Euthanasia and Patient

The worst fear of a normal human being, is death therefore we are constantly doing everything in our power to avoid having to be faced with this dreaded yet unavoidable aspect of human life.

Than there are those whose only wish is to fasten the end of their life because of the excruciating circumstances that they may be facing. Sitting in a doctor's office and having to hear phrases like "you have cancer," "there is nothing that medicine can do in your situation," "here is a list of facilities offering hospice care," and "the best we can do for you is to do our best to alleviate the pain that you will go through because of your disease" can mark the beginning stage of someone who will soon have their perfect world crumble down into a million pieces. It is at these specific moments that one may consider euthanasia.The Encyclopedia Dictionary of Medicine, Nursing, ; Allied Health defines Euthanasia as "an easy or painless death" as well as "the deliberate ending of life of a person who is suffering an incurable disease." in recent years this definition has been broaden to include the practice of withholding extraordinary means or any heroic measures that would allow the patient to die.

An extraordinary measures is any type of treatment, usually invasive and in some cases may be considered burdensome to the patient.A distinction must also be made between positive (active) euthanasia and negative (passive) euthanasia. Active Euthanasia, is when there is a deliberate ending of life and an action is consciously taken to cause the death of a patient. A consciously taken action, would be something like providing the patient with an narcotic overdose, or simply providing any medication that will intentionally speed up the death of such patient.Passive Euthanasia is the withholding of life-preserving procedures and treatments that would prolong the life of one who is incurably and terminally ill and has no possibility of survival without these measures.This would include actions such as removing a patient from a breathing machine or not providing the patient with a necessary treatment such as dialysis.

In most cases, Passive Euthanasia is carried out at the patient's or their family's request when they are informed that the patient is not able to sustain by means of their own.Another important factor to consider when speaking of Euthanasia, is Physician Assisted Suicide (PAS). PAS, is when the physician supplies information to the patient and the means for committing suicide. For example, a physician has the ability to provide the patient, at their request, a lethal dose of sleeping pills, or give its patient a supply of carbon monoxide gas so that this person may easily terminate his or her life. PAS is commonly known in today's day and age as "Voluntary Passive Euthanasia (VAE)."Involuntary Euthanasia, another known form of this procedure, is often used to describe the killing of a person who has not requested aid in ending their life.

This is most often done to patients who are considered to be in persistent vegetative state or in a coma and will most likely never recover consciousness. It is in this area, that many questions arise. Medicine has advanced in such ways, that now medical professionals are capable of maintaining life through artificial measures. Therefore the question to be asked now, when referring to Involuntary Euthanasia, is what is the right to life? does it mean to merely stay alive, or does it include a meaningful life? Also, are we to allow someone to end their life by natural causes or because we can no longer keep them alive thru artificial measures?If that is the question, who than defines the natural causes of death?Vaibhav Goel, in his article "Euthanasia-a Dignified end of life!" states that allowing euthanasia is nothing else but giving medical professionals a permit or a license to end the life of a person in question.According to surveys that have been done in European countries, there is indication that many thousands of patients are routinely assisted to end their lives by doctors every year.

The Netherlands, is the only country in the world that is openly and freely able to practice Euthanasia and Physician Assisted Suicide. Although Physician Assisted Suicide is still subject to the country's criminal law, a physician will not be persecuted if they perform these acts as long as they follow certain regulations. In 1984, the Royal Dutch Medical Association decided that physician must meet the following requirements that will guarantee those physicians that they will not be persecuted if euthanasia was carried out.First of all, the request had to be made by the patient itself and it must be voluntary, durable, and persistent. Another requirement, was that the patient had been fully informed about the medical condition and the prognosis as well as the that there was nothing else that could be used as an alternative treatment.

Lastly, physicians would not be persecuted if the patient had unbearable pain and suffering. The Royal Dutch Medical Association, stated that "legal euthanasia should remain a crime, but that if a physician, after having considered all the aspects of the case, shortens the life of a patient who is incurably ill and in the process of dying, the court will have to judge whether there was a conflict of duties which could justify the act of the physician." Sadly, this can only mean that there are countries our there that have already been given this license or permit to end a life.On May 25, 1995 The Northern Territory of Australia became the first place in the word to pass law which allowed a physician to end the life of a terminally ill patient. The Right of the Terminally Ill Act, was made a law on July 1, 1996. Some of the requirements to carry out this law, were that the patient had to be of at least eighteen years of age, with a sound mind, and suffering from a terminally ill disease with an unacceptable amount of paint and suffering.

A little over six months after this act had become law, it was overturned by the Australian Federal Senate.Ending an adult's life may seem a little more acceptable, because it's a known fact that this adult patient has already lived his or her life. But what happens when the life at stake is that of an infant or a severely ill newborn? A study conducted in The Netherlands with a group of neonatologists, showed that each year there are approximately fifteen to twenty case of euthanasia in newborn infants who would be categorized into that third groupAccording to the New England Journal of Medicine, of the 200,000 children born in The Netherlands every year, approximately 1000 die during their first year of life. Six-hundred of those small patients, lost their life due to a medical decision that was made on their behalf. Infants and newborns for whom such an end of life decisions have to be made, can be divided into three categories.First of all, there are those infants that have absolutely no chance of survival.

This group consists of infants who will most likely die soon after birth, despite the good care they may receive.A second category, is that of infants that have a very poor prognosis and are dependent of intensive care. These patients may survive after a period of the Intensive treatment, but expectations regarding their future are very low. This category refers to patients that who have severe brain damage and abnormalities or extensive organ damage caused by hypoxemia. Usually if and when this infants are able to survive beyond the intensive care days, the quality of life is extremely poor with a very poor prognosis.

Last, infants with a hopeless prognosis who experience what the parents and medical experts would classify as unbearable suffering. Although these patients may not require nor may be dependent on intensive medical treatment, the quality of life is extremely poor and is associated with sustained suffering.Legalizing Euthanasia, with no doubt may in fact be the biggest threat to the human race. Whether Euthanasia is carried out in newborns, infants, teenagers, or adults, the question that one must ask themselves is: what is the ethical aspect of this controversial issue? As health care administrators, one must be able to distinguish that very fine line between what it is a liberate action of intentionally killing a patient and withdrawing care because there is no more hope for them and the quality of that life that they will be allowed to enjoy.Withdrawal of treatment for a patient who can no longer be helped by the advances of medicine can be a controversial discussion among families.

Many times as Healthcare Administrators, we are required to interact with the families about the decisions that must be made about their loved one. It is very clear to every family that we do not want to see our loved ones depart from us. It is for that reason, that there must always be a plan in place to deal with situations that may require a little more attention and sympathy for our families.There are no specific strategies that have proven to work successfully when dealing with patients, their families, and the decision to end life. Many families, when given the devastating news that their loved one is no longer able to continue to have a life full of independence, quality, and health; all they want to do is spend those last few minutes or hours at the side of the patient. As healthcare managers, our primary job is to be able to provide to the best of our ability the privacy and sympathy that this family will need while saying goodbye to their loved this last time.

Another strategy that may be considered successful when dealing with such situations, is to provide the family the help that they may need in regards to their own nutrition and well being. A human being natural reaction to losing some one the love, is to isolate themselves from the world that surrounds them. As the administrator, it is our job to work along side with case management and social workers to make sure that the family has the correct and abundant resources that they will need to be able to take care of themselves. Many times, this may required that we step out of our offices and out of our comfort zone and make sure that this family is well taken care for.When it comes to managing a healthcare facility, educating our faculty and staff is key to being successful. Many times, our medical professionals walk into our facilities with no experience under their belt and therefore do not know how to act or react to these difficult situations.

It is the job of a healthcare administrator to be certain that his or her staff is appropriately equipped to deal with all kinds of dilemmas and different difficulties that we may face in our jobs constantly.One strategy would be to have all the medical professional properly trained. The development of a special program can be carried out to teach our staff to be able to set our preferences and views to one side and think about the patient and the best possible care for them. Staff could be allowed and trained to provide comfort to the patients's family.