Introduction
Medical aid in dying (MAiD) is a contentious issue worldwide, often igniting discussions on the ethical and moral complexities associated with interventions that end life (Goldberg et al., 2023). According to Hannig(2019), most of the people who oppose Medical Aid in dying compare it with the typical suicide of people suffering from different mental illnesses and argue that it does not end suffering but causes extreme pain and unending pain for the families who are left behind by their loved one. Furthermore, the opponents of medical aid in dying argue that suicide is often viewed as a tragic outcome of conditions such as depression, isolation, anxiety, and hopelessness and supporting any form of suicide is normalizing the tragedy of mental illnesses Hannig (2019). Besides,for those who oppose medically assisted dying, the underlying ailment of a patient does not hold significant ethical or practical significance in justifying what they perceive as a premature departure (Hannig, 2019). On the other hand, the proponents of medical aid in dying argue that it cannot be compared with an act of suicide that usually results from depression and hopelessness. The proponents of medical aid in dying also hold the view that even if everyone has access to specialized palliative care, some individuals nearing death may still endure unmanageable physical or emotional suffering that cannot be eliminated. Furthermore, forcing such people to endure such agony goes against the principles of modern medicine in the 21st century (British Medical Association ,2021).
Researched case scenario
Nancy, diagnosed with ALS in March 2008, faced a critical moment when she began losing her ability to speak. By the following year on January, doctors estimated her life expectancy to be less than six months. Although she qualified for Oregon’s aid-in-dying law at that point, Nancy was not ready to take the drugs for end-of-life assistance. Despite her desire to live as long as possible, the progression of her speech difficulties forced her to reconsider. She did not want to reach a point where she could not swallow, leading to the necessity of a feeding tube. Nancy’s older sister, Marnie, recalled her determination to wait until June or July, but her deteriorating condition made it impossible. In April 2009, Nancy ultimately chose to end her life using the lethal medication (Hannig, 2019).
The ethical dilemma is that after her diagnosis of ALS, Nancy wanted to live up to the end of her time but her deteriorating condition that was evident when she experienced advanced speech difficulties forced her to consider medical aid in dying. Although Nancy wanted to live up to the end up to the time the doctors had predicted her life would end, Nancy did not support the idea of losing her ability to swallow and depending on a feeding tube. On one side Nancy had the autonomy of deciding the manner in which her life would end due to her medical condition as the law in Oregon allows but there ethical considerations regarding the sanctity of life and the disease exerting undue influence over her decision-making process.
The scenario is similar to another case I witnessed at a hospital where a patient was diagnosed with pancreatic cancer in its advanced stages. Despite undergoing surgery and chemotherapy sessions his health condition deteriorated where he suffered from severe pain. After the medical team confirmed that the treatment was unlikely to succeed and the patient and his family were informed, he asked if he could be supported with medical assistance in dying. However, the medical team needed further consultations as most of the team members were uncertain about the best way to handle the case.
Thesis Statement
Assisted Suicide Medical Assistance in Dying should be embraced to support terminally ill patients because it alleviates suffering, supports patients’ autonomy and can offer peace of mind to terminally ill patients.
Point of View
I support the view that Medical Assistance in Dying should be adopted because it alleviates pain and suffering of patients with terminal illnesses that have no chances of getting cured. Although my religion prescribes that God is the giver of life and he is the only one with the power to end life, the teachings from the religious book also encourages us to be compassionate of the suffering. Therefore, supporting Medical Assistance in dying is an act of compassion. Furthermore, I also come from a culture where adults are allowed to making independent decisions about their lives including marriage and jobs and the same applies to decisions affecting their health and their end of life wishes. Therefore, I hold the view that allowing medical assistance in dying guarantees autonomy for patients and relatives and other external parties should not force them to make decisions against their will. According to the Government of Canada (2024), the parliament passed Bill-C7to amend the requirements for qualifying for medical assistance in dying and the evaluation procedure. Furthermore, according to the Government of Canada (2024) the law prescribes an exclusion criteria for receiving medical assistance in dying including having attained the age of 18 years and having the capacity to make decisions.
Ethical Theories
According to deontology does not support any form of killing even where refusing to do creates more suffering. Deontology requires people to observe universal norms in their actions. Because killing is considered to be morally wrong universally, the supporters of deontological ethics cannot support medical assisted dying because they consider it as a killing act (Körner & Deutsch, 2023).Furthermore, the ethical relativism may hold opposing views to medical aid in dying because it suggests that morality depends on the cultural norms a person belongs to (Bajrami & Demiri, 2019). In some societies medical assisted dying may be considered to be morally wrong and therefore the practice cannot be implemented in such a society. However, Egoism ethical theory would support the actions taken in medical assisted dying. The reason is because egoism encourages people to act in their own self-interest (Kao, 2019). Therefore the provisions of egoism would people who are suffering from pain due to a disease that cannot be cured to request for medical aid in dying and avoid further suffering. Egoism allows the person to access medical aid dying irrespective of whether their family and the society is opposed to the action(Kao, 2019).
Ethical Principles
The ethical principle of non-maleficence may to some extent be opposed to medical assisted dying. The ethical principle emphasizes that people have an obligation to ensure that the do not harm others (Varkey, 2021).Therefore, although medical assisted dying aims at alleviating suffering for patients, the process involves causing harming the patient through death. The ethical principle of beneficence can also be used to oppose medical assisted dying because it requires a person to do good and safeguard other people’s wellbeing. Therefore people who oppose medical assisted dying may argue that healthcare professionals have the obligation to preserve life at all costs and should not be involved in ending lives. However, the principle of autonomy supports medical assisted dying because it states that people should be accorded the right to make individual decisions including how their life should end (Varkey,2021).
Nursing Standards and Law
According to CNO (2021), when a patient opts for practitioner-assisted medical aid in dying, only nurse practitioners and physicians are authorized by law to administer drugs to induce the patient’s death. Other healthcare professionals, such as registered nurses and registered practical nurses, are not legally authorized to administer medication for medical aid in dying. Therefore, although the law safeguards the healthcare workers who are involved in administering drugs for medical assisted in dying, not all nurses are allowed to administer the drugs and therefore nurses should follow the law when dealing with patients who opt for medical assisted dying. Moreover, according to CNO(2021) when a nurse supports a nurse practitioner or a physician in delivering medical aid in dying within legal boundaries, they undertake various responsibilities, including but not limited to educating patients, offering support and solace to both patients and their families, inserting an intravenous line as directed to administer medications inducing the patient’s death, and serving as an independent witness. On the other hand according to CNO (2021)the regulations within the Criminal Code concerning medical aid in dying were initially implemented on June 17, 2016, following the enactment of Bill C-14. The legislation permitted eligible individuals to access medical assistance in dying (CNO, 2021).
Ethical Action
When dealing with cases where patients request medical assistance in dying, they should not be denied the service as long as the law in their jurisdiction allows. The ethical principle of autonomy should be observed because patients have a right to make decisions about their life including when they need to be supported to end their suffering. However, however, healthcare professionals should demonstrate professional integrity when dealing with all patients and ensure that they do not neglect patients during treatment due to the availability of medical assistance in dying. Therefore, healthcare workers should ensure that they do their best to take care of all patients and medical assistance in dying should only be as a result of a patient’s decision after all treatments have failed and they cannot endure the pain.
Conclusion
Medical assistance in dying remains a contentious issue, stirring debates around ethical, moral, and legal considerations. Advocates argue for its implementation to alleviate suffering and respect patient autonomy, while opponents raise concerns about the sanctity of life and undue influence. Nancy’s case exemplifies this complexity, where autonomy clashes with ethical principles and deteriorating health. Ethical theories like deontology may oppose MAID due to universal norms against killing, while egoism may support it, emphasizing self-interest. Conflicting ethical principles of non-maleficence and beneficence highlight the dilemma, with autonomy emerging as a primary argument for MAID. Nursing standards emphasize legal compliance and holistic patient care. In conclusion, while MAID poses ethical challenges, respecting patient autonomy within legal boundaries and ensuring compassionate care are crucial. Future exploration should focus on refining ethical framework to ensure that patients can access MAID and at the same time health care workers remain professional.
References
Goldberg, R., Nissim, R., An, E., & Hales, S. (2021). Impact of medical assistance in dying (MAiD) on family caregivers. BMJ supportive & palliative care, 11(1), 107-114.
Hannig, A. (2019). Author (iz) ing death: medical aid-in-dying and the morality of suicide. Cultural Anthropology, 34(1), 53-77.
Government of Canada (2024).Canada’s medical assistance in dying (MAID) lawhttps://www.justice.gc.ca/eng/cj-jp/ad-am/bk-di.html#:~:text=As%20of%20March%2017%2C%202021,the%20result%20of%20external%20pressure
Bajrami, D., & Demiri, B. (2019). Ethical relativism and morality. ILIRIA International Review, 9(1), 221-230.
Körner, A., & Deutsch, R. (2023). Deontology and utilitarianism in real life: A set of moral dilemmas based on historic events. Personality and Social Psychology Bulletin, 49(10), 1511-1528.
Kao, Y. Y. S. (2019). What’s in it for Me? On Egoism and Social Contract Theory. Introduction to philosophy: Ethics.
Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17-28.
CNO( 2021). Guidance on Nurses’ Roles in Medical Assistance in Dying. https://www.cno.org/globalassets/docs/prac/41056-guidance-on-nurses-roles-in-maid.pdf
British Medical Association (2021). Key arguments used in the debate on physician-assisted dying. https://www.bma.org.uk/media/4394/bma-arguments-for-and-against-pad-aug-2021.pdf
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