Euthanasia Essays (2071 words) - Euthanasia, Medical Ethics

Euthanasia Euthanasia is clearly a deliberate and intentional aspect of a killing. Taking a human life, even with subtle rites and consent of the party involved is barbaric. No one can justly kill another human being. Just as it is wrong for a serial killer to murder, it is wrong for a physician to do so as well, no matter what the motive for doing so may be. Many thinkers, including almost all orthodox Catholics, believe that euthanasia is immoral. They oppose killing patients under any circumstances. Every human being has a natural inclination to continue living. Canadian and most other law forbids any form of homicide, including euthanasia and it is alleged that assisted suicide does eventually accustom a society to violence. It has been claimed that euthanasia brutalizes a society, as mercy killings are seen as a form of socialized violence. In any case killing a human being is immoral and unethical. Life should be valued, not abused, since everyone is only given one chance to live. Because death is final and irreversible, euthanasia contains within it the possibility that mistakes do happen and in fact an incorrect diagnosis is possible. If society condemns patients who are "terminally ill" and in the end a mistake in the diagnosis is discovered then the suffering and blame would not fall on technology but on society itself. Suffering is surely a terrible thing and society has a clear duty to comfort those in need and to ease their suffering when it can. But suffering is also a natural part of life with values for the individual and for others that we should not overlook. Knowing that a life can be taken at any time will incline people to give up too easily, hence seeking an escape in euthanasia. Killing a human being is not justified under any circumstances, which is why euthanasia should no longer be in practice. Although many countries around the world accept assisted suicide as part of their social norm, the fact remains that any type of murder is illegal in most societies. The American case of "It's over Debbie", in which a gynecology resident gave a lethal injection of morphine to a woman with ovarian cancer, questions the legality of any doctor's intents and actions. First, the resident appears to have committed a felony: premeditated murder. Direct intentional homicide is a felony in all American jurisdictions, for which a plea of merciful motive is no excuse. Second, law aside, the physician behaved altogether in a scandalously unprofessional and unethical manner contrary to the policy of the American Medical Association. He did not know the patient: he had never seen her or her family, he did not study her chart, and he did not converse with her or her physician. He took, as an unambiguous command, her only words to him, "Let's get this over with." Instead of thinking of ways in which he could ease her suffering, he brought her death. This is no humane and thoughtful physician succumbing with fear and trembling to the pressures and wishes of a patient, for which there was truly no other recourse. "This is an impulsive yet cold technician, arrogantly masquerading as a knight of compassion and humanity" who should be punished for his actions. When a patient asks for assistance in dying, and the doctor then gives the patient a lethal injection, there is no way of disguising what is happening. The doctor's intention is clear, this is undoubtedly a killing and not an allowing to die. An essential aspect of euthanasia is that it involves taking a human life of a person who is suffering from some disease of injury from which recovery cannot reasonably be expected. The action is deliberate and intentional as stated in section 231(2) of the Canadian Criminal Code: Murder is first degree when it is planned and deliberate. Section 222(1) of the Criminal Code states: A person commits homicide when, directly or indirectly, by any means, he causes the death of a human being. Therefore, when a doctor injects a lethal injection he is doing so deliberately with the intention to cause death to his patient. Nowhere in the Criminal Code does it state that one can use a merciful plea as a defense for murder. People like Dr. Kevorkian of Michigan, who continue masquerading as"helpful god" to assist terminally ill patient in death, should be incarcerated for breaking the law. If society allows one or two or three people get away with cold-blooded murder, then a sure downfall will follow.

Caring for Individuals with Acute Mental Health Needs The WritePass Journal

Caring for Individuals with Acute Mental Health Needs Abstract Caring for Individuals with Acute Mental Health Needs ). Suicidal behaviour is a persistent and lethal public health problem that is among the leading cause of death worldwide (Mitchell et al. 2009). Depression is a important risk factor for suicide (Knapp and Ilson, 2002).   It can increase suicidal tendencies four-times higher compared with the general population, this can increase 20-fold in the severely ill (Bostwick Pankratz, 2000). Suicide accounts for ~ 1% of deaths, while two-thirds of these deaths occur in depressed individuals (Sartorius, 2001). There are several forms of depressive disorders, including major depressive disorder, which can interfere with everyday living, characterised by an inability to work, sleep, study, eat or take enjoyment in activities , as stated in the Quality Standards (QS8) (NICE, 2001). Minor depression is diagnosed when symptoms have persisted for 2+ weeks as in the case of Michael, but do not meet the total evaluation for major depression (Moussavi et al., 2007). However, without treatment minor depression can develop into major depressive disorder (Nicholson et al. 2006). Furthermore, an estimated 50% of depressed individuals are not recognised in primary care (National Collaborating Centre for Mental Health, 2009). Diagnosis Depression can be reliably diagnosed and is covered by QS8. Diagnosis of depression is based on its severity and persistence, as well as the occurrence of other symptoms, as well as the extent of functional and social impairment (Kupfer, 1991). The National Health Service (NHS) has a number of models to aid clinicians to diagnose depression. Recognition, assessment and initial administration of individuals presenting with symptoms of depression is covered by the GC90 NICE guidelines, which states that persons presenting with symptoms of depression should be referred to appropriate professionals if the practitioner is not competent in mental health assessments (NICE, 2004, 2007, 2009). Michael’s presentation and the complication of suicide thoughts means that Michael is on step 4 of the stepped care model (figure 1) and was referred immediately to an acute psychiatric ward. Figure 1: Stepped care model (NICE 2009) Risk assessment Michael has suicidal thoughts, which means he presents considerable immediate risk to himself and so requires referral to specialist mental health services (DH, 2007).   However, referral can result in increased anxiety, agitation and suicidal ideation during initial treatment. As such, medical staff should be vigilant for mood changes, negativity, hopelessness and suicidal ideation, and increased support should be provided such as frequent contact (NICE, 2004). Evidence-Based Practice and Treatment There are a number of effective treatments for depression. The recommended treatment options for moderate to severe depression, as stated by the World Health Organisation (WHO), consists of psychosocial assistance in conjunction with antidepressant medication and/or psychotherapy, which includes CBT, interpersonal psychotherapy or problem-solving treatments. Initial treatment of depression often begins when the patient consults their GP, NICE (2011) states that a comprehensive assessment is required that is more than a symptom tally, but accounts for functional impairment or disability. To ensure this the GP will frequently give the patient a questionnaire to fill in for assessment which may use rating scales such as GAD, PHQ or Whooley. Michael was assessed as significant risk to himself, therefore he was referred to a specialist mental health service. NICE (2011) states that effective delivery of interventions for depression requires competent practitioners to deliver interventions, which may include psychosocial and psychological interventions. Michael’s treatment would consist of medication, however as he presents with suicidal ideation, medication toxicity as well as the quantities issued, should be assessed stringently (Simon et al., 2006). Antidepressants can be valuable in treating moderate to severe depression, but should not be the primary form of treatment for mild depression (WHO, 1992). The potential side-effects, addiction potential and importance of taking prescribed medication should be explained (Anderson, et al., 2008). Medication support should be provided for at least six months following remission of a depressive episode of (Jick et al., 2004). Michael should be monitored by nursing staff and he should be reassured that he can talk to them, although he must be told that staff have a duty to inform the doc tors of any concerns. It is important to remember to not offer false reassurance; problem-solving is the best treatment. If Michael is released into the community, he should be monitored at least weekly (WHO, 1992). NICE (2011) guidelines suggests that patients with continual sub-threshold depressive symptoms should be offered self-help guides on cognitive behaviour therapy (CBT) either manual or computerised, or structured group activity programmes. Michael (and his family, if he consents) should be advised of the expected symptoms, such as the potential for increased agitation and to be mindful of mood changes, negativity and suicidal ideation (Waraich et al., 2004). He should be offered some form of psychological therapy, especially to help with his feelings of loss, due to his failed romance and any other lifestyle problems that may be affecting him. These could include behavioural activation, cognitive-analytic therapy, cognitive behavioural therapy (CBT) and do-it-yourself CBT, group therapy, counselling (family or relationship), interpersonal therapy or psychodynamic psychotherapy/psychoanalysis (Simon et al., 2004). The use of psychosocial/psychological treatment and medication are benef icial in treating moderate to severe depression, such as Michael’s case. Competence frameworks should ensure the patient receives regular supervision, reviewed treatments with monitoring and evaluation of those treatments that may include video or audio tapes and external scrutiny (NICE, 2011) .Collaborative care ought to consist of case management, which should be administered by a senior mental health professional. Care of depressed individuals also requires close cooperation between primary and secondary health services and/or specialist mental health services. Finally, long-term coordination of care and good follow-up with Michael will reduce the risks associated with recurrence of depression. Conclusion The best clinical practice for depression in adults has been defined in QS8, which discusses the measures, audience descriptors, and assessment and clinical management of depression required to provide to patient.   The current guidelines for depression ensure that patients are no longer simply given antidepressants in the long-term without psychosocial/psychological treatments which ensure the patient is involved in their recovery. However, while best practices are derived from the best research evidence available, they are not a replacement for professional acuity and clinical judgement (NICE 2011). References American Psychiatric Association (Ed.) 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(2006) Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. European Heart Journal 27(23), 2763-2774. Sartorius, N. (2001) The economic and social burden of depression. Journal of Clinical Psychiatry 62(Suppl 15), 8-11. Simon, H.C., Bruce, M.L., Lee, P.W. et al. (2004) Preventing suicide in primary care patients: the primary care physicians role. General Hospital Psychiatry 26(5), 337-345. Simon, G.E., Savarino, J., Operskalski, B. and Wang, P.S. (2006) Suicide risk during antidepressant treatment. American Journal of Psychiatry 163(1), 41-47. Waraich, P., Goldner, E.M., Somers, J.M. and Hsu, L. (2004) Prevalence and incidence studies of mood disorders: a systematic review of the literature. Canadian Journal of Psychiatry 49(2), 124-138. WHO (1992) The ICD-10 classification of mental and behavioural disorders. Clinical descriptions and diagnostic guidelines. 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