The Emotional Effects of “Euthanasia” Among Healthcare Providers and Patients

The Emotional Effects of “Euthanasia” Among Healthcare Providers and Patients
Lindsey Dukes
HPEB 550
April 25, 2012
Ken Watkins

Introduction

Euthanasia is generally defined as the act, undertaken only by a physician, which intentionally ends the life of a person at his or her request in which the physician administers the lethal substance ending the patient’s. On the other hand, physician-assisted suicide is when a person self-administers a lethal substance that is prescribed by a physician, ending their own life (Pereira, 2011). The proposition of euthanasia has been, and still is a large debate between various groups of people throughout the world. Many factors contribute to how euthanasia affects society as a whole, but everyday patient and caregivers (physicians, nurses) are manipulated and influenced by the pressures and contributing influences of Euthanasia, which not only affects their jobs but their personal lives as well. A lot of research and time has been put towards the underlying factors of euthanasia and the pressure that it creates among people emotionally which is impacting the healthcare profession altogether. Many of the research studies that have been done regarding euthanasia have been accumulated by using anonymous questionnaires concerning patients and physicians in various cultures, random surveys on physicians and nurses, research on a numerous amount of euthanasia and physician-assisted suicide cases and the physicians report on the case, and how the depression stage in the 5 stages of grief model alters a patients perception and judgment on euthanasia. The substantial amount of research that has been conducted has been very helpful for understanding things regarding euthanasia, but it has also brought about additional questions that acutely concern people. For example, is postponing death the right thing to do or should a patient with a terminally ill disease have the right to make the decision to end their life? Much of the research that has been manipulated has proven the importance of the patient and the caregiver’s relationship and how the outcome of many cases regarding terminally ill patients is affected by euthanasia.

The Emotional Effects of “Euthanasia” Among Healthcare Providers and Patients
Euthanasia is a very emotional subject and has garnered debate within the healthcare profession. Research has shown that one of the main factors of choosing euthanasia is depression. Often times, patients with terminally ill diseases become depressed at some point before they die. Depression alters their perception, therefore affecting their ability to think rationally. When physicians begin to recognize a change in their patient’s behavior, this is when it is crucial for the physician to be able to become aware of the certain warning signs of depression. Because of this, physicians need to stay highly alert of their patient’s emotional state, provide a therapeutic relationship, and take precautions to prevent their patient from committing suicide (Taffard, 2011). People throughout their lives aren’t taught how to psychologically handle how to take care of someone that unexpectedly is about to die, so when physician’s are put in situations with a patient that has a terminally ill disease, many uncertain emotions arise complicating the physician’s professional duty and the patient’s sensitivity. Other research that has been analyzed has shown that a large number of physicians and nurses have experienced patients with some sort of terminally ill disease that has expressed feelings towards their caregiver about euthanasia or physician-assisted suicide. These healthcare professionals explained that the main things they noticed about their relationships with these terminally ill patients included there being communication barriers, judgments and thoughts about suicide, unresolved grief, emotions, inadequate knowledge, and justifications for euthanasia (Valente, 2011). The causes creating these circumstances between the patient and caregiver can create overbearing emotions. The intense emotions of the patient suffering and being depressed and the caregiver having immense feelings for the patient potentially leads the patient and the caregiver to believe that euthanasia is an acceptable alternative.

End of Life Sensitivity of Different Physicians, Patients, and Family Members Since euthanasia and physician-assisted suicide is such a perplex topic, many interventions and surveys have been done. Some of the interventions that are administered at the end of someone’s life in specific cases like terminally ill patients include withdrawal of futile life-sustaining treatment, active pain control, withholding of life-sustaining measures, and active euthanasia and physician-assisted suicide (Yun & Han, 2011). Withdrawal of futile life-sustaining treatment has to do with when a physician doesn’t have the “ethically” continue to treat a patient that they believe is not being benefited by their treatment. Active pain control is when a patient with a chronic and terminally ill disease is continuously being treated for the severe pain they are in through the use of study pain medications. Lastly, withholding of life-sustaining measures is also known as life support and is when a patient is continuously treated to prolong their life but with no cure or treatment that will reverse the medical condition. All of those interventions have to do with the end of a patient’s life which alternatively, in most cases, leads to euthanasia or physician-assisted suicide. In other words, most interventions involving end of life patients relate to euthanasia and physician-assisted suicide. A study was administered to four different groups of people about their attitudes towards these specific end of life medical interventions and the study included 3,840 individuals that consisted of 1,242 of the participants being cancer patients, 1,289 of the participants being family members, 303 of the participants being physicians, and 1,006 of the participants being just within the general population of the area. Doing a research study like this one, is a proficient way to show how people really feel about euthanasia and physician-assisted suicide because they are categorized into separate groups depending on how they are related to the topic of euthanasia. To begin the study, each participant was administered a questionnaire about the different interventions regarding the end of life of a person. All of the questionnaires were later collected and then compared by multivariable analyses’ in order to compare the different attitudes of the people and also to identify socio-demographic characteristics that were associated with these specific attitudes. The results within the four different groups varied depending on what intervention was being asked about. One of the most interesting things that the survey indicated about the attitudes of all of the participants within the survey was that almost all of them have positive attitudes toward the withdrawal of futile life-sustaining treatment and the practice of pain control (Yun & Han, 2011). This evidence therefore shows that emotionally all of the individuals, including the random subjects that were not related to the other three groups, are pro the concept “death with dignity” and are against “bad” ways of dying. The results also demonstrated that all of the participants agreed that patients at the end of their life shouldn’t have to suffer and should therefore be allowed to request high dosages of medication to avoid any type of pain. The other results showed variance in attitudes towards the other interventions, depending upon what “group” the individuals were associated with. The cancer patient group and the general public group had a good bit of similar attitudes that supported patient autonomy and speeding up the death process. Controversially, the physicians and the family members had negative attitudes towards the questions on euthanasia, physician-assisted suicide, and anything else that had to do with ways of speeding up the death process of patients. Another intriguing thing that the study showed was that many of people’s attitudes towards euthanasia and physician-assisted suicide were associated with age. The participants that were older in age showed a lot more positive attitudes towards euthanasia and physician-assisted suicide then the participants that were younger in age.
Overall, this study highlights the pressures that a physician faces when deciding whether to perform euthanasia. The study proved that people’s emotions highly affect their attitudes and why they make some of the decisions they do when it comes to the end of someone’s life. Above all, one main conclusion was that everyone, no matter if you were the one suffering from cancer or if you were perfectly healthy, agreed with each other when it came to the interventions on active pain control and withdrawal of futile life-sustaining treatment. Therefore this concludes that everyone agrees that there is no reason to prolong a patient to continue suffering and that they should be allowed to “end their life”. Conversely, when euthanasia was brought into the picture, there was a split in the attitudes of the participants. The general population and the cancer patients were in favor of euthanasia and this is most likely because of two things. The cancer patients were the ones that were suffering and new that they only had a certain amount of time left to live, so therefore this emotionally affected how they felt about ending their life early so they wouldn’t have to suffer. The general population wasn’t related to the terminally ill cancer patients in any way, so therefore they continued to agree that there is no need to prolong the suffering of patients that have a terminally ill disease. The other two groups’ attitudes, for the most part, had a different perspective of euthanasia. The physicians were emotionally distressed by the idea of it for a number of reasons including that they may be uncertain about the prognosis, religious beliefs, legal circumstances, and mainly because they feared of putting pressure upon the vulnerable patients. The family members were against the idea of it for emotionally reasons as well, but for differential reasons. They didn’t want to lose someone that they loved and especially didn’t want to feel as if they had anything to do with the death of their loved one. They didn’t realize how much physical pain their family member was in because they were influenced by all of their own emotions, and contritely the patient didn’t realize how much misery their family was in because the physical pain they were suffering through was altering their ability to think proficiently. This study is a conclusive illustration of how terminally ill diseases emotionally affect patients, physicians, and family members in complete different ways, and why euthanasia can be such an overwhelming decision for any of these person to have to make.
How Euthanasia Affects the Patient
When one is diagnosed with a terminally ill disease, there are no words to describe how that person is feeling. Trying to understand how someone feels that has been told that they only have a few months to live is incomprehensible. A terminally ill disease is one from which there is no expectation of recovery. Once someone is told that they have a disease that is incurable and that they only have a certain amount of time left to live, their whole world has been flipped upside down instantly. This can be very hard on a person physically as well as emotionally and this is when the “5 stages of grieving” comes into play. The normal phases that someone goes through during an illness is the before diagnosis phase, the acute phase, and the recovery phase. After the recovery phase, the patient is healthy again and continues going about their life like nothing ever happened. The stage’s a patient goes through with a terminally ill disease is nothing like that unfortunately. There is no recovery phase for these patients. The disease they have acquired is chronic so therefore instead of getting better, they continue to get worse. As there health continues to decline the patients know that every minute that passes by, is a minute closer to when they are going to die. There is no positive outlook on terminally ill diseases like there is for acute diseases because someone with a chronic disease knows there isn’t a chance for them to get better, only for them to get worse and die. It is a life-changing situation, not only for the patient but for the patient’s family and friends as well, and can trigger mixed emotions and can be a very confusing matter for someone to understand. In many cases, patients in these situations become extremely depressed alternatively provoking them to start having thoughts of suicide. Most patients don’t realize that they are depressed and believe that committing suicide is the only way out. Statistics today show that nearly 90% of patients that are suffering from terminal illnesses who attempt suicide are depressed (Taffard, 2011). Overall, cancer patients have statistically been shown to be effected by depression more than people with other diseases because patients that have been diagnosed with some sort of cancer have a higher chance that the disease is terminal (Yun & Han, 2011). Depression is a serious illness that can corrupt and affect someone’s ability to properly think and make decisions, and this is why patients that are depressed chose to take their own life instead of going through the grieving process of death. The five stages a patient goes through that has been diagnosed with a terminally ill disease are denial, anger, bargaining, depression, and acceptance. These stages are better known as the “five stages of grief”. These five stages have been developed in order to establish a healthy process of emotions that one goes through before they die. Once a patient has accepted the terms with their illness, they can then come to peace with themselves and can continue the rest of their life being happy by surrounding themselves with people and commodities that they love. Unfortunately because of the rapid growing awareness of euthanasia and assisted suicide, the” grieving process” isn’t as effective as it used to be on patients. Once someone undergoes the depression stage, a lot of the times it is hard for them to get out of it. A lot of these patients feel as if they are a burden to society and their family. They see themselves as basically just a waste of society’s medical and financial resources which therefore summons them to believe that they might as well just commit suicide or have their physician do it for them. The patient is very emotionally unstable and has feelings of intense sadness, hopelessness, emptiness, and exhaustion (Taffard, 2011). Caregivers seeing their patients this depressed and in so much pain can emotionally exhaust them as well. This generally is what contributes and influences caregivers to help their patients go through with death so that they don’t have to suffer anymore.

Legalization of Euthanasia and the Illusions of Safeguards and Controls In today’s society, with people’s growing awareness of euthanasia and physician-assisted suicide, the concept of it is rapidly becoming thought of as an acceptable alternative for terminally ill patients (Taffard, 2011). A small number of countries and even a few states in the United States have legalized euthanasia. As of today the Netherlands, Belgium, and Luxembourg have legalized euthanasia. In the United States, Oregon and Washington have legalized euthanasia respectively, mandating it to the extent that a terminal illness with a prognosis of less than 6 months to live has to be present before there are even thoughts about euthanasia being taken place. As for the rest of the United States, euthanasia still remains completely illegal. As goes for all other mandated laws, there are rules and regulations that have been created in order to prevent euthanasia and physician-assisted suicide practices from being abused and misused. Laws, safeguards, and prevention measures that have been placed upon legalization of euthanasia include that the requesting person must provide an explicit written consent and must be competent at the time the request is made, it has to be voluntary, it has to be well-considered and informed, there must be mandatory reporting of all cases, administration can be done only by physicians, and there must be consultations by a second physician (Lofmark & Nilsun, 2008). Unfortunately, in many cases these laws and safeguards are abused and are regularly ignored. Research shows that a huge factor that influences why these laws are likely to be abused is because many of the cases are simply not even reported so therefore no one is prosecuted of doing anything wrong. A study showed that about 900 people annually were administered lethal substances without given explicit consent, and in on jurisdiction, almost 50% of the cases of euthanasia were not reported (Pereira, 2011). Another concern that has been addressed is the involvement of nurses within the practice of euthanasia because all the jurisdictions require that the acts of euthanasia be performed only by physicians. A recent study though showed that 120 nurses reported having cared for a patient who received life-ending drugs without explicit request (Pereira, 2011). A lot of these cases, the physicians were reported to not even be present. Clinical depression regarding patients with terminally ill disease has created an additional problem with the legalization of euthanasia. A recent study in Oregon demonstrated that 1 in 6 patients with a terminally ill disease had clinical depression and still received a prescription for a lethal drug. Clearly, there are a lot of issues that need to be addressed regarding the legalization of euthanasia and the jurisdiction laws that are required to be followed during the administrative process. Since people’s awareness and knowledge on the subject matter of euthanasia is growing so rapidly these days, many more people are beginning to create publicity regarding legalizing it. Based on recent studies on euthanasia throughout different countries, many of the safeguards, protocols, and laws drastically need to be changed and more strictly enforced.

Conclusion
An extensive amount of research has been done regarding euthanasia, and a lot of it shows how the effects of it in general drastically take an emotional toll upon not only the sick patient, but the healthcare professionals as well. Depression clearly is a main factor that contributing to the downfall of a terminally ill patient. Explicitly, many physicians struggle emotionally as they watch their patient as they suffer. These deep emotions intertwined together, lead to euthanasia being the only resort in which the physician believes they can help their patient and the patient being able to not have to suffer anymore. The topic on this subject has been debated for decades now but is only now essentially becoming a prominent interest within the healthcare industry. These intense debates on euthanasia are now inaugurating an idea that leads to the question. Should Euthanasia be legalized, and if so how will it in the future emotionally impact physicians and their patients? Research studies that have already been conducted regarding euthanasia have proven that in many of the cases, the law or any jurisdiction that has been given to the rights of euthanasia have been ignored. Much of the research that has already been conducted concludes that euthanasia needs to be explored and rationed on many different levels, especially in relations to human and communication within the healthcare profession before any major decisions should be made.

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