To Explore the Nurses’ Roles in Discouraging Palliative Patients from Euthanasia
To Explore the Nurses’ Roles in Discouraging Palliative Patients from Euthanasia
To Explore the Nurses’ Roles in Discouraging Palliative Patients from Euthanasia
Introduction to the Problem
The issue of dying with dignity and the right to die has been debated for decades. The debate revolves around whether a person should be allowed to choose to die when they can continue living at a diminished capacity with the aid of life support. The debate is centered on the ethical position of the medical intervention. One of the questions is whether the right to die is universal and only applicable in palliative care. On an ethical basis, health professionals should adhere to patient autonomy which questions euthanasia as a care intervention. Nurses in assisted death face conflicting requirements from autonomy, maleficence, and non-maleficence. However, the concept of freedom of expression exists where the dying patient has a right to make decisions regarding their health.
Nurses play a vital role in caring for patients during their end of life compared to other health care professionals. Technological advancement in healthcare has facilitated quality of life and prolonged life. However, technological advancement has also led to controversial debates on euthanasia. According to Asai et al. (2019), the attitudes towards the legality and the ethics of euthanasia has drastically changed in the last few decades. This has led to the legalization of euthanasia in some countries, but the circumstances of assisted suicide vary from one city to another.
The issue of cancer is a global issue, and it has increased the need for palliative care services. Nurses provide care geared towards patient satisfaction. In palliative care, the nurses work towards meeting cancer patients’ needs during the end of life care (Henson et al., 2016). During the end of life, the patients and the family face challenges and must make choices that benefit the patient. Wright et al. (2016) explain that choices during the end of life may have a
PHASE FIVE
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quality of life dimension where the nurse guides the patient and the career to adapt to painful realities and confront difficult situations.
Problem Statement
The practice of euthanasia involves medical procedures that end life to relieve the patients suffering or pain. The concept of euthanasia is explained by the American Medical Association’s Code of Medical Ethics (1997) as a process where a health professional facilitates a patient’s death by providing the necessary means and information to enable the patient to perform the life-ending act” (p. 56).
According to Gill (2019), there are different forms of euthanasia; passive, active, voluntary and non-voluntary. On voluntary euthanasia, the patients request health professionals to die, while non-voluntary involves death assistance in patients who cannot make requests like infants and comatose patients. On active and passive euthanasia, passive procedures withhold life-sustaining treatments while active is injected with lethal drugs. According to Gill (2019), the goal of euthanasia is to relieve patients from unbearable pain and allow them to die with dignity. Although cancer is a significant cause of palliative care, a rising number of patients like children and neonates require palliative care. Some of the conditions resulting in palliative care include frailty, dementia, learning disabilities, and seniors with multiple comorbidities.
Significance of the Problem to Nursing
Although nurses spend more time with palliative patients and receive euthanasia requests, their views on the procedure remain unclear. This creates a research gap and a need to conduct an in-depth exploration of nurses’ attitudes towards decision-making process in euthanasia procedure. The responsibility of nurses in palliative care is to provide compassionate and comprehensive end of
life care. According to Weaver et al. (2018), the cost of caring for the palliative patient has a financial impact physical, emotional and psychological.
The caring process may negatively affect caregivers resulting in physical illness, psychiatric illness, physiologic responses, impaired health habits, psychological distress or death. Several factors influence the attitudes of nurses towards palliative care. For example, religion views euthanasia as a practice that is against the value of human life. Such nurses may view the practice as an unethical sanctioned choice hence discouraging euthanasia. Due to the varying factors influencing the decision making of euthanasia in palliative care, there is a need to explore the attitude of palliative nurses towards euthanasia.
Purpose of the Research
The purpose of the study is to describe and explore the attitude and beliefs of palliative nurses towards euthanasia.
Research Questions
The primary research topic is; what is the attitude of nurses regarding voluntary euthanasia, and should they encourage or discourage the process? The following specific research questions will address this.
· What is palliative nurses’ attitude towards voluntary euthanasia?
· What are the ways in which palliative nurses wish to get involved in involuntary euthanasia?
· What is the relationship between the demographic characteristics of palliative nurses and their attitude towards voluntary euthanasia?
Master’s Essentials that aligned with your topic
The concept of euthanasia is in line to the World Health Organization definition of palliative care. According to WHO, palliative care is,
“… an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual” (National Consensus Project for Quality Palliative Care, 2009, p. 8). Palliative care “affirms life and regards dying as a normal process” and “intends neither to hasten nor postpone death” (Ferrell et al., 2018, p. 8).
Although euthanasia involves the prevention of suffering and relieving patients’ pain, it is against the goal of nursing care, which is to promote quality of life. However, it is in line with palliative care on providing care and support to help patients die with dignity (Ferrell et al., 2018). Different professional organizations in nursing address the issue of euthanasia and the clinical participation of health professionals. Assisted suicide is contrary to professional role integrity as it violates the social construct of health professionals to the people. Besides, the procedure is contrary to the role of nurses and other health professionals in promoting healing, creating a social risk.
A master’s in palliative care is to promote patient outcomes through quality palliative care facilitated by quality improvement and research. The role of the course is patient care improvement through the delivery of effective and accessible education. The goal is to help nurses to develop, extend and share their understanding, knowledge and application of evidence to palliative care.
Other essentials include research evidence, challenges, frameworks, and core understanding that develop and optimize palliative care and palliative medicine practice. It also assists students in identifying significant issues in their practice and conducting evidence-based research (Ferrell et al., 2018). The goal is to attain vital information to the practice and knowledge of palliative care and palliative medicine.
Phase 2
There is an increase in the debate over the issue of dying with dignity and the right to die. The issue of euthanasia has caused ethical dilemma amongst healthcare providers on whether the request made by the patient on assisted suicide should be adhered to or not. Most of the debates are focused on the ethical position on some of the medical interventions that are undertaken (Gill, 2019). The focus of this research paper is to explore nurses’ attitudes and influence on euthanasia practice during palliative care.
Nurses are making major contributions towards healthcare services delivery to the patients in the palliative care as compared to other professionals. Nurses are not directly involved in the performance of euthanasia, but are directly taking part in the process that starts when the patients request euthanasia and ends with the provision of support to the patient’s family members and healthcare providers after the act. In this case, it is always crucial for the nurses to be aware of the role they play during the euthanasia procedure (Wilson et al., 2021). Nurses are required to be open-minded and to be non-judgment towards accepting euthanasia requests as their professional attitude can discourage patients from assisted suicide/euthanasia.
The role of the nurses in discouraging palliative patients from euthanasia begins with the pre-euthanasia which begins with the assessment. In this stage, nurses are required to carefully listen to the patients to help in the successful assessment of the reasons for requesting euthanasia and the factors that are linked to such decisions. According to Martin (2021), all patients need to be assessed for awareness about their medical diagnosis, their conditions, and the prognosis, and other available alternatives like palliative care to make sure that
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the decision made are well-informed as a full disclosure that is important in the execution of the right to the self-determination freely.
The role of the families in the assisted suicide/euthanasia cannot be ignored, there nurses must be in a position to assess them concerning their attitudes and perceptions or take concerning such procedures. It is important to have effective communication process and listening skills to help in the determination of the needs of both families and that of patients (Mathews et al., 2021). In this situation, nurses are required to remain sensitive and maintain professional approaches in the performance of the assessment.
In the pre-euthanasia stage, nurses are required to support effective consultation process by acting as the advocators of the patients. They have to ensure that patients have the require information about their conditions as well as wishes of their relatives to promote the considerations of patients’ opinions. The second phase is the intra-euthanasia which is carried out within a special rook to given an opportunity for having a peaceful environment that supports the human right to die with dignity and the reduction of the disturbance in the process (Gill, 2019). This phase involves preparation, assistance, and recording. In the preparation, nurses help with the preparation of the medication to induce a light sleep-in case the patient is not wishing to be aware of the comma induction moment. In the assistance role, a nurse provides emotional support to the family members when they are present in the procedure. Under recording, nurses are responsible for keeping all the records of the medication, for signed consent forms, the pain assessment form, and the record of euthanasia.
The third phase is the post-euthanasia and the nurse has the responsibility of explaining to the family about the need to stop the procedure ad goes to the last office procedure. According to Gill (2019), when the decisions are deliberately made, the grieving process and the feelings of guiltiness among the family members might occur. In this case, the emotional support by providing reassurance and listening to the feelings of the patients and the family members. A nurse is required to have good communication and counseling skills and ensure that there is timely referral process to the counselor for the families who are emotionally affected.
Methodology and the Design of the Study
This will be a case study using the interviews and questionnaire as the data collection technique with target of specific healthcare facilities that are selected for the study. The collection of the data to be used for the study will involve the use of interviews and questionnaires. The interview process as a method of collecting data will be targeting the nurses in charge of the selected healthcare facilities. The questionnaire will be used for the selected nurses from the targeted facilities. The questionnaire or interview will be delivered to the participants in person or by emailing them. The information to be collected from the patient will involve the collection of the demographic data of the participants for example age, gender, the year of employment within the facility, and their positions within the facility (Gill, 2019). Other questions will involve asking their perception or attitudes concerning voluntary euthanasia; the methods they wish to be involved in interviews in relation to the euthanasia as palliative nurses; and how their demographic features for example years of work experience as a nurse are impacting the palliative role and their attitudes towards voluntary euthanasia.
Sampling Methodology
The sampling methodology to be adopted in this case will involve the use of the nurses of ages above 25 years. In this case, a total of 60 participants will be used in the study i.e., 10 nurses in charge and 50 nurses within the selected facility. Before the involvement of the participants in the study, they will be taken through a consent process where the objectives of the study will be explained and informing them that the study is done for academic purposes. The participants will also be assured of confidentiality and that their names will not feature anywhere. They are also allowed to take part or to leave the study (Gill, 2019). The selection of the study participants will follow a random process from the few selected healthcare facilities to help in understanding the role played by the nurses in discouraging palliative patients from euthanasia procedures.
The Necessary Tools to be Used
One of the research tools is the questionnaires that give the chance of obtaining information from a larger population who are unlikely to have time to attend an interview or take part in the experiments. This tool is important in enabling the participants to take time, think about the research question, and return the questionnaire later. The questionnaire allows the participant to state their views or feelings privately without worrying about the possible reactions of the researcher (Gill, 2019). The questionnaire tool is composed of multiple- choice questions, attitude scales, open-ended questions, and close-ended questions. The other research tool is the interview and it can be administered either though face to face or in-person. The advanced computer technology can also be adopted and this will be based on the comfortability of the interviewee. The interview will target nurses in-charge and some few management staff within the facility.
Phase 3: Implementation
The third phase will elaborate on the implementation procedure of the proposed methodology to help in the successful completion of the research study. The topic of study includes nurses’ attitudes towards palliative patient care, and the use of euthanasia will be focused on and aligned with the methodology. The details about the data collection, data analysis, data interpretation will be the discussion. The budget planning and the timeline of the study will also be discussed.
Steps
Selection of the Participants
The methodology starts with the sampling, and the implementation phase starts from here to the data analysis. The researcher has studied the different theoretical approaches of sampling relevant studies, so the participation selection shows the researcher’s knowledge of the subject. The sampling process should be chosen carefully to help in the generation of the expected results (Asai et al., 2019).
The participants in the study will involve the exclusion and the inclusion criteria. The inclusions criteria will be that the participants have to be nurses who are working in the palliative care. The nurses must have experience in handling patients with severe illness and handling the voluntary and involuntary euthanasia issues. The nurses must also be aware of the challenges encountered while handling such patients.
There will be 60 participants in the study, 50 participants will be nurse staffing, and ten will
be in-charge nurses. The nurses will be aged above 25 years of age and this is basically based on their experiences within the organization. Assisted suicide/euthanasia is a major healthcare concern that is commonly experienced by the healthcare providers. Therefore, selection of the nurses based on this age group is based on the idea that they have witnessed or handle cases of assisted suicide/euthanasia. Palliative care is crucial, and it will be researched in detail by the experience of nurses.
Euthanasia remains an arguable topic because it is faced with different ethical dilemmas about its use. Moreover, the nurses will be informed beforehand that their time will be taken for the interviews. Coronavirus has affected all industries, and the healthcare industry has become highly vulnerable. The researchers usually plan to conduct the research and collect the data in live interaction, but the situation might change. The coronavirus can alter the plan, and other ways will be considered.
The procedure of collecting data will involve contacting the targeted nurses of healthcare facilities. An arrangement will be done with both management and nurses on the suitable time that the interview and questionnaires can be submitted and conducted respectively. The next step will be to contact the hospital management, and they will be informed of the purpose of the research. The hospital management already knows the importance of using euthanasia in the hospitals.
Ethical Standards
Ethical standards are essential for nursing, so they should be followed, and some of them are discussed below.
Consent
The research cannot be conducted without obtaining the consent of participants because it has been seen that the research needs to be conducted for publishing purposes. Therefore, participants need to know why they are contacted and their role in the research. If they are comfortable with the purpose of the research and their responsibilities, the nurses will then decide whether they will be part of the research or not. All those who will agree will be contacted further for the research (Asai et al., 2019). There is no possibility that a research project will only have advantages, but there are some risks. It is part of ethical standards to inform the nurses about the side effects or risks of the research. Moreover, it is seen that the researcher will have the duty to inform them the confidential information about the research. This is important in ensuring that the ethical standards and requirements in a research process are followed.
Confidentiality
After selecting participants, they are given assurance by the researcher that their privacy will be protected. In this case, the names, their positions in the organization will not be revealed since the research is meant for academic work and the outcome will be used to help in improving the performance of the facility in handling issues related to euthanasia. The information collected will be analyzed and the be used in building an evidence-based solutions that can be used by the facility and other healthcare facilities in ensuring that the issue of euthanasia are dealt with effectively (Asai et al., 2019).
Autonomy
Autonomy in a research is when the participants make their own decisions about what to do or what to agree to. As a researcher, it is important to respect the participant’s own informed decisions on whether to participate in the research. The participant must be given an opportunity to quit the research or continue to take part in the research when they feel so (Ferrell, 2018).
Beneficence
Beneficence involves the aspects of benefits that the participants will get from the research work. In this case, the research objectives or any other activities that the participants is involved in throughout the research work must be free from harm. The participants must be guaranteed about their safety and it is the responsibility of the research participants to ensure that there is no harm occurring to the study subjects (Henson, 2016).
Data Analysis
The next step that helps in interpretation, describe, and analyze the data is data analysis. The statistical tools are used to show the probability of the relationship and prediction of the relationship between the variables. The research will be a mixed methodology, including both the qualitative and quantitative approaches. So, it will be in consideration to know the appropriate statistical techniques. The basic and descriptive statistics will be used for data analysis (Wright, 2016).
Training
The research outcomes will decide the shortcomings in palliative care, and nurses will be given guidelines on how they should deal with the patients and the gaps that need to be addressed (Weaver, 2018).
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