient’s wishes, that death be postponed by every means available is contrary to law and practice. It is also cruel and inhumane. There comes a time when continued attempts to cure are not compassionate, wise, or medically right. Euthanasia and assisted suicide are not private acts. Rather, they involve one person facilitating the death of another. This is a matter of very public concern since it can lead to tremendous abuse, exploitation and erosion of care for the most vulnerable people among us (Marker and Hamlon, 2010).
1.2. General Purposesa. To explain about euthanasia and the types of euthanasia;
b. To explain the arguments against euthanasia;
c. To explain the law of euthanasia in some country;
d. To explain about religious views on euthanasia;
e. To give example of the case of euthanasia;
f. To explain the roles of nurses
CHAPTER II
CONTENTS
2.1. Definition of EuthanasiaEuthanasia is Greek for good death which translates into English as easy death or mercy killing. It was accepted by the ancient Greeks and Romans (Kasule, 2008).
There are two types of patients are involved in euthanasia. The first type is a patient in a persistent vegetative state who is awake but is no aware of self or the environment, such a patient has no higher brain function s and is kept alive on artificial live support (respirators, heart-lung machine, and intra-venous nutrition). And second types are patient in terminal illness with a lot of pain, psychological suffering and loss of dignity. The patient may or may not be on life-support (Kasule, 2008).
2.2. Types of Euthanasia2.2.1. Active EuthanasiaActive Euthanasia is an act of commission, is taking some action that leads to death like a fatal injection. For example, administering a fatal dose of morphine to a terminally ill cancer patient (Kasule, 2008).
2.2.2. Passive EuthanasiaPassive Euthanasia is an act of omission, is letting a person die by taking no action to maintain life. Passive Euthanasia can be withholding or withdrawing water, food, drugs, medical or surgical procedures, resuscitation, and life support such as the respirator. The patient is then left to die from the underlying disease. Sometimes a distinction is made between normal nutrition and hydration on one hand and medical nutritional support involving intravenous and naso-gastric feeding on the other hand Passive Euthanasia is an act of omission, is letting a person die by taking no action to maintain life (Kasule, 2008).
2.2.3. Voluntary EuthanasiaVoluntary euthanasia can then by defined as a means chosen by an individual making a request on the basis of a voluntary decision not to have his life prolonged under specific circumstances of ill- health. The operative principles are voluntarism and self- determinism (Colabawalla, 2008).
2.2.4. Non-Voluntary EuthanasiaThis is where the person is unable to ask for euthanasia (perhaps they are unconscious or otherwise unable to communicate), or to make a meaningful choice between living and dying and an appropriate person takes the decision on their behalf, perhaps in accordance with their living will, or previously expressed wishes (Kasule, 2008).
Situations in which the person cannot make a decision or cannot make their wishes known, includes cases where:
a. The person is in a coma.
b. The person is too young (e.g. a very young baby).
c. The person is senile.
d. The person is mentally retarded to a very severe extent.
e. The person is severely brain damaged.
f. The person is mentally disturbed in such a way that they should be protected from themselves.
2.2.5. Involuntary EuthanasiaInvoluntary euthanasia, which is indistinguishable from murder or manslaughter, occurs when the act is done against the wishes of a competent individual or a valid advance directive (Kasule, 2008).
2.3. Arguments Against Euthanasia
2.3.1. Euthanasia would not only be for people who are "terminally ill."There are two problems here, the definition of "terminal" and the changes that have already taken place to extend euthanasia to those who aren't "terminally ill." There are many definitions for the word "terminal." For example, when he spoke to the National Press Club in 1992, Jack Kevorkian said that a terminal illness was "any disease that curtails life even for a day." The co-founder of the Hemlock Society often refers to "terminal old age." Some laws define "terminal" condition as one from which death will occur in a "relatively short time." Others state that "terminal" means that death is expected within six months or less (Vernaw, 2008).
Even where a specific life expectancy (like six months) is referred to, medical experts acknowledge that it is virtually impossible to predict the life expectancy of a particular patient. Some people diagnosed as terminally ill don't die for years, if at all, from the diagnosed condition. Increasingly, however, euthanasia activists have dropped references to terminal illness, replacing them with such phrases as "hopelessly ill," "desperately ill," "incurably ill," "hopeless condition," and "meaningless life" (Vernaw, 2008).
2.3.2. Euthanasia can become a means of health care cost containment"...drugs used in assisted suicide cost only about $40, but that it could take $40,000 to treat a patient properly so that they don't want the "choice" of assisted suicide..." ... (Wesley J. Smith, senior fellow at the Discovery Institute, 1997).
Legalized euthanasia raises the potential for a profoundly dangerous situation in which doctors could find themselves far better off financially if a seriously ill or disabled person "chooses" to die rather than receive long-term care (Vernaw, 2008).
2.3.3. Euthanasia will only be voluntaryEmotional and psychological pressures could become overpowering for depressed or dependent people. If the choice of euthanasia is considered as good as a decision to receive care, many people will feel guilty for not choosing death. Financial considerations, added to the concern about "being a burden," could serve as powerful forces that would lead a person to "choose" euthanasia or assisted suicide (Vernaw, 2008).
People for euthanasia say that voluntary euthanasia will not lead to involuntary euthanasia. They look at things as simply black and white. In real life there would be millions of situations each year where cases would not fall clearly into either category.
Legalized euthanasia would most likely progress to the stage where people, at a certain point, would be expected to volunteer to be killed (Vernaw, 2008).
2.3.4. Euthanasia is a rejection of the importance and value of human lifePeople who support euthanasia often say that it is already considered permissible to take human life under some circumstances such as self defense, but they miss the point that when one kills for self defense they are saving innocent life either their own or someone else's. With euthanasia no one's life is being saved life is only taken (Vernaw, 2008).
History has taught us the dangers of euthanasia and that is why there are only two countries in the world today where it is legal. That is why almost all societies’ even non-religious ones for thousands of years have made euthanasia a crime. It is remarkable that euthanasia advocates today think they know better than the billions of people throughout history who have outlawed euthanasia (Vernaw, 2008).
2.4. The Law of Euthanasia in Some Country
2.4.1. United State of AmericaIn early 2006 Oregon was the only state with a law allowing physician-assisted suicide and then only in limited circumstances. Attempts to allow assisted suicide have been defeated in California, Washington, Michigan, Maine, and Wyoming (Miller, 2004).
In November 1994 Oregon voters approved Measure 16 by a vote of 51% to 49%, making Oregon the first jurisdiction in the United States to legalize physician-assisted suicide. Under the Oregon Death with Dignity Act (ODDA), a mentally competent adult resident of Oregon who is terminally ill (likely to die within six months) may request a prescription for a lethal dose of medication to end his or her life. Critics charge that assisted death is now "state-subsidized" because Medicaid money may be used to pay for physician-assisted suicide for the poor (Miller, 2004).
Between 1994 and 1997 the ODDA was kept on hold due to legal challenges. In November 1997 Oregonians voted to defeat a measure to repeal the 1994 law. Immediately after this voter reaffirmation of the Death with Dignity Act, the Drug Enforcement Administration (DEA) warned Oregon doctors that they could be arrested or have their medical licenses revoked for prescribing lethal doses of drugs.
Key facts for euthanasia:
a. At least two doctors must concur on diagnosis, prognosis and the patient's capability;
b. The patient must provide a written request to their physician witnessed by two individuals who are not family members or primary caregivers;
c. The patient must ultimately administer the prescription him/herself.
2.4.2. NetherlandsEuthanasia and assisted suicide have been widely practiced in the Netherlands for a number of years.
Both euthanasia and assisted suicide have been widely practiced in the Netherlands since 1973 although they were against the law until 2002. The Dutch situation between 1973 and 2002 was an outgrowth of a series of court decisions and medical association guidelines, beginning with a 1973 District Court case in which Geertruida Postma, a Dutch physician, was convicted of the crime of euthanasia after she ended the life of her seriously ill mother (Lagerway, 1988).
While finding Dr. Postma guilty of the crime of mercy killing that was punishable by imprisonment for a maximum of 12 years, the court imposed a one-week suspended sentence and a week’s probation (Gomez, 1991).
On the initiative of physicians and with the support of the Dutch Medical Association, other cases followed, each widening the boundaries and further liberalizing the conditions under which euthanasia and assisted suicide, although remaining illegal, would not be punished.
On April 10, 2001, the Dutch Parliament approved the "Termination of Life on Request and Assisted Suicide (Review Procedures) Act." It amended sections of the criminal code, specifically stating that the offenses of euthanasia and assisted suicide are not punishable if they have been "committed by a physician who has met the requirements of due care" that are described in the act and if they have informed the municipal "autopsies" in accordance with the Burial and Cremation Act (Gomez, 1991).
The inclusion of "due care" requirements transformed the crimes into medical treatments as physicians had advocated. Under the new law, minors between sixteen and eighteen may request that their lives be terminated and, although parents or guardians must be consulted, they have no authority to prevent the requested death. Children between the ages of twelve and sixteen may request euthanasia or assisted suicide but a parent or guardian must agree with the decision (Gomez, 1991).
In addition, the law recognizes the right of a physician to carry out euthanasia based on a written advance request for death of a currently incapacitated patient who is 16 years old or older (Although the person must be at least 16 years old to be euthanized there is no requirement that one be at least 16 when the request is put in writing).
2.4.3. BelgiumThe Belgian act legalizing euthanasia was passed on May 28, 2002 and went into effect on September 23, 2002. It limits euthanasia to competent adults and emancipated minors (European Journal of Health Law, 2003).
Embrace of euthanasia by medical professionals has led to the formulation of more convenient ways to end patients’ live. In early 2005, a pharmaceutical company announced that home "euthanasia kits" would be available soon in more than two hundred Belgian pharmacies so that doctors could carry out in-home deaths with greater ease. Reports indicated that the kits will contain a barbiturate, a paralyzing agent, an anesthetic, and instructions for use, and will cost approximately 45 Euros (Hovine, 2005).
As in the Netherlands, the practices of euthanasia and assisted suicide in Belgium illustrate how rapidly induced death, first accepted for difficult cases, expands to death-on-demand and how that actual demand need not be made by the victim (Hovine, 2005).
2.4.4. EnglandEuthanasia is illegal in all countries of the United Kingdom. However, as a devolved matter to the Scottish parliament, it is possible that at some point in the future different laws on euthanasia could apply within the UK (Parliament,2009).
In 1935, Lord Moynihan and Dr. Killick Millard founded the British Voluntary Euthanasia Society (now known as EXIT) which created A Guide to Self Deliverance which gave guidelines on how a person should commit suicide. This publication caused a controversy because of the Suicide Act of 1961 which states that the legal system can allow up to 14 years in prison for anyone that assists in a suicide (Gorman, 2008).
The Suicide Act 1961 makes it illegal to aid, abet, counsel or procure the suicide of another and sets a maximum prison sentence of 14 years. Although it is illegal to assist a patient in committing suicide, many doctors still assist their patients with their wishes by withholding treatment and reducing pain, according to a 2006 article in the Guardian. This, however, is only done when the doctors feel that death is a few days away and after consulting patients, relatives or other doctors.
The Nuffield Council on Bioethics launched an enquiry in 5th November 2006 into critical care in fetal and neonatal medicine, looking at the ethical, social and legal issues which may arise when making decisions surrounding treating extremely premature babies (Kate, 2007).
2.4.5. IndonesiaIn Indonesia, the law of euthanasia is illegal. This statement is obtained in 344th section Kitab Undang-undang Hukum Pidana (”Barang siapa menghilangkan nyawa orang lain atas permintaan orang itu sendiri, yang disebutkannya dengan nyata dan sungguh-sungguh, dihukum penjara selama-lamanya 12 tahun”). And also in 338th section (“Barang siapa dengan sengaja menghilangkan jiwa orang lain karena pembunuhan biasa, dihukum dengan hukuman penjara selama-lamanya lima belas tahun.”), 340th section(“Barang siapa dengan sengaja dan direncanakan lebih dahulu menghilangkan jiwa orang lain, karena bersalah melakukan pembunuhan berencana, dipidana dengan pidana mati atau penjara seumur hidup atau penjara selama-lamanya dua puluh tahun.”) of KUHP.
Farid Anfasal Moeloek from Ikatan Dokter Indonesia said that euthanasia or well death is rejected by the value and ethics of Indonesian.
2.5. Religious views on euthanasiaThere are many different religious views on euthanasia, although many moral theologians are critical of the procedure.
2.5.1. Euthanasia and suicide in IslamIslam categorically forbids all forms of suicide and any action that may help another to kill them. It is forbidden for a Muslim to plan, or come to know through self-will, the time of his own death in advance. The precedent for this comes from the Islamic prophet Muhammad having refused to bless the body of a person who had committed suicide. If an individual is suffering from a terminal illness, it is permissible for the individual to refuse medication and/or resuscitation.
a. Life is sacred
Euthanasia and suicide are not included among the reasons allowed for killing in Islam.
Do not take life, which Allah made sacred, other than in the course of justice. (Qur'an 17:3)
b. Allah decides how long each of us will live
When their time comes they cannot delay it for a single hour nor can they bring it forward by a single hour. (Qur'an 16:6)
And no person can ever die except by Allah's leave and at an appointed term. (Qur'an 3:14)
c. Suicide and euthanasia are explicitly forbidden
Destroy not yourselves. Surely Allah is ever merciful to you. (Qur'an 4:29)
The Prophet said: "Amongst the nations before you there was a man who got a wound and growing impatient (with its pain), he took a knife and cut his hand with it and the blood did not stop till he died. Allah said, 'My Slave hurried to bring death upon himself so I have forbidden him (to enter) Paradise.' “(Sahih Bukhari 4.56.66)
2.5.2. Euthanasia and suicide in ChristianChristians are mostly against euthanasia. The arguments are usually based on the beliefs that life is given by God, and that human beings are made in God's image. Some churches also emphasize the importance of not interfering with the natural process of death (British Broadcasting Corporation, 2009).
a. Life is a gift from God
All life is God-given. Birth and death are part of the life processes which God has created, so we should respect them. Therefore no human being has the authority to take the life of any innocent person, even if that person wants to die.
b. Human beings are valuable because they are made in God's image
Human life possesses an intrinsic dignity and value because it is created by God in his own image for the distinctive destiny of sharing in God's own life. The process of dying is spiritually important, and should not be disrupted.
Many churches believe that the period just before death is a profoundly spiritual time. They think it is wrong to interfere with the process of dying, as this would interrupt the process of the spirit moving towards God (British Broadcasting Corporation, 2009).
c. All human lives are equally valuable
Christians believe that the intrinsic dignity and value of human lives means that the value of each human life is identical. They don't think that human dignity and value are measured by mobility, intelligence, or any achievements in life.
d. Exceptions and omissions
Some features of Christianity suggest that there are some obligations that go against the general view that euthanasia is a bad thing:
1) Christianity requires us to respect every human being.
2) If we respect a person we should respect their decisions about the end of their life.
3) We should accept their rational decisions to refuse burdensome and futile treatment.
4) Perhaps we should accept their rational decision to refuse excessively burdensome treatment even if it may provide several weeks more of life.
e. End of life care
The Christian faith leads those who follow it to some clear-cut views about the way terminally ill patients should be treated.
The Roman Catholic view, Euthanasia is a grave violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person. (Pope John Paul II, Evangelism Vitae, 1995).
As Catholic leaders and moral teachers, we believe that life is the most basic gift of a loving God – a gift over which we have stewardship but not absolute dominion. (National Conference of Catholic Bishops (USA), 199).
The Roman Catholic Church does not accept that human beings have a right to die. Human beings are free agents, but their freedom does not extend to the ending of their own lives. Euthanasia and suicide are both a rejection of God's absolute sovereignty over life and death (British Broadcasting Corporation, 2009).
2.5.3. Euthanasia and suicide in HinduismMost Hindus would say that a doctor should not accept a patient's request for euthanasia since this will cause the soul and body to be separated at an unnatural time. The result will damage the karma of both doctor and patient. Other Hindus believe that euthanasia cannot be allowed because it breaches the teaching of ahimsa (doing no harm).
For Hindus, culture and faith are inextricable. So although many moral decisions taken by Hindus seem more influenced by their particular culture than by the ideas of their faith, this distinction may not be as clear as it seems.
Karma is Hindus believe in the reincarnation of the soul (or atman) through many lives - not necessarily all human. The ultimate aim of life is to achieve moksha, liberation from the cycle of death and rebirth. A soul's next life is decided by karma, as the consequence of its own good or bad actions in previous lives (British Broadcasting Corporation, 2009).
Non-violence is another important principle is ahimsa, not being violent or causing harm to other beings (British Broadcasting Corporation, 2009).
Dharma is Hindus live their lives according to their dharma - their moral duties and responsibilities. The dharma requires a Hindu to take care of the older members of their community (British Broadcasting Corporation, 2009).
Death: The doctrine of karma means that a Hindu tries to get their life in a good state before they die, making sure that there is no unfinished business, or unhappiness’s. They try to enter the state of a sannyasin - one who has renounced everything.
The ideal death is a conscious death, and this means that palliative treatments will be a problem if they reduce mental alertness. The state of mind that leads a person to choose euthanasia may affect the process of reincarnation, since one's final thoughts are relevant to the process. There are two Hindu views on euthanasia:
a. By helping to end a painful life a person is performing a good deed and so fulfilling their moral obligations.
b. By helping to end a life, even one filled with suffering, a person is disturbing the timing of the cycle of death and rebirth.
Prayopavesa, or fasting to death, is an acceptable way for a Hindu to end their life in certain circumstances (British Broadcasting Corporation, 2009).
Prayopavesa is only for people who are fulfilled, who have no desire or ambition left, and no responsibilities remaining in this life. It is really only suitable for elderly ascetics. Hindu law lays down conditions for prayopavesa:
a) Inability to perform normal bodily purification.
b) Death appears imminent or the condition is so bad that life's pleasures are nil.
c) The decision is publicly declared.
d) The action must be done under community regulation.
An example of prayopavesa:
Satguru Sivaya Subramuniyaswami, a Hindu leader born in California, took his own life by prayopavesa in November 2001.
After finding that he had untreatable intestinal cancer the Satguru meditated for several days and then announced that he would accept pain-killing treatment only and would undertake prayopavesa - taking water, but no food. He died on the 32nd day of his self-imposed fast (British Broadcasting Corporation, 2009).
2.5.4. Buddhism, euthanasia and suicideBuddhists are not unanimous in their view of euthanasia, and the teachings of the Buddha don't explicitly deal with it. Most Buddhists (like almost everyone else) are against involuntary euthanasia. Their position on voluntary euthanasia is less clear (British Broadcasting Corporation, 2009).
The most common position is that voluntary euthanasia is wrong, because it demonstrates that one's mind is in a bad state and that one has allowed physical suffering to cause mental suffering. Meditation and the proper use of pain killing drugs should enable a person to attain a state where they are not in mental pain, and so no longer contemplate euthanasia or suicide. Buddhists might also argue that helping to end someone's life is likely to put the helper into a bad mental state, and this too should be avoided.
Buddhists regard death as a transition. The deceased person will be reborn to a new life, whose quality will be the result of their karma (British Broadcasting Corporation, 2009)
The Buddha himself showed tolerance of suicide by monks in two cases. The Japanese Buddhist tradition includes many stories of suicide by monks, and suicide was used as a political weapon by Buddhist monks during the Vietnam War. But these were monks, and that makes a difference. In Buddhism, the way life ends has a profound impact on the way the new life will begin. So a person's state of mind at the time of death is important - their thoughts should be selfless and enlightened, free of anger, hate or fear. This suggests that suicide (and so euthanasia) is only approved for people who have achieved enlightenment and that the rest of us should avoid it (British Broadcasting Corporation, 2009).
2.6. Case of Nancy CruzanOn January 11, 1983, 25-year old Nancy Cruzan was driving alone on an icy road, lost control of her vehicle, and was seriously injured in the resulting accident. She never regained consciousness and became one of the approximately ten thousand Americans living in a persistently comatose state.
Contrary to persistent media lies, she was not in a "persistent vegetative state;" her medical status was that of a "severely handicapped" person. She required no life support machinery other than a feeding tube implanted in her stomach in early 1983. She was not terminally ill.
However, she was now an inconvenience to many people; the health care system, the state, and in particular her parents, Joe and Joyce Cruzan. But she was the opportunity of a lifetime for pro-euthanasia.
Cruzan could not be killed without being dehumanized first, a task expertly performed by Dr. Fred Plum, Chief of Neurology at the Cornell New York Hospital.
Nancy's parents petitioned a lower court to order the Missouri Rehabilitation Center at Mount Vernon to starve their daughter. The court granted the petition, but the Missouri Supreme Court overturned the lower court decision, ruling that a decision to withhold or refuse treatment must be an "informed" one, and, most importantly, that the State's interest in human life does not depend on the quality of that life.
The Supreme Court narrowly averted making this case euthanasia's Roe v. Wade by denying that the so-called "right to die" is unfettered and absolute. The justices ruled that the States may require "clear and convincing" evidence that comatose persons actually wished to die before they lost their ability to decide their own fates.
The Court essentially held that the states do not have to yield to family member's demands when a patient's wishes cannot be concretely determined.
The ruling, however, indicated that there is a Constitutional right to refuse tube feeding and other life-sustaining measures when patients make their wishes clearly known before they become incompetent.
So a determined Joe and Joyce Cruzan headed back to the Missouri courts, and rounded up a string of Nancy's co-workers who were willing to testify that she would never want to live "like a vegetable." Nobody bothered to explain how her co-workers could all remember such a statement so clearly after eight years — or why, at the young age of 25, she would say such a thing.
During this phase, Nancy enjoyed no representation of any kind in the state court; no-one testified for her, because all those who wanted her to live were ruled non-parties by the judge. The outcome of the one-sided hearing was a foregone conclusion.
So the Court sentenced Nancy to death by starvation. Her feeding tube was disconnected on December 14, 1990 at the Missouri Rehabilitation Center in Mount Vernon, Missouri.
In a chilling portent of the future, the first rescue mission mounted to save a born person from death occurred on Tuesday, December 18, 1990. Police arrested 19 rescuers as they tried to reach Nancy's hospital room and charged them with criminal trespass and unlawful assembly, they same charges they encountered at abortion mills.
Scores of armed police officers patrolled the halls of the Missouri Rehabilitation Center until Nancy Cruzan finally died of starvation and thirst after 12 days, on the day after Christmas 1990 (Nachtigal, 1990).
2.6.1. Analyzing Case of Nancy CruzanFrom the United State of American’s law, this case is illegal because it’s not in Oregon. But Doron Webster of the New York chapter of the Society for the Right to die stated ominously, "We feel that Nancy Cruzan has made legal history." (The Oregonian, December 27, 1990, pages 1 and 12)
Beside the Christian religion, the case of Nancy Cruzan is rejected because birth and death are part of the life processes which God has created, so people should respect them. Therefore no human being has the authority to take the life of any innocent person, even if that person wants to die.
2.7. Nurses Roles in United StateIn sequential order, the way participating palliative care nurses viewed their roles in the different phases of euthanasia.
2.7.1. Hearing the request for euthanasiaInterviewed nurses reported that the caregivers' role in euthanasia involved more than simply administering a lethal medication. The care process began when the patient formulated a euthanasia request. Palliative care nurses felt they played an important role during this phase, as their experiences taught them that a nurse's professional attitude could dissuade the patient from pursuing euthanasia. This professional attitude entailed nurses accepting the euthanasia request with “active openness”, thus taking the request seriously rather than passing it over as unimportant. It also required that nurses took the time to listen carefully to patients, with the aim of uncovering their reasons for requesting euthanasia. Identifying these reasons is critical to formulating an adequate palliative response to deal with the specific issues of suffering that underlie the euthanasia request. According to palliative care nurses, improper euthanasia requests often originate from suffering that can be alleviated by alternative courses. Palliative care nurses observed that, by offering palliative care alternatives, many improper requests for euthanasia were withdrawn and undignified deaths were avoided (Gastmans, 2005).
2.7.2. Participating in the decision making processNurses stated that every persistent request for euthanasia must be addressed and discussed openly. The palliative care nurses we interviewed argued in favor of an interdisciplinary decision making process, requiring nurses' input. The participation of nurses in this process was deemed crucial because of the nurses' expertise in dealing with terminally ill patients and their unique, close relationship with these patients. A fundamental element of the patient/nurse relationship is continuity: daily follow up gives the nurse insight into the patient's experiences and how these experiences may develop and contribute to the patient's request for euthanasia. Because a nurse's viewpoints are not based on momentary impressions, euthanasia requests deemed impulsive can be largely excluded. As mentioned, nurses are uniquely positioned to gauge the validity of euthanasia requests (Gastmans, 2005).
Palliative care nurses indicated that their close and often physical dealings with their patients foster a trusting environment in which in depth discussions can safely take place. Through this intimacy, nurses can communicate the significance of the patients' suffering to other caregivers. In addition, because of their holistic training, nurses can gain insight into the physical, psychological, social, and spiritual dimensions of the patient's suffering. This ensures that the euthanasia decision making process is not based on a one sided interpretation of the situation (Gastmans, 2005).
2.7.3. Participating in the execution of euthanasiaConcerning the actual act of performing euthanasia, palliative care nurses saw their role primarily as assisting the patient, the patient's family, and the physician by being present, even if they could not reconcile their morals with actually carrying out a request for euthanasia. Nurses were willing to set personal convictions aside in order to meet their patients' needs in a professional manner, especially since they viewed dying as a significant event during which the patient could not be left alone. Nevertheless, the nurses also felt that their presence during the administration of the lethal drug was justified only when in compliance with the patient's wishes (Gastmans, 2005).
2.7.4. Supporting family members and colleaguesThe palliative care nurses we interviewed believed they had an important role in supporting the patient's family once their loved one had passed away. Euthanasia can give rise to questions, doubts, and feelings of guilt in family members, possibly resulting in a pathological mourning process. Relatives might need reassurance about making the right decision. These nurses also indicated that family members might need someone who would listen to their thoughts and feelings (Gastmans, 2005).
Having good communication with the patient's relatives also served as a great relief for our participant nurses.
2.8. Nurses Roles in IndonesiaBeside the law, whatever the reasons, euthanasia in Indonesia is illegal. The nurse should give education and keep communication with the patients and their family. As long as they can stay alive, they must keep it. But, some statement said that euthanasia can be permitted for specific condition when the patient just can stay alive by the life support such as the respirator, and it can be removed because there are some patients who have more life chance (wordpress, 2008).
CHAPTER III
CLOSURE
3.1. ConclusionEuthanasia is the act of putting a person or animal to death painlessly or allowing them to die by withholding medical services, usually because of a painful and incurable disease. There are two arguments about this case. They are pro and contra whether in our country and abroad. Euthanasia in some state is rejected. In our country “Indonesia”, it is rejected by the value and ethics of Indonesian. There are many different religious views on euthanasia, although many moral theologians are critical of the procedure. People argue that euthanasia is legal because it can help the client and their family from the misery. But, some people argue that euthanasia is illegal because it is opposite with fate of God. As a nurse we must use our professional to solve this case.
REFERENCESBritish Broadcasting Corporation. 2009. “Religion and Assisted Suicide”. From http://www.bbc.co.uk/religion.shtml. Viewed on April 4, 2010.
Gastmans. July 12, 2005. “Nurses' views on their involvement in euthanasia”. From http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565778/. Viewed on April 6, 2010.
Gomez. 1991. “Assisted Suicide & Death with Dignity”. From http://www.internationaltaskforce.org/rpt2005_3.htm#29. Viewed on April 4, 2010.
Gorman. 2008. “Euthanasia”. From http://en.wikipedia.org/wiki/Euthanasia. Viewed on April 4, 2010.
Kasule. 2010. “Euthanasia: Ethic-Legal Issues”. From http://www.missionislam.com/health/euthanasia.htm. Viewed on March 26, 2010.
Miller. 2004. “Euthanasia Suicide and Physician-Assisted Suicide - The Battle Over Legalizing Physician-assisted Suicide”. From http://www.libraryindex.com/pages/3124/Suicide-Euthanasia-Physician-Assisted-Suicide-BATTLE-OVER-LEGALIZING-PHYSICIAN-ASSISTED-SUICIDE.html. Viewed on March 29, 2010.
Nachtigal. December 27, 1990. "Nancy Cruzan Dies Peacefully". From http://www.hli.org/index.php/the-facts-of-life/614?task=view. Viewed on April 4, 2010.
Vernaw. July 29,2008. “Euthanasia”. From http://www.oppapers.com/essays. Viewed on March 26, 2010.
