NURS 4234 Issues in Professional Practice

The aim of the report was to deal with a case study which emphasizes on a patient suffering from a rare type of cancer and her demand for euthanasia. The results indicate that there are elaborative laws on delivering euthanasia to terminally ill patients. The report concludes that there must be provisions in law to deal with extraordinary situations that deal with human feelings.

Introduction

Euthanasia is a voluntary ending of life, where the person suffering from an ailment which will show no sign of recovery in future (Steck, 2013).

The report deals with a case study where patient suffering from a rare type of cancer showing no sign of recovery wanted her nurse friend to kill her to prevent herself from suffering. While the nurse delivered the euthanasia herself, this led to violation of the several nursing law and nursing ethics.

The report outlines the laws that were violated by the act of the nurse, the analysis of the laws related to euthanasia, the legal consideration of the case, and a personal reflection on the whole case study.

The case study is based on Alexa Chung aged 30 who is a cancer patient suffering from Aggressive natural killer cell leukemia. Miss Alexa was having this rare type of leukemia which is common in Asians among the young adults. After checking several cancer treating hospitals, Miss Alexa was not having any gain on the cancer. Later Alexa found one of her friend named Emma Rose, works as a nurse in Seattle Cancer Care Alliance in Washington. Alexa was suffering from this rare form of cancer for 1 year and as Alexa is a Malaysian, thus went to some Malaysian hospitals. Whereas, the doctors were unable to identify this rare form of cancer. Alexa had weight loss and hepatosplenomegaly which deteriorated the health conditions of Alexa. Finally, after moving to Seattle, on her friend’s reference, the doctors of the Seattle Cancer Care Alliance were able to identify and designate the cancer which was from Aggressive natural killer cell leukemia. After several months of chemotherapy, Alexa was showing no signs of recovery. Depending on the deteriorating health condition of Alexa, the doctors of the Seattle Cancer Care Alliance decided to perform the stem cell transplant. Even after the transplantation of stem cells, Miss Alexa was not showing any signs of recovery. After all this, Miss Alexa became terribly underweight and lost all her hair, and was under immense depression. Miss Emma Rose being the friend nurse was always comforting and caring Alexa, but as the day passed Alexa’s pain increased considerably. Alexa was going through a depressing condition which and was experiencing unbearable pain. Doctors said that Alexa can survive for a maximum of 7 months, while her organs will fail to function subsequently. After knowing the truth, Alexa had no light of hope but to ask Emma Rose to kill her, to prevent her from suffering.

Statement of the violation; description of the act of omission or commission  

The Nurse Emma Rose was unable to see the suffering of her ailing friend, Alexa Chung. Emma wanted to relieve the pain of Alexa, and thus Emma went on to administer Alexa a lethal dose of potassium chloride, just as Alexa asked. Potassium Chloride is sometime given as an euthanasia drug to animals (Underwood, 2013).

There are several violations according to the law prescribed in the Washington Death with Dignity Act, Initiative 1000 are as follows (www.doh.wa.gov, 2017):

• The act allows the terminally ill patients to request for the lethal doses of drug from osteopathic and medical physicians to end their life.
• The terminally ill patients must be a Washington state resident
• The terminally ill patient must have less than 6 months to live.

In depth description of the Standard of Practice or Law involved

According to the (Doh.wa.gov, 2017) the in depth description of the Standard practice of Death with dignity reveals the following:

• it is mandatory that only a qualified patient can write a written request in order to self-administer the euthanasia drug.
• To establish the residency in Washington, a person needs to show the Washington driver’s license, leases a property in Washington, registration to vote in Washington.
• If a person wants to self-dispense the drug, then the concerned person must send an application form as provided by Department of Health (DOH). Two witness must be present at the time of signature.
• The patient need to make apply before 15 days which includes the initial step of making an oral request, then a written request followed by a second oral request. It is Only after the patient’s second oral request, the attending physician will offer to fulfil the patient’s request (Emanuel et al., 2016).
• The patient has to wait for at least 15 days before the patient receives a prescription from the attending physician.
• Within the 30 calendar days of writing the prescription by the attending physician. The physician needs to send the prescription along with completed written request of the patient, physician’s form demarcating the compliance, consulted physician’s form of compliance, psychological or psychiatric form of compliance to the State Registrar, Centre for Health Statistics. And then if the attending physician is allowed to administer then he does so under the law. The final step requires sending a copy of Pharmacy Dispensing Record Form in a period of thirty days of administering the drug (Dyer, White & Rada, 2015).
• The law says that only a licensed osteopathy or a doctor of medicine in Washington Cn write the prescription.
• If the patient is willing to dispense the drug on his/her own, then no physician need to prescribe the medications.

Analysis of the legal considerations of the case

According to the case study, the legal violation involves the following:

• Firstly, the nurse herself dispensed the medication to the patient which according to the law is not permitted. The medication if not self-administered includes an osteopathic physician or a medical doctor to dispense the drug. The nurse neither informed any doctor or a physician not followed that standard procedure necessary for the delivering the euthanasia.
• Secondly, the nurse dispensed a lethal dose of Potassium Chloride that is generally administered to the animals to stop the heart from functioning. The nurse totally ignored the several procedures that needs to be followed before administering euthanasia as mentioned in the Washington Death with Dignity Act. According to the statutes, only a medical doctor or an osteopathy physician can prescribe the drug for the euthanasia.
• Thirdly, there is a strong mention that patients to whom euthanasia will be dispensed must be a Washington resident. While the present case is a complete violation of the statute. Legally the nurse can face criminal charges because Alex is a Malaysian not a Washington resident, while the nurse completely ignored the statutes of the Washington Death with Dignity Act.
• Lastly, the doctors already said that Alexa can still survive for atleast 7 months. While this information too was ignored by her friend nurse. According to the Washington Death with Dignity Act, euthanasia cannot be delivered to a terminally ill patient who can survive more than 6 months. Although Alexa could have survived 7 months, the law does not permit euthanasia to delivered to a patient who can still survive 7 months. Hence, just like the above point the nurse will face criminal charges for neglecting the law provisions.  

Analysis of the ethical and/or political considerations of the case

According to (App.leg.wa.gov, 2017) the nursing ethical laws of euthanasia has several revelations and if the nurse is found guilty of conduct can face disciplinary actions.

• The unauthorized distribution and usage of the drugs in any way illegitimate way, usage of drug other than the therapeutic purposes (Carmi & Schneider, 2012).
• Failure to cooperate with the discipline authority.
• Incompetence and negligence, or malpractice resulting in the injury of the patient, or creates an unreasonable risk of harming the patient. Usage of unprofessional means that result in patient’s harm (Chadwick & Gallagher, 2016).
• The registered nurse must possess the understanding and knowledge of the regulatory measures and the laws that govern nursing practices.
• The registered nurse shall be held accountable as well as responsible depending on the nurse’s conduct.
• Willfully failing or repeating to administer the medications and treatments according to the standards of nursing.
• Intentionally and repeatedly failing to work according to the policies and procedures, and wasting drugs where the nurse works or is employed.
• For the safety of the patients, the attending nurse is held responsible and accountable.
• Performing or trying to attempt a nursing technique, where the nurse is lacking the experience, knowledge, education and falling to obtain the necessary supervision, instruction and consultation from the doctor for the patient safety (Westrick, 2014).

Summary of the facts involved.

According to the case study, the cancer patient Alexa was suffering from a rare type of cancer called Aggressive natural killer cell leukemia. Just because Alexa’s illness was a terminal illness, her health was deteriorating as the day progressed. Hence, Alexa requested her Nurse friend Emma to kill her, so that Alexa could avoid the pain. While Emma overlooked all the nursing ethics and laws, neglected the correct procedure of administering the euthanasia. Emma dispensed a dose of Potassium Chloride which stopped Alexa’s heart. There are several provisions in Washington Death with Dignity Act which designates Emma accountable for the misconduct.

Personal Opinion

I think the laws framed by the Washington Government in the Washington Death with Dignity Act is accurate to deal with all the mishap relating to the Nursing ethics and laws. Keeping aside the law, the feeling of hopelessness of Alexa and her depressions and the pain that Alexa was going through were unbearable. It is natural for her friend, Emma to act in such an unethical way. Emma delivered the Euthanasia just to reduce the pain of her ailing friend Alexa. While, rules are there to discipline people, there must be some provisions in law that address the rarest of the rare situations (Pearson, 2013).

Conclusion 

Therefore, from the above disclosure, it can be concluded that euthanasia is the best solution for the patients who want to die to reduce their pain. While there are laws in Washington that deal with euthanasia elaborately, there must be provisions that deal with extraordinary situations where human feelings come to play.

References

App.leg.wa.gov. (2017). WAC 246-840-710: Violations of standards of nursing conduct or practice.. App.leg.wa.gov. Retrieved 8 November 2017, from http://app.leg.wa.gov/wac/default.aspx?cite=246-840-710

Carmi, A., & Schneider, S. (Eds.). (2012). Nursing law and ethics(Vol. 4). Springer Science & Business Media.

Chadwick, R., & Gallagher, A. (2016). Ethics and nursing practice. Palgrave Macmillan.

Doh.wa.gov. (2017). Death with Dignity Act :: Washington State Department of Health. Doh.wa.gov. Retrieved 8 November 2017, from https://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/DeathwithDignityAct

Dyer, O., White, C., & Rada, A. G. (2015). Assisted dying: law and practice around the world. BMJ, 351, h4481.

Emanuel, E. J., Onwuteaka-Philipsen, B. D., Urwin, J. W., & Cohen, J. (2016). Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe. Jama, 316(1), 79-90.

Pearson, H. (2013). Science and intuition: do both have a place in clinical decision making?. British Journal of Nursing, 22(4).

Steck, N., Egger, M., Maessen, M., Reisch, T., & Zwahlen, M. (2013). Euthanasia and assisted suicide in selected European countries and US states: systematic literature review. Medical care, 51(10), 938-944.

Underwood, W., Anthony, R., Gwaltney-Brant, S., Poison, A. S. P. C. A., & Meyer, R. (2013). AVMA guidelines for the euthanasia of animals: 2013 edition. Schaumburg, IL: American Veterinary Medical Association.

Westrick SJ (2014) Essentials of Nursing Law and Ethics (2^nd Ed) Burlington, MA: Jones and Bartlett Learning  ISBN-13:978-1284030204 and 10:1284030202