Ethical, Legal, and Moral Analysis of Euthanasia in Advanced Practice Nursing

Euthanasia, often referred to as mercy killing, is the deliberate act of ending a person’s life to alleviate intractable suffering. As societal attitudes and legal frameworks evolve, euthanasia has become a polarizing topic in nursing practice. This paper explores euthanasia through the lens of advanced practice nursing, analyzing the interplay between legal, ethical, and moral dimensions: Ethical, Legal, and Moral Analysis of Euthanasia in Advanced Practice Nursing.

Legal issues pertain to the codified laws governing euthanasia; ethical issues revolve around professional and philosophical principles and moral issues stem from individual and cultural beliefs. This complexity requires advanced practice nurses (APNs) to critically assess their role and stance on euthanasia, particularly in states like Minnesota, where euthanasia remains illegal.

Legal Context in Minnesota and the United States

Euthanasia laws have not received equal standards across the United States. At this time, there is no legal existence for euthanasia in Minnesota, no enabling statutes regarding terminal care, physician-administered suicide, or active euthanasia. Many of the state’s laws allow only for the protection of life and prohibit actions that result in the taking of human life. However, there are some states like Oregon and Washington where physician-assisted suicide is legalized under certain conditions, such as under the Death with Dignity Act (Lee, 2023).

To date, there is no federal law in Australia that directly allows euthanasia, which remains the exclusive domain of the states. The absence of a coherent legal provision for ethical decision-making is unsuitable for APNs involved in ethical issues because of the legal. The usability of euthanasia negates moral standards of law such as autonomy or beneficence.

Pro Decision: Permitting APNs to Provide Euthanasia

Ethical Theory: Utilitarianism

Utilitarianism, a consequentialist ethical theory, provides a strong foundation for supporting euthanasia. According to this theory, an action is right if the result of the action leads to the most amount of total utility excluding harm. From this angle, allowing APNs to offer euthanasia is in step with the no-win vision of providing unbearable pain relief and honoring the client’s decision-making rights during the dying process.

Ethical Principles Defending the Pro-Decision

Autonomy

Suffering patients have the right to personal autonomy, which consequently gives them the right to die whenever they want. Disregarding this choice violates the patient’s autonomy while letting the APNs respect the decision and enhances self-determination (Olejarczyk & Young, 2024).

Beneficence

Euthanasia can be seen as an act of compassion aimed at relieving pain and suffering that cannot be mitigated through other medical interventions.

Justice

The provision of euthanasia services in such a manner eradicates differences in service provision concerning vulnerable groups who could otherwise be denied or not have access to specialized palliative services.

Relevant Nursing Codes of Ethics

The American Nurses Association (ANA) Code of Ethics emphasizes respect for patient autonomy and the provision of compassionate care. Provision 1 explicates the nurse’s obligation to maintain respect for human personhood, and Provision 2 refers to the promotion of patients’ rights. The International Council of Nurses (ICN) Code of Ethics also challenges nurses to relieve suffering because it is compassionate to do so.

Con Decision: Opposing APNs’ Involvement in Euthanasia

Ethical Theory: Deontology

Deontology, an ethical theory rooted in duty and adherence to moral rules, opposes euthanasia on the grounds that taking a life is inherently wrong, regardless of the consequences. From this perspective, APNs have a professional and moral obligation to save lives and to do harm to no one intentionally.

Ethical Principles Defending the Con Decision

Nonmaleficence

The principle of “do no harm” conflicts with euthanasia, as intentionally ending a life is fundamentally harmful, even if intended to alleviate suffering.

Sanctity of Life

Deontological ethics prioritize the inherent value of human life, viewing euthanasia as a violation of this principle.

Professional Integrity

Involvement in euthanasia may undermine the public’s trust in nursing as a profession dedicated to healing and care.

Relevant Nursing Codes of Ethics

The ANA Code of Ethics explicitly states that nurses should not participate in actions intended to end a life, emphasizing their role in providing comfort and support without hastening death. Provision 5 highlights the importance of preserving the nurse’s integrity, which could be compromised by participation in euthanasia.

Ethical or Moral Stance: Pro-Decision

Having considered the arguments of Con and Pro, this paper is in agreement with the Pro arguing that APNs should be allowed to perform euthanasia legally but under specific legal and Ethical guidelines. It has an authoritative base proper for beneficence and self-governing agendas, which are aimed at the partiality of suffering and on patients’ desires about their life termination.

Impact on Population Health

Allowing euthanasia means that there are risks to population health. First, it ensures that all patients, particularly those with terminal diseases, get decent treatment to help minimize needless pain. Second, this approach contributes to increased trust between patients and healthcare facilities since the latter shows that they value patients. But in order to avoid the abuse of such instruments, coercive measures should be employed with respect to the categories of persons who can be considered vulnerable (Picón-Jaimes et al., 2022).

Exercising a medical practitioner’s full control over a patient’s death through euthanasia requires assessing and satisfying cultural requirements. For example, before designing a program on end-of-life care, various stakeholders in the health care field should first consult the various cultural groups to be served in order to better understand their cultural attitudes towards the issue at hand. This cultural competence can improve confidence and ensure that euthanasia services are rendered as per the cultural belief system of the patients. However, stronger measures need to be put in place to ensure the proper standard is set, mainly the eligibility criteria, proper and comprehensive patient evaluation, and second opinions, amongst others, to enhance ethicality.

Addressing Moral Distress

Recommendations for Practice

Ethics Consultation Services

Establishing ethics committees within healthcare institutions provides APNs a platform to discuss and resolve ethical dilemmas, reducing moral distress.

Continuing Education

Presenting a program on ethical decision-making and end-of-life care prepares APNs by providing them with awareness of the aspects that they may meet in their practice.

Support Systems

The institutions should ensure that they avail themselves of sessions and peer support groups for APNs who may be emotionally stressed by participation in euthanasia.

Recommendations for Scholarship

Research Initiatives

Encouraging research on the psychological impact of euthanasia on APNs can inform strategies to address moral distress.

Collaborative Forums

Creating interdisciplinary forums for APNs to share experiences and best practices fosters a supportive professional community.

Ethics Curriculum Development

Universities offering nursing education should ensure that an advanced course in ethics is incorporated into the preparation of APNs, including euthanasia.

Moral distress must also be managed by ensuring good organizational culture, such as communication and employees’ emotional health. It is recommended that practice settings provide time for a debriefing of events whereby the APNs can discuss their practice encounter and challenges experienced and get direction from other APNs or supervisors. It is not only relieving short-term pressure but is also a form of building staff immunity and strengthening professional development.

Moreover, creating mentorship programs will enable newly employed nurses to approach seniors in a way that would readily provide them with crucial information regarding ethical dilemmas and ways of handling stress. All these measures complement each other so as to make sure that APNs feel encouraged to practice their ethical standards, especially as they deal with more challenging clinical situations.

Conclusion

Euthanasia is an area that has legal, ethical, and moral dimensions and that puts professional responsibilities into conflict with the personal beliefs of the APNs. Allowing APNs to perform euthanasia is the recommendation of this paper while maintaining the principles of autonomy and benevolence alongside mitigating the factors causing moral distress. As a result, some of the consistencies include the fact that the care provided to patients has to meet legal and ethical requirements, the need for effective APN care, and practical approaches that foster effective APN professional practice.

It must be the resolve of APNs in each era that they embrace and practice ethical behavior and adherence to the code that regulates health care while meeting the ever-changing unknowns of society’s patients. Moreover, discussion of the different possibilities of euthanasia as one of the important issues can be used to create rational outlooks among providers and clients. Changes in educational curricula for APNs, policy transformation, and a supportive professional environment will in the future allow APNs to manage euthanasia ethical issues without compromising the existing professional ethics.

References

Lee, M. A. (2023). Ethical Issue of Physician-Assisted Suicide and Euthanasia. Journal of Hospice and Palliative Care, 26(2), 95–100. https://doi.org/10.14475/jhpc.2023.26.2.95

Olejarczyk, J., & Young, M. (2024, May 6). Patient Rights and Ethics. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538279/

Picón-Jaimes, Y. A., Lozada-Martinez, I. D., Orozco-Chinome, J. E., Montaña-Gómez, L. M., Bolaño-Romero, M. P., Moscote-Salazar, L. R., Janjua, T., & Rahman, S. (2022). Euthanasia and assisted suicide: An in-depth review of relevant historical aspects. Annals of Medicine and Surgery, 75(75), 1–6. https://doi.org/10.1016/j.amsu.2022.103380

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Analyze theoretical frameworks and concepts related to ethical dilemmas in the advanced practice role.

PC-2.3: Demonstrate integrity through the application of relevant codes of conduct and social responsibility within one’s profession.

Canada is the first country to permit Nurse Practitioners to provide euthanasia. Assisted dying legislation has been introduced in health systems in Europe, North America, Australia, and New Zealand.

From the perspectives of your nursing practice specialization (Nurse Executive leader, Nurse Practitioner, and Nurse Educator), propose both a Pro and Con decision for nurses to consider as they reflect upon the law vs ethics vs morals to their own participation in euthanasia, a contemporary societal issue of significance for nursing practice.

Directions:

1. Write an introduction on euthanasia and the differences between legal, ethical, and moral issues.
2. Identify the laws of your state (Minnesota) and country USA pertaining to euthanasia.
3. Construct a Pro decision to permit the APN/APRN to provide euthanasia which includes the following:
   • Select an ethical or moral theory reflecting your thought process.
   • Integrate ethical or moral principles defending the decision.
4. Construct a Con decision to permit the APN/APRN to provide euthanasia which includes the following:
   • Select an ethical or moral theory reflecting your thought process.
   • Integrate ethical or moral principles defending the decision.
5. Select relevant American Nurses Association or your specialty nursing association codes of ethics that apply to the APN/APRN role.
6. Take an ethical or moral stance based upon your Pro or Con decision addressing how your stance will impact population health.
7. Provide recommendations to address APN/APRN moral distress which support ethical conduct in practice and scholarship.
8. Write a conclusion presenting key takeaways.

This paper should be 4 pages in length, not including title and reference pages.

Be sure to include scholarly resources to support your written work at least 3 sources or more.