Ethics in Nursing > Chapter 2

Chapter 2: Human Dignity and Euthanasia

This chapter examines the first two provisions of the ANA Code of Ethics along with associated case studies and examples which clarify the provisions as they relate to the respect for human dignity and euthanasia.

Topics Covered

a. The concept of human dignity and its application to nursing.

b. The Ethics of Euthanasia

Respect for Human Dignity

Of the various provisions presented in the code of ethics for nurses, the provision which demands a respect for human dignity is perhaps the most readily accepted and appreciated since it applies not only to nursing but to almost every other professional field. The concept of an inherent dignity of a human being is certainly not a new one; even since the time of ancient Greek philosophers it was accepted that human beings are endowed with special qualities which set them apart from other living things (Beyleveld & Brownsword, 2002).

With time, the idea of respecting human dignity has become one of the foundations of western civilization. The Universal Declaration of Human Rights begins with the recognition of human dignity along with equal and inalienable rights for all members of humanity and calls this the foundation for all freedom and justice, as well as peace in the world (UN, 1998). Clearly, these are lofty aims and it becomes difficult for individuals to understand how this very concept can be applied to their own professions. This is particularly true for the medial and nursing fields where human dignity is often difficult to maintain (Beyleveld & Brownsword, 2002).

Ethically, the nurse is expected to have respect for human dignity and exhibit this respect in her day to day duties (Jacobs, 2001). In the simplest of terms, a nurse can show his respect for the dignity of others if he treats them the same way he expects treatment from someone else. For example, given that Nurse Mark is not respectful of subjects in a drug treatment study and considers working with them to be waste of time, then Nurse Mark can be said to be going against the first provision of the code of ethics and not accepting the human dignity of the test subjects equal to his own.

Nursing ethics demand that individuals should not be taken as means to an end (Jacobs, 2001). As shown in the example above, by not showing subjects the respect they deserve, Mark is treating those individuals as means which could lead him to treat other individuals without respect. On the other hand, take the case of Nurse Jane as described below. Jane works in the children's ward of the local hospital and has a high regard for human dignity. She always makes it a point to close the curtains around a bed when she is performing her duties with a patient, even if she is performing something minor like an administering an injection. Even though her patients are mainly adolescents or young children she recommends giving the patient all reasonable access to his/her privacy.

This situation is a good example of the respect for human dignity, even when it comes to the dignity of someone who may not care for, or even understand, the concept of privacy. Nurse Jane shows us that all human beings have to be respected in equal terms and, if adults can ask for curtains to be drawn while they need privacy, then children should also be given the same treatment regardless of their age or individual ailments. While privacy concerns are one aspect of ensuring the human dignity of the patient, the respect for the dignity of a patient also extends to respecting the uniqueness and cultural values a person holds dear.

For example, a patient who holds conservative values may not feel very comfortable in disrobing before or being examined by a person of the opposite sex. A person belonging to the Jewish faith may not be very happy and could even be outraged if pork is served to them. A Muslim woman who adheres to the rules regarding appearances in public may not be very comfortable if asked to wear some hospital garments. In all situations where human dignity or patient values are in conflict with the provision of optimum care, it becomes the duty of the nurse to create a balance between what must be done to deliver the aid required by the patient and to conserve the dignity of the individual in question. If a nurse can form a positive connection with a relationship of respect with the patient, then a large part of the human dignity ethics requirement is already satisfied (Soderberg et. al., 1997).

A Dying Patient

Nurse Carrey thinks that patients who are suffering from a terminal disease and have less than a few months to live would probably not care anymore if they are supposed to exercise or not. She further thinks that since they can not be saved by medical science, they should be made to leave the hospital regardless of their state since they are only using up valuable and limited resources. These ideas are unethical simply because the nature of the health problem, or an individual's closeness to death, does not make them any less human or worthy of our support and professional assistance (Soderberg et. al., 1997).

A nurse is guided by ethics that she should work towards the promotion and restoration of health and, in case there is no hope of recovery, she should continue to provide supportive care for people who are on their death bed. Even if a person is suffering from a debilitating disability or any other ailment which does not allow them to take part in life as much as a normal person could, the nurse should still seek out means to provide physical well being, social support, spiritual connections and emotional help for the patient (ANA, 2001). Clearly there are some health problems from which recovery is impossible and medical science gives up after a certain level of effort. No matter how ethical or good a nurse can be, she cannot prevent death, but the ethics concerning human dignity and the equality of individuals demand that a nurse show as much concern for a person about to die, as towards a person who can be saved with effective care.

Of course a question can be raised as to why such ethical procedures must be followed? The application of this ethical principle in nursing is made obvious by the fact that the process of dying takes its toll not only on the patient but also on the family and friends of the individual who is at the end of her life (Soderberg et. al., 1997). The role of the nurse who provides ethical and dutiful service in this case extends to the family of the patient who are united in their aim to ease the last few days of the dying person. When nurses have to deal with death on a daily basis it can become commonplace, and the emotions associated with death can be suppressed completely by a professional. However, the ethical nurse knows that her duty is to use nursing skills in alleviating the suffering and pain of the dying patient as much as possible (ANA, 2001).

Euthanasia and Human Dignity

Euthanasia is a very important topic in the context of ethical nursing and its application with regard to the first provision of the code of ethics comes with regard to human dignity for dying patients. Nurses are asked to be active participants in the assessment process for eliminating treatment strategies which are medically and ethically unwarranted or not desired by the patient. Soderberg et. al. (1997) discuss several situations with regard to human dignity where nurses can also be called upon to help with decisions concerning:
  • Resuscitation
  • Removing or withholding life support
  • Pain management and control of medical symptoms
The ethical nurse is asked to do all that he can in order to alleviate pain and reduce symptoms in a dying patient even if the steps taken by the nurse can hasten the dying process (ANA, 2001). Ethically, the idea of prolonging life for a dying patient is only viable when the patient is not suffering, but if the patient is in pain, then alleviating pain is the ethical requirement for maintaining human dignity and patient comfort.

The code of ethics is absolutely clear on the point that no nurse can act in way which comes with the sole intention of ending a patient's life, even if the motive is sympathy, kindness, or concern for the patient and his family (ANA, 2001). While the code of ethics clearly does not permit euthanasia, it does leave the door open for debate on this topic since nurses are asked to actively work towards helping individuals with end of life decision and to work in their own area to help people, as well as fellow nurses towards research, study, education and policy making decisions on the topic. As reflected by changes made in previous ethics codes, there is room for growth and things might change as society develops (Fowler, 2000).

Policy making and education on the topic of euthanasia and human dignity connects directly with the idea that patients have an ethical right of self-determination which is also a legal right. This right gives the patient the ability to select what treatment they can receive, the way the treatment is given and to refuse treatment if they wish to (ANA, 2001). Nurses have an ethical duty to help patient make these decisions by informing them as much as they can about the disease, the treatment and the effects of the treatment. In no way should a nurse be deceptive, coercive or withhold information from a client when giving advice or helping the process of informed consent (Rankin, 2000).

Take the case of Nurse Edwina who was asked by a terminal patient if refusal of a certain treatment would bring about the event of death quicker. Nurse Edwina knows that the patient wishes to die and feels compassionate enough to clearly tell the dying man that death would come sooner if treatment is refused. However, she withholds a vital piece of information that refusal of treatment would increase the pain and suffering of the patient during the short time he would be alive. In this situation, Edwina has acted very unethically since she can be held liable for two breaches of the code of ethics. First, she has withheld information from a client and second, she has not done all that she could to alleviate the pain and suffering of those in her care.

Of course the ethics concerning informed consent and human dignity apply in universal terms regardless of the patient's age, or even his/her ability to fully comprehend the treatment, but nurses can play a valuable rule in making sure that even children can understand the nature and value of the treatment being given to them. If a nurse fully accepts the ethics concerning the respect for human dignity then it becomes a part of his duties to make sure that the patients are also involved in the process of health care as much as they can be. In cases where consent and other matters concerning the patient can not be handled by the patient herself, the nurse should immediately consult the designated decision maker for the patient (Rankin, 2000).

It can be ethically difficult to accept the choices made by the appointed decision maker especially; when it comes to procedures like resuscitation or withholding life support; but it must be noted that the decision maker is supposed to be a person trusted completely by the patient. Therefore, the choices made by the decision maker are as ethically important as the choices made by the patient (ANA, 2001). While dealing with terminal patients, it would be a good idea to have a talk with designated decision makers before they are needed so as both the nurse and the third parties involved in the care of the patient can be on the same page. It must be noted that cultural influences may make some patients defer to the wisdom and words of other decision makers even when the patients are able to make their own decisions. In such situations, nurses need to respect both the decision and the method by which the decision was made since cultural differences have to be taken in stride.

There can be situations where there is no decision maker present and the nurse has to make a choice for the patient. The ethics for such situations are quite clear because the nurse is supposed to do exactly what is in the best interest of the patient (ANA, 2001). There are several ways in which a nurse can make judgments about the best interest of a patient as concerning the issue of human dignity. Getting to know the decisions made earlier by the patient, as well as the personal values of the patient, can be useful bits of knowledge (Jacobs, 2001). These can help a nurse in getting to an informed judgment regarding the end of life scenario, or refusal of certain treatments, keeping the best interest of the patient at heart.

Finally, the ethics concerning human dignity and the respect for others figure largely in the relationships which a nurse has with her professional peers as well as other individuals. The code of ethics suggests that the ideals of respect should be held up regardless of the person the nurse is interacting with since compassion and understanding are important for the ethical nurse (ANA, 2001). Relationships with medical professionals figure more prominently in other provisions of the code of ethics but the idea of human dignity and the respect for others does not lose its importance, as it is discussed in later chapters.
Question No.10. Alfred is suffering from terminal cancer and it is not expected that he will live for more than a few more days. He reports that he is in extreme pain and asks for something which can alleviate the pain symptom. You can give him Drug X to alleviate the pain but you know that Drug X will also hasten the dying process. Is it ethical to give Drug X to Alfred:

a. No, this would be euthanasia which is unethical
b. No, only doctors can give drugs which can lead to euthanasia
c. Yes, because euthanasia in cases of extreme pain is ethically mandated
d. Yes, because drugs can be given to alleviate pain even if they hasten the dying process

Ethics in Nursing > Chapter 2
Page Last Modified On: August 23, 2015, 08:15 PM