Debate_Assignment

Debate Assignment “Everyone has the right to decide when and how to die “ This assignment will focus on the statement above and the issues surrounding it. This area has become an issue because, people believe ending of a person’s life is usually wrong and life is regarded as precious. The author will present this assignment using the structure of a reflective model, the model I have decided to use is Gibbs, and the reason for this as it makes it possible to explore all issues in depth. The debate was conducted by a class of third year student nurses; the class was split up into two groups, one for the motion above and one against the motion. Each group consists of a chairman, two main speakers and a summariser. Their goals are to provide evidence to support for or against the statement. The author was in the group for the argument. The author felt that this debate was carried out to the best of the group’s abilities, bringing an array of differing issues for and against the motion. At the end of the debate the audience were asked to vote on who they thought gave a better argument, and the against group won. This debate went well because everyone’s opinions were valued and appreciated. The author feels that she gained from this experience as it gave her a better understanding of the area and issues around, do people have the right to decide when and where to die' Nevertheless the author still understands that her knowledge is limited and therefore will look into three areas raised in the debate to get a better understanding on “the right to decide when and how to die”. One of the issues the author feels important is the Mental Capacity Act does it or does it not support the right to die. The Mental Capacity Act (2007) was created to promote autonomy and empowerment by encouraging people to participate in the decision making process. It empowers people to appoint a person to act on their behalf if they lack capacity to do so for themselves in the future. The Mental Capacity Act, to an extent also supports passive and voluntary euthanasia. Passive euthanasia is withdrawing treatment with the deliberate intention of causing the patient's death and voluntary euthanasia is a clearly competent person makes a request for help to die (Colabawalla 1996). The act supports this by allowing patient’s to make advanced decisions to decline treatment even in life threatening cases. This is done by a document called an Advanced directives, these must be very detailed and state exactly what the patient wants, because a health care professional has a duty to save lives and protect the patient, so therefore the patient will not have a choice to decided when and how to die (NHS 2006). This should be completed in writing and witnessed by a person with full competency (Department of Health 2004). The advanced directive gives the individual a right to die with a greater level of dignity, but is completed in the best interests of the patient. They will have to be specific, relate to conditions that were anticipated, and the patient must not have done anything inconsistent with the decision since it was made advance decisions will be given statutory power. Health care professionals have a responsibility to prolong life but not to end of life (Crest 2004). The problem with the Mental Capacity Act is that integrated within the refusal of treatment of water and nourishment which are a basic requirement of life. Some people feel that not giving a patient food and water is a form of euthanasia (Marita, 2000). The Nursing Midwifery Council (NMC) highlights that a patient autonomy needs to be respected, even if a patient refuses treatment and it ends in premature death (NMC 2004). It also highlights that patients have a choice of when and how to die. The information that was brought forward against the argument is that both euthanasia and assisted dying are illegal in United Kingdom. Which means that choices to end a person’s life are illegal' There are two acts that support this, the Suicide Act of 1962, in which a person can be held liable for a suicide as its illegal. Also the Murder Act of 1965 which states that intentional murdering even with the persons consent, for empathetic reason is a crime. For example the Dianne Pretty’s case she had motor neurone disease and unsuccessfully applied to the courts that her husband could help her die, that he wouldn’t be prosecuted but it was overruled because of the law (Ministry of Justice 2006). Because of this, many people feel that they don’t have a right to die (Jones 2006). Despite current laws, a recent survey conducted by the National Centre for Social Research showed that 82% of people feel that euthanasia should be made legal to give more patients’ choice of when and where to die (Gormally 1997). But this could be dangerous because people could misuse the right, ending in unnecessary deaths .Vulnerable patient’s are most as risk from advanced directives as these could neglect the patient’s if a party makes decision over their lives, therefore statutory power’s could make these advanced directives dangerous (Yamey 2002). The Suicide Act 1965 have decimalised suicide to give people the right to commit suicide as long as the act of death is done alone (Suicide Act 1965). Indirect euthanasia is conducted every day by health care professionals under double effect (Yamey 2002). This is an act that is good it has two effects an intended and not reasonable affect and intended and foreseen evil effect. Some people abuse double effect like in the case of Harold Shipman. Shipman shortened his patient’s lives with high doses of drugs, this was wrong as he manipulated his patients by securing their trust and then he murdered them for his own personal gain e.g. patient assets (Rocker 2001). The legal policy of "double effect" justifies giving pain-relief treatment, provided it is set with the primary intention to alleviate pain, and excuses any inescapable, but unwanted, life-shortening effect of doing so. In short, the act of pain relief is warranted — it is a right act; its unwanted outcome of shortening life is accepted (i.e., tolerated) in the conditions (Marquis 1991). An explanation carries the significance of shortening life is wrong, but the person who does so will not be prosecuted (i.e., he or she will have legal immunity) (Marquis 1991). The doctrine of "double effect" requires, first, that the action resulting in a bad effect (such as the shortening of life) is morally neutral. Providing pain-relief treatment would qualify as at least a morally neutral act. This could be an ethical dilemma, because all health care professional’s have an obligation to involve patients in their care (NMC 2004). Health care professionals do not perceive this act as euthanasia but as providing a pain free death. This is because health care professionals have an obligation to prolong life, but not death (Crest 2004). Would the patient feel burdened to agree with euthanasia' The trust between health care workers and terminally ill patients This issue has come from the increasing number of people wanting to legalise euthanasia. A Bill going through the House of Lords is attempting to change the law around assisted dying and only months after UK doctors took what they described as a “historic decision” to drop their long-held resistance to physician-assisted dying (Hanlon 2006). If assisted dying was made legal this would put a considerable burden on these patients to consider it even if they would not even entertain the idea if they were fully well. Health professionals explaining options for the management of terminal illness would have to take account of assisted dying (Emanuel L 1998). Patients might feel indebted to choose it for the wrong reasons, such as if they felt a burden to their family or concerned about the financial implications for their care. 65 per cent of people agreed that if such a change went ahead, "vulnerable people could feel under pressure to opt for suicide" (Care not Killing 2006) The connection with the health care team is an important issue determining the experience and adaptation of the dying patient and his or her family. The relationship with the treating doctor has particular importance (Kohlwes 2001). The doctor also faces a set of complex emotional demands in responding to the request for assisted suicide when it arises. The doctor-patient interaction has additional importance where legislation permits assisted suicide, because if assisted suicide was legalised this would change the relationship between the doctors and the patient. There could be a shift in the trust between the two parties this is an issue for doctors that appose the idea of assisted suicide (BMA 2006). The relationship could suffer and the patient could feel no trust from the doctor. As medicines primary goal is to heal this would impact on how doctors relate to their own role and to their patients. Patients not only benefit by physical and clinical advances but also gain by having their own belief respected and be able to achieve their own goals whether from treatments to death. There are also benefits if euthanasia is legalised people who be given the right to choose for themselves to control how their life was ended (BMA 2006). To conclude this statement, is a major issue within today’s society. This is due to there being laws to prevent people committing any form of euthanasia and assisted suicide e.g. Human Rights Act (1998), Murder Act (1965) and the Suicide Act (1961). This means that unless a person has an advanced directive, or refuses treatment or commits suicide, then how a person dies is left to nature. Now because of the change in law the suicide act allows for people to take their own lives with out being prosecuted, this is giving these people choice. Older people are important to the infrastructure of the United Kingdom, but when it comes to the end of life people with cancer can receive higher standards of care than older people. Sometimes they are given limited choice of how they want to die, this is because the majority of older people wish to die at home, but only 20% of older people achieve this. The author believes this is due to there being an overall lack in resources within the community setting. Altogether the author felt strongly and agrees with the argument that everyone should have the right to die where and how but agrees in the fact that not everyone gets that opportunity to die where and how they want in this society. From writing this piece of reflective writing, the author plan of action is to make sure she increase her knowledge on all the current polices on the issues of whether people have the right of when and how to die. References BMA, (2006),’Assisted dying – a summary of the BMA’s position’ [online] available from: [accessed on 12/11/07]. Colabawalla, (1996),’Understanding voluntary euthanasia: a personal perspective’ Indian Journal of Medical Ethics, Jan march 1996-4 (1). Care Not Killing,(2006),’ Euthanasia Bill would give green light for more Shipman cases, according to new poll’, [online] available from: [accessed on 12/11/07]. Crest, (2004), ‘Guidelines for the management of the enteral tube feeding in adults’, [online] available on: < www.crestni.org.uhltube-feeding-guidleine.pdf> accessed on 12/11/07. Department of health, (2005) The mental Capacity Act: Summary [Online] Available from: http://www.dca.gov.uk/legal-policy/mental-capacity/mca-summary.pdf [Accessed on 17/11/07 Emanuel L: Facing requests for physician-assisted suicide: toward a practical and principled clinical skill set. JAMA 1998; 280:643–647[Abstract/Free Full Text] Gormally, L, (1997). Euthanasia and assisted suicide: seven reasons why they should not be legalized [Online] Available from: http://www.linacre.org/newsle~1.htm [Accessed on 21/11/07] Hanlon, (2006) ‘Society puts impact of assisted dying on agenda as part of wider debate’, The Pharmaceutical Journal, Volume 276 No 7384 p67-68. Kohlwes RJ, Koepsell TD, Rhodes LA, Pearlman R: Physicians' responses to patients' requests for physician-assisted suicide. Arch Intern Med 2001; 161:657–664[Abstract/Free Full Text] Nursing and Midwifery Council, (2004). Code of Professional Conduct: Standards for Conduct Performance and Ethics. London. Crown Copyright Marquis, D.B., "Four Versions of Double Effect," Journal of Medicine and Philosophy, 16 (1991): 515-44; Cataldo, P.J., "The Principle of the Double Effect," Ethics & Medics, 20 (March 1995): 1-3.] Marita, T, (2000). Pain and Symptom Management: Terminal Sedation for Existential Distress, American Journal of Hospice and Palliative Care 17, (3) pp 189- 195 Ministry of Justice. (2006). ‘Human Rights: Rights and Responsibilities’. [online] Available from: < http://www.justice.gov.uk/docs/hr-handbook-introduction.pdf> [accessed on 12/11/07] Rocker G. Ethical dilemmas: Can doctors and nurses be trusted' When a colleague is charged with murder. Program and abstracts of the 8th World Suicide Act (1961). The Suicide Act 1961 [Online] Available from: http://www.statutelaw.gov.uk/content.aspx'LegType=All+Primary&PageNumber=69&NavFrom=2&parentActiveTextDocId=1132509&ActiveTextDocId=1132509&filesize=16165 [Accessed on 19/11/07] Yamey, G, (2002). Legalising active euthanasia and physician assisted suicide, British Medical Journal, 11, (5) pp 846