Letter to Editor

Euthanasia in End-of-Life Care: Ethical Compassion or Dilemma?

To Editor

Euthanasia, comes from the Ancient Greek word εὐθανασία (Euthanasia), which combines εὐ- (eu-, “good”) and θάνατος (Thanatos, “death”), meaning a good death. It involves a premeditated act of ending a patient’s life to alleviate severe suffering.¹ Euthanasia refers to a physician actively ending a life, while physician-assisted suicide involves assisting a patient in ending their own life. Active euthanasia involves direct actions to cause death, whereas passive euthanasia involves refraining from life-sustaining treatments. Both concepts raise complex ethical, legal, and moral considerations regarding patient autonomy, suffering, and the role of healthcare professionals.² This practice poses a significant ethical challenge in modern healthcare, especially for individuals with terminal illnesses who are under end-of-life care. Euthanasia is a method of managing the dying process for some individuals. However, in nursing, moral agency, the ability to think, act, and take accountability for one’s actions, can be hindered by conflicting values. The practice of euthanasia intersects with deeply ingrained ethical principles, necessitating a careful consideration of autonomy, non-maleficence, beneficence, and justice, all within the broader context of healthcare providers’ duties and responsibilities.^3,4

The ethical debate focuses on autonomy, which affirms the right of mentally competent individuals to make informed decisions about their own bodies and lives, including the choice to end life in the face of intolerable suffering. Supporters of euthanasia argue that respecting a patient’s voluntary and well-considered request reinforces human dignity and personal freedom. Denying such a request may, in their view, subject patients to unnecessary and unwanted pain, which is ethically indefensible. However, this stance conflicts with the Nightingale Pledge, which emphasizes abstaining from harmful actions and drugs. In Iran, this aligns closely with the legal and ethical framework, as nurses are expected to prioritize preserving life and participating in euthanasia would be considered a violation of professional ethics and religious beliefs.^5-7

Another layer of ethical complexity arises when evaluating consent and mental competence. Ensuring that a patient’s request for euthanasia is fully informed, voluntary, and free from coercion or impaired judgment can be challenging. Patients in the terminal stages of illness often experience depression, cognitive decline, or emotional distress, all of which can impact decision-making. To address these concerns, rigorous procedural safeguards such as psychiatric evaluations, second medical opinions, and mandatory waiting periods are essential to confirm the authenticity and soundness of a patient’s choice.⁸

The principle of justice also plays a crucial role in shaping the euthanasia debate. Ethical policies should strive to protect vulnerable individuals and ensure equal access to appropriate care. Without proper oversight, euthanasia could become more accessible to patients who lack palliative care options or adequate social support, ultimately highlighting systemic inequities rather than promoting true autonomy.⁹

Healthcare professionals may experience moral distress when involved in end-of-life procedures, particularly when their personal beliefs conflict with patient choices or institutional policies. These conflicts can impede patient access to euthanasia and shift the ethical burden to other clinicians. Institutions must address this tension by establishing clear ethical guidelines, providing emotional and professional support, and ensuring a fair distribution of responsibilities.^9,10

Moral prohibitions are ethical restrictions placed on certain actions or practices that are deemed unacceptable in a society or culture. These prohibitions are typically rooted in deeply held beliefs about what is right and wrong, particularly in terms of patient autonomy, beneficence, non-maleficence, and justice within the realm of medical ethics.¹¹ According to “Principles of Biomedical Ethics” by Beauchamp and Childress, experts in medical ethics emphasize the importance of these four principles in guiding healthcare practices. The objective is to find a harmonious balance between ethical considerations and the complex process of making medical decisions.¹²

In the field of nursing, the application of ethical principles is crucial as nurses often work directly with patients and advocate on their behalf. The nursing profession follows codes of ethics that are based on universal principles of biomedical ethics, focusing on patient dignity, respect, and comprehensive care. These ethical guidelines help nurses address moral dilemmas that may arise in areas like end-of-life care, patient consent, and confidentiality. Nursing ethics promotes the delivery of fair and compassionate care while maintaining the profession’s integrity. It also emphasizes the nurse’s role as a patient advocate, ensuring that ethical considerations are always prioritized in clinical practice.^13,14

However, it should be noted that the legal status of euthanasia varies by jurisdiction, reflecting differing views on autonomy and medicine. Proponents emphasize the importance of choice and relief from suffering, while opponents argue for the sanctity of life and highlight the risks of coercion, calling for safeguards to be put in place.¹⁵

In conclusion, euthanasia policies need to find a balance between respecting autonomy and upholding the principles of non-maleficence, beneficence, and justice. To minimize risks, changes to policy should focus on standardizing informed consent procedures, requiring psychiatric evaluations, and establishing strong safeguards. It is also important to expand palliative and psychosocial care services. Future research should compare different legal frameworks, assess stakeholder experiences, protect vulnerable populations, and examine the ethical implications and moral distress faced by nurses. International studies can offer valuable insights to help establish best practices and create clear guidelines for both practice and legislation.

Competing Interests

None declared.

Ethical Approval

Not applicable.

References

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