The legalization of euthanasia in several countries creates challenges for nurses in facing a series of complex ethical and moral decisions, as it relates to the extent to which one is involved in these new care choices (Pesut et al., 2020). Nurses have diverse perceptions of euthanasia, often influenced by their ethical values, religion, and professional experiences. Some nurses view euthanasia as a violation of the principle of care that focuses on preserving life, while others accept this practice as an option to end patients' inevitable suffering. Ultimately, nurses' perceptions of euthanasia are influenced by the legal and cultural frameworks in which they work (Cayetano-Penman et al., 2020). Similarly, research by Cordeiro et al. (2022) indicates that nurses reject euthanasia because it contradicts professional ethics and moral values, while others support it as a means to alleviate the suffering of terminal patients. Factors such as family support, colleagues, and bioethical principles, including beneficence and autonomy, influence their decisions.
Global Trends Regarding Euthanasia
The pain suffered by patients is not the primary reason for requesting euthanasia. Factors that more often drive requests for euthanasia include the loss of autonomy, decline in quality of life, and loss of dignity, which underlie 61% of cases in the Netherlands and 52% in Belgium (Mroz et al., 2021).
Patients and physicians frequently have misconceptions regarding the distinctions between palliative care and euthanasia. A study by Leboul et al. (2022) revealed that many patients seeking euthanasia in palliative care settings often fail to grasp or overlook the differences between the two. Such requests typically stem from patients seeking medical help to end their lives, rather than a simple wish to hasten death or an aimless desire to die. This misunderstanding can be attributed to various factors, including the occurrence of rapid deaths within palliative care units, the administration of morphine and sedatives, and legal frameworks that acknowledge the right to relief from intolerable suffering, which often require palliative care teams to be involved in decision-making processes after patients express their wishes.
Research by Chutarattanakul et al. (2024) shows a high prevalence of misunderstanding between palliative care and euthanasia among doctors in Thailand. Many doctors mistakenly assume that discontinuing life-sustaining procedures at the patient's request and allowing palliative patients to die in hospitals constitute euthanasia. Additionally, some doctors confuse the belief that using sedatives and muscle relaxants to hasten a patient's death is part of palliative care, while using them to relieve suffering is considered euthanasia.
Both studies indicate that limited knowledge and confusion regarding the concepts of palliative care and euthanasia occur not only among patients but also among doctors. This highlights the importance of better education and training to ensure a clear understanding of the concepts of palliative care and euthanasia, enabling patients to make informed decisions about their end-of-life care and allowing doctors to provide accurate information and avoid errors in care.
From various studies, it can be concluded that palliative care does not only focus on end-of-life treatment but also aims to improve patients' quality of life. Better education and training regarding the concepts of palliative care and euthanasia are crucial to ensuring clear understanding. This can assist patients in making informed decisions about their end-of-life care, as well as helping doctors provide accurate information and avoid care errors. Overall, palliative care plays a vital role in supporting patients facing terminal illnesses; however, misunderstandings about euthanasia and the need for improved education to ensure a clear understanding of the concepts of palliative care and euthanasia remain critical.
It is important to provide broader access to quality palliative care, which not only alleviates physical suffering but also meets the psychosocial and spiritual needs of patients. Adequate access to this care can reduce requests for euthanasia, as patients will feel more holistically supported in facing the end of their lives.
Palliative care plays an essential role in supporting patients with terminal illnesses, focusing on improving quality of life and not merely addressing end-of-life issues. The new challenges faced include long-term support for patients living with cancer or other diseases. Euthanasia and physician-assisted suicide are topics that provoke ethical, social, and moral debates, especially regarding the right to life. Although there are differing views on the relationship between euthanasia and palliative care, both highlight the importance of adequate access to palliative care to alleviate suffering and provide meaningful choices for patients.
REFERENCES
- Bandieri, E., Castellucci, E., Potenza, L., Luppi, M., & Bruera, E. (2024). Assisted suicide and euthanasia requests in early palliative care. BMJ Supportive & Palliative Care. https://doi.org/10.1136/spcare-2024-005072
- Cayetano-Penman, J., Malik, G., & Whittall, D. (2020). Nurses' perceptions and attitudes about euthanasia: A scoping review. Journal of Holistic Nursing, 089801012092341. https://doi.org/10.1177/0898010120923419
- Chutarattanakul, S., et al. (2024). Misconceptions between palliative care and euthanasia among general practitioners in Thailand. BMC Palliative Care, 23, 96. https://doi.org/10.1186/s12885-024-01430-6
- Cordeiro, J. K. R., Lima, M. F. G., Nbrega, W. F. S., Oliveira, M. E. C., Carvalho, J. C., Abro, F. M. S., & Costa, A. M. (2022). Percepo dos enfermeiros sobre a prtica da eutansia: uma reflexo biotica. Research, Society and Development, 11(6), e31311629228. https://doi.org/10.33448/rsd-v11i6.29228
- De Lima, L., Woodruff, R., Pettus, K., Downing, J., Buitrago, R., Munyoro, E., Venkateswaran, C., Bhatnagar, S., & Radbruch, L. (2017). International Association for Hospice and Palliative Care position statement: Euthanasia and physician-assisted suicide. Journal of Palliative Medicine, 20(1), 8-14. https://doi.org/10.1089/jpm.2016.0290
- Fadhillah, N., & Jannah, N. (2017). Pelaksanaan prinsip etik keperawatan dalam asuhan keperawatan pada perawat pelaksana. Jurnal Ilmiah Mahasiswa Fakultas Keperawatan, 2(3).
- Flora, H. S. (2022). Euthanasia dalam hukum pidana Indonesia dan hukum kesehatan. Jurnal Hukum Kesehatan Indonesia, 2(02), 82-96.
- Huemer, M., Jahn-Kuch, D., Hofmann, G., Andritsch, E., Farkas, C., Schaupp, W., Masel, E. K., Jost, P. J., & Pichler, M. (2021). Trends and patterns in the public awareness of palliative care, euthanasia, and end-of-life decisions in 3 Central European countries using big data analysis from google: Retrospective analysis. Journal of Medical Internet Research, 23(9), e28635. https://doi.org/10.2196/28635
- Kitchen, R., Faull, C., Russell, S., & Wilson, J. (2024). Handbook of palliative care. John Wiley & Sons Ltd.
- Leboul, D., Bousquet, A., Chassagne, A., Mathieu-Nicot, F., Ridley, A., Cretin, E., Guirimand, F., & Aubry, R. (2022). Understanding why patients request euthanasia when it is illegal: A qualitative study in palliative care units on the personal and practical impact of euthanasia requests. Palliative Care & Social Practice, 16, 26323524211066925. https://doi.org/10.1177/26323524211066925
- Marn-Olalla, F. (2018). Euthanasia: A 21st century right. Gaceta Sanitaria, 32(4), 381-382.
- Mroz, S., Dierickx, S., Deliens, L., Cohen, J., & Chambaere, K. (2021). Assisted dying around the world: A status quaestionis. Annals of Palliative Medicine, 10(3), 3540-3553. https://doi.org/10.21037/apm-20-637
- Pesut, B., Greig, M., Thorne, S., Storch, J., Burgess, M., Tishelman, C., Chambaere, K., & Janke, R. (2020). Nursing and euthanasia: A narrative review of the nursing ethics literature. Nursing Ethics, 27(1), 152-167. https://doi.org/10.1177/0969733019845127
- ener, ., & Dikmen, Y. (2023). Attitudes and behaviors of palliative care nurses on euthanasia. Florence Nightingale Journal of Nursing, 31(Supp1), S66-S70. https://doi.org/10.5152/FNJN.2023.23056
- Zenz, J., Tryba, M., & Zenz, M. (2015). Palliative care professionals' willingness to perform euthanasia or physician-assisted suicide. BMC Palliative Care, 14, 60. https://doi.org/10.1186/s12904-015-0058-3
