The tricky business of death has hit the news again lately, with Bob Brown’s proposed euthanasia bill, two pro-euthanasia ads banned on television and various discussions of the problematic ethics behind making death a political dilemma.
These have made me stop and reflect on my thoughts on the matter. I am a recently registered nurse in my new graduate year. I also have an extensive history in working in aged care. Issues such as euthanasia and especially “do not resuscitate” orders, are not avoidable for me, as they are part of my work day in, day out.
I once looked after a mother of two who had a minor fall at home. She lost consciousness, couldn’t breathe on her own, had minimal brain activity and was kept alive in ICU. Her family was stuck with non-functioning mother who couldn’t communicate, made little response and will suffer chronic health conditions for life. Her children were traumatised and her husband unable to cope with the “loss” of his wife, while still dealing with her being kept alive medically.
Another patient, a woman in her late 90s, was admitted to emergency with chest pains. She tried to refuse all treatment, but doctors persisted and persisted (which, legally, they had to do). She kept claiming she was allowed to refuse but they went on with the treatment. She ending up deteriorating in hospital, despite her pleas to go home to her house of 40 years and be with her cat. Eventually, she was sent to a nursing home.
As always with bio ethics (ethical dilemmas in health care) issues, the law is tightly wound through the whole problem. As registered nurses in Australia, we have a legal requirement to act ethically and ethical principles woven into our common law and legislation in Australia. To become registered nurses, we must agree to abide by the ethical principles of the registration board. However, in situations such as “do not resuscitate” (DNR) orders and euthanasia, I do not believe that the law is ethical.
DNR orders are a constant headache for many nurses working in the health system. If we get a “bat call” (a call from ambulances officers informing us of a serious accident or injury) we have to treat that person. If we don’t know who they are and they are not able to communicate with us, the law gives us implied consent and we must treat them.
Not treating people, even with their wishes, is a very tricky minefield. The four ethical principles guiding medical professionals are autonomy, non-maleficence, beneficence and justice. Nurses work to find a balance between achieving these principles, but at times this can be extremely difficult. Autonomy refers to a person’s right to self-determination while non maleficence asks us to do no harm, and beneficence then tells us to do good. How can we respect that someone wishes to die with dignity but do no harm to them? More importantly, how can we not provide treatment without being called up for negligence?
Our health systems are currently stretched and deeply underfunded. While I do not believe that health has a price, we need to consider the benefit of using over-stretched resources in instances where the success of our treatment may be minimal.
In nursing we talk about two different success rates. Success as in the patient being brought back to life or being kept alive by medical technology and also success as in the quality of life afterwards. Not often enough is a person who is brought back to life or woken up from intensive care rewarded with a perfect quality of life.
Today, if I was in an accident and left with constant pain and injuries preventing me from communicating with my friends and family and contributing to society, I have no doubt the doctors and nurses would work to save my life with little regard for my wish to be allowed to die with dignity. This is due to the reality that DNR orders are currently only the domain of our palliative or seriously ill citizens. Hospitals have a culture of intervention with the aim to save people’s lives and preserve their health. We may be young, happy and healthy today but life changes quickly. We can only give consent for a “do not resuscitate” order when we are of full legal capacity to give it but DNR orders are not given to the happy and healthy. Wouldn’t it be nice if we could have our wishes placed on a register that our medical doctors could not ignore?
A final thought to leave you with is when you are about to pick up the phone to call an ambulance for a palliative, ill or dying family member: strongly consider whether you are making the right decision as you may just be prolonging their death, not giving them life. Maybe pause for a few moments with them and remember the life you have had with them and the “life” that may lie ahead if medical intervention occurs.