Physician Assisted SuicideThe ethical topic of interest within this paper is physician assisted suicide.  Physician assisted suicide is known as a person voluntarily taking their own life with the help of the medical field. Most of the time physician assisted suicide pertains to a doctor prescribing lethal medication for the patient after they have made up their mind. This choice is usually made by a patient reaching the end of their life. This paper will discuss the ethical issue pros, and cons of physician assisted suicide, as well as the four ethical principles and how they pertain to this argument. Physician Assisted Suicide Ethical IssuePhysician assisted suicide is a very controversial topic within the United States. Currently a few states within the United States have legalized physician assisted suicide. The main issue is whether assisted suicide is ethical or unethical. Physician assisted suicide becomes available to patients getting close to the end of their life but may also be suffering. This option is sometimes given to these patients along with a few more such as choosing on their own what they want, continuing treatment for as long as they choose to, or even in some cases being presented with the option to die medically (Lehto, Olsen, & Chan, 2016).  Should physician assisted suicide be an option for patients reaching the end of life? Ethical Principles       The first ethical principle is known as autonomy. This principle can be defined as a way for someone to be able to make their own decisions regardless of what anyone else thinks about the situation (Butts & Rich, 2016, pp. 36-37). This principle is important to patients and their decisions of what they want as well as being respected by the nurses and doctors. The next two principles fall hand in hand with one another. Nonmaleficence is the commitment to never harm a patient or anyone else no matter the situation. Beneficence is the commitment to always do good, if in some case good cannot be done then the nurse must do everything in their power to not harm the patient (Butts & Rich, 2016, pp. 42-43). Those two principles have very powerful meaning within the nursing world because nurses always want to make sure they are treating patients well. Although, sometimes a nurse may not be able to do good because they have a patient’s health to worry about, they must make sure they do not purposefully cause harm. The last principle is justice, which is also a very important principle for nurses to live by. Every patient must be treated equally and with respect (Butts & Rich, 2016, pp. 46).  Justice goes into much more detail than just respect and dignity, but justice truly is a virtue as well as a principle (Butts & Rich, 2016, pp. 46).Pro Argument     According to the New Mexico law review (2018), patients in the United States have four options at the end of their life. These options are the complete termination of all medications, not eating anything ever again, complete sedation till death, or physician assisted suicide. This last option is not legal all over the United States, therefore its only an option sometimes. This argument pushes a great example for the first principle, autonomy. If a patient is to be given the option of physician assisted suicide, they can choose whatever they want to and be respected by it. Although this argument does uphold the standards for the first principle, is violates nonmaleficence. The act of physician assisted suicide is causing harm, even if it is at the patients own request. In the state or Oregon, doctors can prescribe oral lethal medication to patients who choose to end their own life with certain regulations as well as banned euthanasia (Lehto, Olsen, & Chan, 2016).  This allows the patient to terminate their own life without having to choose euthanasia. This argument also violates beneficence because the nurses and doctors are not doing good necessarily. Although the patient can make their own decision to end their life, the doctor is not only doing good. Provision one states that the nurse must respect the patient and treat them with dignity and compassion (Butts & Rich, 2016, pp. 463). If a patient decides to move forward with physician assisted suicide, the nurse must uphold the respect and dignity for this patient as they would for anyone else. This argument can be stated in comparison to provisions 2 and 3 as well. Provision 2 advocated for the nurse’s primary responsibility being the patient and provision 3 is based on the nurse protecting the patient is any way needed (Butts & Rich, 2016, pp. 466-468). A nurse must never give their opinion to a patient or about a decision a patient must make, but when a patient does decide, the nurse must stick with them and protect the patient.  When the option of physician assisted suicide is presented to patients, is enlightens them to one more option available, and it opens the relationship more between the staff and patient (Heide, Voorhees, Rietjens, & Drickamer, 2014).  This argument is upheld to the last principle, justice. If the patient chooses assisted suicide, the nurse must provide them with respect and dignity that justice serves.  Within provision 4 and 5, the nurse provides the most care needed as well as promoting the best health for the patient and oneself. This provision can be upheld due to the nurse providing the most care for the patient and their choices regarding their health. Provision 5 can be upheld they same way except the nurse has to provide the same care for itself as others. Provisions 6, 7, & 8 all tie together in a sense that they work to make the environment safe and effective for the patients, they follow the health care policy, and collaborate with other health care professionals about the patient’s rights and policy procedures (Butts & Richs, 2016, pp. 478-482). Nurses must follow the health care policy and if the patient chooses something the nurse does not personally agree with, they still must follow the policy. Physician assisted suicide gives the patients another option to help end the suffering of the end of their life.Con Argument     According to Jukka Varelius (2016), “Involuntary euthanasia is universally- and with good reason- prohibited”. In most states’ physician assisted suicide is illegal for several reasons. A few of the main reasons this option is now allowed is some patients may feel obligated to choose assisted suicide as their choice due to pressure, the choice made may not be the right choice the patient wanted, and doctors are participating in assisting a patient’s suicide (Varelius, 2016).  The banning of physician assisted suicide follows the principle of beneficence, which states that nurses should always do good. Participating in assisted suicide violates the health care policy that nurses should do everything they can to keep the patient, and their health established. Nonmaleficence is the act of doing no harm and in this case that principle is upheld because the physicians and nurses are not participating gin ending someone’s life.  Autonomy is another main principle that is violated within this situation because the patient does not get to make the decision of assisted suicide. In 1997 the US Supreme Court banned assisted suicide in two different court cases (Myers, 2016).  Justice is said to be upheld within this situation because the patients are being treated equally if assisted suicide is banned. Provision one and two are upheld in this argument banning physician assisted suicide because it is the nurse’s responsibility to keep the patient alive and as healthy as possible (Butts & Rich, 2016, pp. 463-468).  Provision 3 is the nurse advocating for the patient as well as the rights and safety of the patients. Although it does seem like the choice is the patient’s, they do not have the right to end their own life through a physician (Butts & Rich, 2016, pp. 468-472). Within the banning of physician assisted suicide, provision four is established because the nurse is providing optimal care as well as being responsible for the patient’s health and life (Butts & Rich, 2016, pp. 473-475).  One of the consequences states is “physician assisted suicide is fundamentally inconsistent with the physician’s role as a professional and trusted healer” (O’Rourke, O’Rourke, & Hudson, 2017). Provision six is stated to maintain an ethical, safe, and trusted environment for patients (Butts & Rich, 2016, pp. 478-479). In this situation, the physician cannot be trusted to save peoples lives due to also participating in assisted suicide. The health care staff is trusted to work hard to save people’s lives instead of assisting them with suicide. Provision five and seven state that nurses need to take care of their selves as well as collaborate with other health care professionals about health care and policies (Butts & Rich, 2016, pp. 475- 481).   These provisions are upheld with the banning of assisted suicide in that they follow policy and can trust other health care professionals with saving people. Along with provision seven, provision eight also goes along with collaborating with other health care professionals about the health of others and communicating with the public (Butts & Rich, 2016, pp. 482-483). Doctors and nurses speak with the public and other professionals about the health care to make sure the policy is being followed. Physician assisted suicide does not follow the health care policy that doctors and nurses have always followed.Conclusion     Physician assisted suicide is very controversial in many states throughout the United States. It is only legal in seven states currently. The pro argument states that in some cases, patients do want the opportunity to have another option to end their life. The con argument states that physician assisted suicide is not following health care policies or maintaining a healthcare provider’s duties. Autonomy, nonmaleficence, beneficence, and justice were compared to several situations within the two arguments. In the pro argument, justice and autonomy were shown to be upheld and nonmaleficence and beneficence were violated. In the con argument, autonomy and justice were violated, but nonmaleficence and beneficence were upheld. The provisions were also shown for each argument and how they violate or help in the argument. Physician assisted suicide will always be an ethical issue.ReferencesButts, J. B., & Rich, K. L. (2016). Nursing ethics: Across the curriculum and into practice. Burlington: Jones & Bartlett Learning.Lehto, R. H., PhD, RN, Olsen, D. P., PhD, RN, & Chan, R. R., PhD, RN. (n.d.). When a patient discusses assisted dying: nursing practice implications. retrieved from EBSCO databaseMyers, R. S. (2017). The constitutionality of laws banning physician assisted suicide. BYU Journal of Public Law, 31(2), 395–408. Retrieved from EBSCO databaseO’Rourke, M. A., O’Rourke, M. C., & Hudson, M. F. (2017). Reasons to reject physician assisted suicide/physician aid in dying. Journal of Oncology Practice, 13(10), 683–686 Retrieved from EBSCO databasePope, T. M. (2018). Legal history of medical aid in dying: Physician assisted death in U.S. courts and legislatures. New Mexico Law Review, 48(2), 267–301. Retrieved from EBSCO databaseVarelius, J. (2016). Active and passive physician-assisted dying and the terminal disease requirement. requirement. Bioethics, 30(9), 663–671 Retrieved from EBSCO databaseVoorhees, J. R., Rietjens, J. A. C., van der Heide, A., & Drickamer, M. A. (2014). Discussing physician-assisted dying: Physicians’ experiences in the United States and the Netherlands. The Gerontologist, 54(5), 808–817 Retrieved from EBSCO database Annotated BibliographyLehto, R. H., PhD, RN, Olsen, D. P., PhD, RN, & Chan, R. R., PhD, RN. (n.d.). When a patient discusses assisted dying: nursing practice implications. retrieved from EBSCO databaseThe authors of this article use a study of a young patient dealing with a terminal illness and the options the patient has. Physician assisted suicide is discussed throughout this article as an option for a patient at the end of their life. These options also include; right to determine their own fate, aggressive treatment of persons with intractable suffering is itself causing unnecessary harm and allowing dying or even performing euthanasia in some cases is more beneficial than continuing life. .This article also discusses different steps medical professionals have to follow when moving forward with a patient who chooses physician assisted suicide. This article will be used as a pro in the ethical analysis paper as an option with terminal illness.Myers, R. S. (2017). The constitutionality of laws banning physician assisted suicide. BYU Journal of Public Law, 31(2), 395–408. Retrieved from EBSCO databaseRichard S. Myers discusses physician assisted suicide as well as the legal points made in the US previously.  Myers goes into great detail about court cases that have occurred and compared them to laws now regarding assisted suicide. This article is going to be used within my ethical analysis paper as a con regarding physician assisted suicide. The information regarding the court cases tie into the author’s opinion about the assisted suicide and how it should be banned.O’Rourke, M. A., O’Rourke, M. C., & Hudson, M. F. (2017). Reasons to reject physician assisted suicide/physician aid in dying. Journal of Oncology Practice, 13(10), 683–686 Retrieved from EBSCO database The authors discuss the basic factors between physician assisted suicide and allowing a patient to properly decline treatment right before they die. This article goes into great detail concerning compassionate care when dealing with patients as well as the consequences of physician assisted suicide. This article will be used in the ethical analysis paper as a negative agreement regarding the assisted suicide and how it affects the doctors and patients.Pope, T. M. (2018). Legal history of medical aid in dying: Physician assisted death in U.S. courts and legislatures. New Mexico Law Review, 48(2), 267–301. Retrieved from EBSCO database Thaddeus Mason Pope discusses the history and facts of medical aid in dying. This author states all options patients have within reasoning. This article also discusses legal matters between states and how the laws differ dealing with assisted suicide dating all the way back to the 1900s. Pope also goes into detail about MAID and how it has benefitted patients all over the US. This article will be used in the ethical analysis paper regarding some of the benefits that assisted suicide may have to some very ill patients.Varelius, J. (2016). Active and passive physician-assisted dying and the terminal disease requirement. requirement. Bioethics, 30(9), 663–671 Retrieved from EBSCO databaseJukka Varelius discusses euthanasia and assisted suicide. He discusses how different states handle physician assisted suicide and the legal ramifications in the US in general. Varelius speaks about terminally ill patients and how they have several options. This author gives the definitions and differences to active and passive euthanasia. Within the ethical paper this article will be used as a negative connotation towards assisted suicide.Voorhees, J. R., Rietjens, J. A. C., van der Heide, A., & Drickamer, M. A. (2014). Discussing physician-assisted dying: Physicians’ experiences in the United States and the Netherlands. The Gerontologist, 54(5), 808–817 Retrieved from EBSCO database Jennifer R. Voorhees, MD Judith A. C. Rietjens, PhD Agnes van der Heide, MD, PhD Margaret A. Drickamer, MD conducted a study with 36 physicians within the United States and The Netherlands (for comparison) dealing with physician assisted suicide. These authors make it clear to discuss the benefits for these patients and the options it opens for them. Physician assisted suicide is almost glorified within this article and study. This article will be considered a pro agreement for physician assisted suicide within the ethical paper.