LM6: Dignity in Death and Dying
relation to giving consent for euthanasia:
Dignity
- associated with worth or esteem. It is an
attribute for a human being or the action of
a human being.
- the actual ‘practical’ meaning of dignity
remains complex and unclear because it is a
multidimensional concept.
Dignity in death and dying
- Movement that promotes the ability to meet
death on your own terms.
- Ending life in a way that is true to one's
preferences, controlling one's end-of-life
care.
How can dignity be promoted?
 symptom control
 promoting independence
 Privacy
 social support and a positive tone of care
 listening, giving appropriate information,
having a caring bedside manner
 showing respect, empathy and
companionship.
 Spiritual care has been shown to be
facilitated by having sufficient time,
employing effective communication, and
reflecting on one's personal experiences.
Euthanasia and prolongation of life
Euthanasia
- The concept of Euthanasia has been a
controversial topic since its inception.
- Defined as the hastening of death of a
patient to prevent further sufferings.  -
Active euthanasia refers to the physician deliberate
act, usually the administration of lethal drugs, to end
an incurably or terminally ill patient’s life.
Passive euthanasia refers to withholding or
withdrawing treatment which is necessary for
maintaining life.
There are three types of active euthanasia, in
 Voluntary: conducted with consent.
 Non-voluntary: conducted on a person who
is unable to consent due to their current
health condition. 
 Involuntary: performed on a person who
would be able to provide informed consent,
but does not, either because they do not
want to die, or because they were not asked.
Euthanasia Advantages:
 Freedom of choice
 Dignity
 Painless death
 Saves family's money
 Shorten the grief and
 suffering of the patient's
 loved ones
Euthanasia Disadvantages:
 Professional roles compromised
 Moral religious argument
 Rejection of the importance and value of
human life
 Destroys life which has potential that is yet
unknown to the patient, doctor or the family
members
EUTHANASIA IS ILLEGAL IN THE PHILIPPINES. IN 1997, THE
PHILIPPINE SENATE CONSIDERED PASSING A BILL LEGALIZING
PASSIVE EUTHANASIA. THE BILL MET STRONG OPPOSITION
FROM THE COUNTRY'S CATHOLIC CHURCH.
Ethical dilemma in practice
Autonomy
Euthanasia will be generally considered as a
good action in nursing when the action
follows patient’s autonomy since healthcare
providers should respect patient’s autonomic
decision.
Beneficence
- The healthcare providers assist terminally ill
patients to end the existing suffering through
euthanasia with sympathetic attitude.
Utilitarianism
- The factor to decide whether it is right or
wrong to cause a human being to death
intentionally is the future happiness of that
human being.
Code of ethics and religious view
- it objects euthanasia on the basis of lives are
divine and our souls are owned by God who
should be the only one controlling human’s
lifespan.
Nurse’s role in euthanasia
 open-minded and non-judgmental 
 listen to the patient carefully
 familiar with the assessment skills
 Sensitive and maintain a professional manner
 Advocate
 Explains the consent with non-threatening
tone and allow time for questions
 Provide peaceful environment for promoting
human right
 Offer emotional support to family.
 keep a record of all used medication, and
involved situations and person.
 good communication skills and counselling
skills in nurses.
Inviolability of human life
- a principle of implied protection regarding aspects
of sentient life that are said to be holy, sacred, or
otherwise of such value that they are not to be
violated.
- This can be applied to both animals and humans or
micro-organisms; for instance, in religions that
practice Ahimsa, both are seen as holy and worthy of
life. The value is inherent: Life is created in the womb
(or artificial environment to mimic womb). Man does
not have ability to create life; thus, man does not have
authority to destroy life. It is the only way for
humankind to exist.
In Christianity
- The phrase sanctity of life refers to the idea that
human life is sacred, holy, and precious. The sanctity
of life is inherent as man cannot create life. Therefore,
man has no authority to destroy life. It is the only way
for humankind to exist. The sanctity of life principle,
which is often contrasted with the "quality of life" to
some extent, is the basis of all Catholic teaching about
the sixth commandment in the Ten Commandments.
Euthanasia and suicide
Assisted suicide
- Assisted suicide, also known as assisted dying or
medical aid in dying, is suicide undertaken with the
aid of another person. The term usually refers to
physician-assisted suicide (PAS), which is suicide that
is assisted by a physician or other healthcare provider.
Dysthanasia
- In medicine, dysthanasia means "bad death"
and is considered a common fault of modern
medicine.
- Dysthanasia is a term generally used when a
person is seen to be kept alive artificially in a
condition where, otherwise, they cannot
survive; sometimes for some sort of ulterior
motive.
Orthothanasia
- In other words, death at the appropriate time
with due respect to the limits of life.
Orthothanasia can also be considered a
natural death, favoring the acceptance of the
human circumstance when faced with death,
without abbreviating or prolonging suffering,
but only providing, as far as possible, quality
of life and relief of suffering in general.
- Orthothanasia refers to the art of promoting
a humane and correct death, not subjecting
patients to misthanasia or dysthanasia and
not abbreviating death either, that is,
subjecting them to euthanasia. Its great
challenge is to enable terminal patients to
keep their dignity, where there is a
commitment to the well-being of patients in
the final phase of a disease.
Orthothanasia possibilities:
1. treatment to prolong life is useless
2. the prolongation of life or the postponement of
death is unduly burdensome
3. needs painkillers or medical sedation
Orthothanasia objections:
1. doubtful treatment
2. the real meaning of death with dignity
3. patient in persistent vegetative state
Administration of drug to the dying
Palliative sedation
- The use of medications to induce decreased
or absent awareness in order to relieve
otherwise intractable suffering at the end of
life.
GOAL: to provide relief or control symptoms
Advance directives
- It is a document made by a competent
individual to establish desired health care for
the future or give someone else the right to
make health care if the individual becomes
competent. (i.e. ventilation, tube feeding,
renal dialysis.)
Advance directives purpose:
 Provides direction to health care providers
 Ensures patient's end of life wishes are
carried through
 May diminish family conflict in making
decision.
 Only used if you are unable to express
his/her decisions
 Documents can be changed anytime
 Does not need an attorney
Disadvantages:
 Advance Directives may not be available
when needed.
 Not readily available in patient charts
 Living wills: may not be specific enough, may
be overridden by MD, doesn't immediately
translate into MD order
Nursing Responsibilities:
- Determine on admission whether advance
directives exist according to Patient Self-
Determination Act (PSDA) of 1990.
Patient self-determination act of 1990
- the rights and responsibilities of the individual to
participate in all decisions regarding his/her health.
1.provide written info on AD
2. nurses must ask if there is an AD
3. document an AD on the patient's chart
4. provide staff education about AD
Types of advance directives
1. Durable power of attorney
- a signed, witnessed (or notarized) document
in which the signer designates an agent to
make health care decisions if the signer is
temporarily or permanently unable to make
such decisions.
- Unlike most Living Wills, the Durable Power
of Attorney for Health Care does not require
that the signer have a terminal condition.
- An agent must be chosen with great care
since the agent will have great power and
authority to make decisions about whether
health care will be provided, withheld or
withdrawn from the signer.
2. Living Will
- the oldest type of health care advance
directive.
- a signed, witnessed (or notarized) document
called a “declaration” or “directive.” Most
declarations instruct an attending physician
to withhold or withdraw medical
interventions from its signer if he/she is in a
terminal condition and is unable to make
decisions about medical treatment.
End of life care plan
- all caregivers responsible for the patient
need to know the patient's wishes. 
- It should have clear terms about withholding
or withdrawing treatments must be included
in advanced directives.
- Advance directives and organ donor
information should be located in the medical
record and clearly identified on the patient
record and/or nursing care plan.
End-of-life guidelines
- let them sleep
- do not worry about urinating
- may see visuals that we cannot
- do not try to reorient