bioethics death and dying

• Types of euthanasia


  • Active euthanasia - actions to bring about the client's death directly, with or without client consent; forbidden by law (murder); violation of code of ethics for nurses
  • Assisted Suicide (variation) - giving clients a means to kill themselves if they request it; some countries permit this
  • Passive euthanasia - "withdrawing or withholding life-sustaining therapy"; more legally acceptable to most persons than assisted suicide
• Dying patients


  • Helping clients die with dignity
  • Hospice and palliative care
  • Meeting the physiologic needs
  • Spiritual support
  • Supporting family
• Any human life is of infinite value as it is a sacred and precious gift from the almighty Creator
• It can never be sacrificed by whatever means for whatever reasons
• Principle of double effect may be applied by those who are competent
• Dysthanasia


  Useless treatment, which values saving the life at any cost and submits patients to therapies which do not prolong life, but rather the death process
• Orthothanasia


  Does not tolerate disproportionate treatments, does not incur in abusive delays, it faces death at the right time
• Hospice care


  • Comprehensive physical, psychological, social, and spiritual care for terminally ill patients
  • Goal: achieve a full life as possible, with minimal pain, discomfort, and restriction
  • Coordinated team effort to help the patient and family members overcome the severe anxiety, fear, and depression that occur with a terminal illness
  • Open communication - evaluating patient care / cope with their own feelings
• The Natural Death Act of 2005 recognizes the fundamental right of adult persons to decide their own health care, including the decision to have life-sustaining treatment withheld or withdrawn in instances of a terminal condition or permanent unconscious condition
• Requirements for a valid advance directive

  • Person of legal age and sound mind
  • 2 witnesses: not related to the declarer by blood or marriage, would not be entitled to any portion of the estate of the declarer upon declarer's decease under any will of the declarer, not the attending physician, not an employee of the attending physician or a health facility in which the declarer is a patient, have no claim against any portion of the estate of the declarer upon declarer's decease at the time of the execution of the directive
• Any physician or health care provider acting under the direction of a physician, or health facility and its personnel shall be immune from legal liability, unless otherwise negligent
• Mercy killing or physician-assisted suicide is not authorized
• Treatments that can help sustain a patient's life

  • Nutrition support and hydration
  • Cardio-pulmonary resuscitation
  • Defibrillation
  • Mechanical ventilation
  • Dialysis
• If patients or caregivers demand a treatment that health practitioners have determined to be useless, a legal resolution may be required
• Medical personnel may find it objectionable to withdraw life support when they know that the inevitable consequence will be the patient's death
• Advance directives (living wills) and durable power of attorney (medical power of attorney) can help ensure a person's wishes are considered if they become incapacitated
• Things to consider when writing a living will

  • Use of equipment such as dialysis machines (kidney machines) or ventilators (breathing machines) to help keep you alive
  • Do not resuscitate orders (instructions not to use CPR if breathing or heartbeat stops)
  • Fluid or liquid (usually by IV) and/or food (tube feeding into your stomach)
  • Treatment for pain, nausea, or other symptoms, even if you can't make other decisions (this may be called comfort care or palliative care)
  • Donate your organs or other body tissues after death
• Do-not-resuscitate (DNR) order


  Withhold CPR; does not exclude other life-prolonging measures; physician can write this order but must consult the patient or surrogate if this is done
• Ethics committees can help update patient care policies pertaining to end of life treatment
• Dying Patients' Bill of Rights

  • Treated as a living human being until I die
  • Maintain a sense of hopefulness however changing its focus may be
  • Express my feelings and emotions about my approaching death in my own way
  • Participate in decisions concerning my care
  • Expect continuing medical and nursing attention even though cure goals must be changed to comfort goals
  • Not to die alone
  • To be free from pain
  • Have my questions answered honestly
  • Not to be deceived
  • Have help from and for my family in accepting my death
  • Die in peace and with dignity
  • Retain my individuality and not be judged for my decisions which may be contrary to the beliefs of others
  • To be cared for by caring, sensitive, knowledgeable people who will attempt to understand my needs and will be able to gain some satisfaction in helping me face my death
• The ethical decision-making process involves identifying the moral aspects, gathering relevant facts, determining ownership of the decision, clarifying and applying personal values, identifying ethical theories and principles, identifying applicable laws or agency policies, using competent interdisciplinary resources, developing alternative actions and projecting their outcomes, identifying nurse codes of ethics, participating actively in resolving the issue, and evaluating the action taken