Week Two 1/21-1/28 Healthcare Policy and the Role of Ethics

Healthcare Policy

Admittedly, as RN “in the field” I never paid attention to health care policy.  My thinking was those in administrative roles would engage in these types of issues.  It wasn’t until pursuing the DNP degree did the realization register that everyone, including patients, families, and healthcare workers, have a voice; and with a substantial amount of voices, changes can occur.

For this week I am beginning at ground zero; and asking the question, “What exactly is a healthcare policy?” To clarify for those who are wondering the same, the World Health Organization (WHO) describes healthcare policy as actions, decisions, and plans initiated to enact specific health care goals within a society (WHO, 2015).  Let’s take this concept and apply it the topic, Death with Dignity, and think about how healthcare policy (or the lack thereof) relates to this topic.  Clearly, as related in Week One’s post, the state of Oregon was a trailblazer with the landmark ruling to legalize physician-assisted suicide in 1994.  Since then, other states have succeeded, but many have failed in their attempts to establish aid in dying policies.  Arizona (AZ) is one such state where the Aid in Dying bill, sponsored by former State Representative, Linda Lopez (Democrat), has consistently been rejected in the House of Representatives.  For those of you who need a quick civics review of how a bill turns into a law, I included a picture because who doesn’t like visuals?

I also included a link to a news clip on how Death with Dignity remains dead in the water (no pun intended).  (For effective view please right click and open as new link).

Death with dignity’ legal in only 5 states, Arizona is not one of them | KVOA.com | Tucson, Arizona.

For those terminally ill patients (living in AZ) seeking to make their own choice in when and how they want to die, this is an extremely frustrating situation.  The only choice for these patients may be a hospice program, where at least end-of-life symptom management is offered.  For others, desperate times call for desperate measures, like violent suicide (e.g, guns); and looking for organizations that may assist in finding measures to hasten one’s death.  For instance, the case of a 58 year old Phoenix woman, Jana Van Voorhis, who inquired the help from Final Exit members to help with her suicide.  Final Exit is an organization that counsels and supports mentally competent people with intolerable diseases end their lives (Final Exit, 2011).  The problem was Jana told members, one being a retired anesthesiologist, that she had terminal conditions that were never verified by her physicians.  In fact, Ms. Van Voorhis had been recently diagnosed as having psychosis; and had persistent disturbing hallucinations.  These members were tried in an AZ court for manslaughter.  The physician was acquitted; and the three other members pleaded to lesser charges (AZ Central, 2012).  This led to a bill, recently signed by former Governor Jan Brewer in 2014, to prosecute any individuals with manslaughter who assist in suicides.  The term assist means providing physical means to end one’s life (Arizona Capitol Times, 2014).

Watch Dr. Sanjay Supta, my favorite CNN consultant, investigate the Jana Van Voorhis case.  Think about what side of the fence you are on in this debate; and if heath care policy could have prevented tragedies like this case.

There are still those in the community keeping the Death with Dignity debate alive.  Arizona State University (ASU) hosted an event, that I attended, in September 2014 titled “Should Arizonans Have the Right to Die with Dignity?”  This event had a panel discussion with two highly informed professors on the topic: Dr. Courtney Campbell, from Oregon State University; and Dr. Helene Sparks, from the University of Washington.  Both taught courses in ethics; and have numerous articles published on topics like physician-assisted suicide.

Here is the video discussion for those interested in this debate.  Think about the question, “Do Arizonans have the right to die with dignity?”

http://www.ustream.tv/embed/recorded/53409222?v=3&wmode=direct

 Role of Ethics

The ASU discussion on Death with Dignity leads us to the topic of ethics.  How does the role of ethics affect the decision-making policy regarding aid in dying for terminally ill patients?  As it stands, the American Nurses Association (ANA) has this position statement regarding assisted-suicide that “prohibits nurses’ participation in assisted suicide and euthanasia because these acts are in direct violation of Code of Ethics for Nurses with Interpretive Statements, the ethical traditions and goals of the profession, and its covenant with society (ANA, 2013, p. 1).  This code also applies to advanced practice registered nurses (APRNs).  With the ANA against assisted-suicide, only strengthens the debate for those opposed to an Aid in Dying bill in AZ.  As a hospice RN in AZ, I believe those diagnosed with a terminal illness; and who are mentally deemed competent should be able to end their own life.  If for any reason to stop drastic, desperate measures by those seeking a safe, painless, monitored way to die.

Let’s talk further about this topic in Week Three when I will delve more into the actual policy-making process!

 References

American Nurses Association (2013). Position statements: Euthanasia, assisted suicide, and aid in dying. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements/Euthanasia-Assisted-Suicide-and-Aid-in-Dying.pdf

Arizona Capitol Times (2012). Brewer signs bill targeting assisted suicide. Retrieved from http://azcapitoltimes.com/news/2014/04/30/brewer-signs-bill-targeting-assisted-suicide/

Arizona State University (2014). Should Arizonans have the right to die with dignity? Retrieved from https://www.lincolncenter.asu.edu/events/should-arizonans-have-right-die-dignity

AZ Central (2012). Jury acquits Phoenix doctor in assisted-suicide case. Retrieved from http://archive.azcentral.com/community/ahwatukee/articles/2011/04/21/20110421phoenix-doctor-assisted-suicide-verdict.html

Final Exit Network (2011). Our guiding principles. Retrieved from http://www.finalexitnetwork.org/

Mullins, Jean (2015, November 4). Sanjay Gupta, MD: Assisted suicide or manslaughter? Retrieved from https://www.youtube.com/watch?v=_of5pFqLB-k

News 4 Tucson (2014, November 3). Death with dignity legal in only 5 states, and Arizona is not one of them. Retrieved from http://www.kvoa.com/news/death-with-dignity-legal-in-only-5-states-arizona-is-not-one-of-them/#.VL7aKRev61M.wordpress

World Health Organization (2015). Health policy. Retrieved from http://www.who.int/topics/health_policy/en/

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10 thoughts on “Week Two 1/21-1/28 Healthcare Policy and the Role of Ethics

  1. swhaines

    As an oncology nurse, I frequently debate the importance of quality of life for patients facing a terminal illness. This has primarily been in the form palliative care and advocating for those patients and families choosing to stop curative treatments. The physician-assisted suicide movement inspired by Brittany Maynard really caused me to think about my own opinions regarding Death with Dignity, including what I would want if in a similar situation. Regardless of one’s personal opinions regarding the Death with Dignity movement, ethically speaking, it is important that each individual have equal access to the benefits or burdens associated with healthcare decision-making (Longest, 2010). Only when an individual is faced with all available information and options is he or she able to make a truly informed decision.

    Reference

    Longest, B. B. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.

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    1. dignitydiscussion Post author

      As an oncology nurse, I can only imagine the hard decisions cancer patients face regarding aggressive treatments versus end-of-life comfort care. If Death With Dignity ever passed in the state of AZ, it would add another decision for these patients. For some people this option would be a relief, for others it would be a scary prospect. Death is never a topic one likes to think about, but I agree with your statement about individuals having access to benefits and burdens related to healthcare decision-making (Longest, 2010). It only makes sense!

      Reference
      Longest, B. B. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.

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  2. waynemcintosh

    I too have discovered my passion for Death with Dignity in the last couple of years. I am not sure what it is but I am acutely aware on of things that I wouldn’t have noticed before.
    Regardless, watching that video made me a bit unsettled about the dignity that was in her own death. Is it right for me to say that the players in her final moments were wrong? Even if they didn’t have all the information it’s her body and her choice.
    I do, however, feel that they didn’t have all the facts and that is irresponsible. She was diagnosed with a mental disorder that wouldn’t allow her to make decisions that are based in reality.
    The first time I saw a patient die I was in my first year or so as a nurse. I was floated to the medical floor and I had just given report. My patient was a DNR and at the end of life but we really didn’t know when that would be. At the end we went into the room and I introduced the new nurse to the family. I was draining one of his tubes and after I did that something changed in the patient and he was taking his final breaths. At that moment the wife said, “Do something!” I just stood there almost frozen and said, “I can’t.” It’s like the wife knew and had this reaction to my statement like she already knew. It’s like skydiving and just as you step out of the plane you realize, “I want to go back. “We all stood there and watched the color drain from his face and for a brief moment it was quiet. I was holding up the wife, who was sobbing. The night nurse and I removed lines, tubes, and anything that didn’t originally belong to him. and then left the room. The night nurse gave me permission to leave and I was in a daze. I walked home in a fog. I didn’t see anything, I didn’t hear anything; all I did was think. “What did I just witness?”
    Years later after many code blues, CRTs, and traumatic patient experiences that I realize that what I saw was someone die with dignity and peace.

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    1. dignitydiscussion Post author

      Your story about your first witnessed death and the the feelings felt is shared by many of your healthcare professional peers. It was a moving depiction of death in a hospital setting. I obviously prefer the home setting at end-of-life (considering my years at a hospice agency), but can appreciate what hospitals offer in terms of aggressive treatments. I believe with providers and specialists backing end-of-life choices like Death With Dignity laws, terminal patients would actually have safe, mandated measures in place to help one die in peace.

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  3. kelster71181

    The case about Jana was very interesting to say the least. What I found disturbing was the fact that she was psychotic according to recent records and yet the physician understood this and did not look further to seek if her diagnoses were real or fictitious. There is an article from the The Washington Time that is stating there is new legislation coming up in California that is almost identical to Oregon’s dying with dignity law. See the video here:

    http://www.washingtontimes.com/news/2015/jan/21/assisted-suicide-movement-gaining-traction-in-acro/?page=all

    References

    Assisted suicide movement gaining traction across u.s.. (2015). Retrieved from http://www.washingtontimes.com/news/2015/jan/21/assisted-suicide-movement-gaining-traction-in-acro/?page=all

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    1. dignitydiscussion Post author

      Dr. Mar,

      I brought up the ANA’s Code of Ethics to reiterate how the nursing profession in no way supports assisting a person to die. As a hospice nurse, I struggle with this code of ethics due to being in the company of patients experiencing insufferable symptoms and begging to die. Thank you for your question. Leslie

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  4. nanettewhittington

    I have really been thinking about your first post and now this one. I read a reply that one of the other students posted and I think with me what has touched me the most is the loved ones that are in the position that they find themselves in. As a wife, mother and grandmother I would never want to see someone who I love so deeply suffer in the way that some of these people have suffered. I truly believe that I would want to help end their suffering. I also believe that there are many factors that contribute to a decision of that magnitude and that many i’s need to be dotted and many t’s need crossed. Thanks to your blog I have gained a new understanding and a new empathy for the people that you have brought into this controversial subject. Thank you.

    Liked by 1 person

    Reply
    1. dignitydiscussion Post author

      Nanette,
      I appreciate you reading my blog considering your experience with end-of-life care. Unfortunately, it sounds like your family went through a sad ordeal with your Grandfather. If I were the nurse in that situation I would have sat down with your family to explain medications and why they are utilized for particular symptoms. I am sorry it was not a different experience.
      In regards to aid in dying it would be imperative to keep all people involved during the entire process so the patient and loved ones are never felt ill informed.
      I invite you to continue reading the blog; and once again thank you for your thoughtful posts.

      Liked by 1 person

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