Ethical Considerations of Voluntary Assisted Dying for Patients with Severe and Persistent Mental Illness

Main Body

Application of bioethical principles

Autonomy

Autonomy can be considered a vital principle in relation to bioethics and denotes the rights granted to a person for making informed decisions with regard to health care and their life. To maintain human dignity within health and social care settings, respecting autonomy can be considered vital. Additionally, VAD proponents place arguments that people with SPMI highlight capacity of decision-making must be allowed the relevant autonomy just like the people having terminal physical disorders thereby providing an allowance to them for selecting an end phase to their ultimate suffering within conditions that they are likely to undergo.

Nevertheless, autonomy within the mental illnesses aspect can be considered complex in characteristics. The decision-making capacity of individual as well as cognitive functions can have a severe impact on mental illness. This reflects doubts with regard to whether people with SPMI shall have the capacity consistently necessary for taking life-ending decisions (Bastidas-Bilbao et al., 2023). Potential safeguards as well as extensive assessments dealing with mental competencies are required to make sure that do not have any chances to undermine vulnerable peoples dignity.

Beneficence

Through the beneficence principle, health providers are required to take actions within their clients suitable interest, and on the other hand, harm avoidance is mandated by non-violence. Within the VAD context for people with SPMI, conflicting situations can be noticed among these principles. On one side, it can be noticed that providing an allowance to VAD can relieve extended and intense suffering for people dealing with major mental health disorders (De Micco & Scendoni, 2024). Opposingly, it is also evident that VADs reversible nature as well as significant misjudgment to determine the risk of mental capacity results in causing potential damage and harm.

Non-maleficence

According to the nonmaleficence principle, physicians have the obligation to not cause any harm to patients. Potential moral rules are supported by this legal principle which denotes patients should not be caused any suffering or pain along with not causing any offense or incapacitating as well as not depriving other people considering their better outcomes in life. Healthcare providers should take into consideration whether accurate assessments can be ensured by them in relation to the mental capacity of a person for making autonomous decisions in relation to VAD (De Micco & Scendoni, 2024). Additionally, misjudgment shall result in irreversible repercussions thereby not abiding by the non-maleficence principle. Therefore, a rigorous procedure of assessment and suitable guidelines can be considered vital for maintaining ethical integrity within mental health care settings.

Justice

The justice principle within bioethics and mental health care comprises providing treatment to people in an equitable and fair manner. Justice application within the VAD context with SPMI includes making sure equitable reach to effective health care services is present and at the same time safeguarding vulnerable people from discrimination. Professionals who carry forward advocacy for VAD also place arguments that people dealing with SPMI who get excluded from VAD policies strengthen the stigma and stereotypes linked with mental health disorders and do not grant this particular group the relevant rights just like people suffering from physical disorders. Nevertheless, allowing patients to get access to the facility VAD specifically without carrying any accurate safeguards can disproportionately create a major impact on the people whose decision-making capacity is found to be greatly compromised and significantly resulting in uneven outcomes (Digby et al., 2020). Furthermore, the ethical justice principle necessitates making sure that fairness is maintained for every person along with respecting their rights. It also provides a specific focus on vulnerable groups of people to safeguard them from any kind of danger or harm.

Relevant ethical concepts and professional conduct codes and ethics

Human dignity concepts with mental health denote measures that need to be undertaken to promote individuals' well-being with disorders of mental health. This further liberates patients from self-stigma shackles, low self-esteem, confidence, social isolation, and withdrawal. Key aspects comprise self-respect, respect for confidentiality, and mutual respect. A lawful framework is provided by the Voluntary Assisted Dying Act of 2017 in Victoria for individuals dealing with as well as dying to select the timing and manner of their death. People in Victoria suffering from severe mental health and terminal disorders and are presently at the last stages of their lives as well as fulfilling strict criteria of eligibility and likely to access the process of voluntary assisted dying (Mishara & Weisstub, 2022). Besides this, the 2021 Act of Voluntary Assisted Dying necessitates discussion that is usually not initiated by practitioners of registered health with regards to the voluntary assisted dying approach or recommending the same to patients they deliver professionalor health care services.

Justification of values judgment

Utilitarian thinking

As per the utilitarian thinking approach, dying patients requesting euthanasia must receive spiritualand psychologicalsupport, loving care, and suitable remedies for any kind of suffering or pain conditions to enable these clients to reside with dignity during the natural death's time period. The double effect principle application necessitates strictly abiding by a specified criterion that specifies the acts object should be morally indifferentor good like administering pain medication for treating pain and the actions intention should be good morally like minimizing suffering (Van der Haak, 2021). The circumstancesshould showcase consistency with the intent and object and not by any evil impact means such as the respiratory kind of depression that is not likely to reduce pain. Basically, the goodimpact shall be proportionate to the poor impact identified as major relieffrom pain from terminallyill patients.

Deontological thinking

Based on the Deontological thinking principle, on a periodic basis, assisted death can be considered incorrect even if permission is provided by the double effectprinciple considering a mere anticipation yet not having the intention to death hasteningtaking place. In consideration of the theory of moral rights, permission is provided to assisted death in a situation that can be considered voluntary in characteristics. With regard to utilitarianism, negativeand positiveexternalitiesshould be taken into serious consideration (Tseng & Wang, 2021). The approach basically denotes the physician must not practice or advise euthanasia due to the fact that a major sublime medicine purpose is prolonging and preserving life. Similarly, the right or duty is obtained by the professional for relieving SPMI patients yet this relief shall not be carried forward to mercy killings extreme state.

Virtue Ethics thinking

A virtue-oriented initiative to VAD specifically denotes the fact that involuntary euthanasia shall be considered incorrect not only for the reason that it showcases disrespect in relation to the autonomy of the patient yet the desire for death to not take place is a major sign that an individual finds life enjoyable and worth living. Arguments have been placed by a few ethicists for lawful euthanasia, placing their opinions that only clients who are chronically or terminally ill must be provided the allowance for requesting euthanasia (Qld gov, 2023). When justification is provided for euthanasia on a voluntary basis depending on the self-determination right, the situation can be found as discriminatory for restricting this right attained to a specific patient population.

Ethics-of-care thinking

There are differences in professional bodies within their behaviors towards VAD. For Palliativeand HospiceCare, concerns have been outlined by the International Association considering the fact that palliative services inadequacymust be addressed and tackled successfully before taking into consideration VAD. Nevertheless, Palliative Care Australia has not been equivocal denoting nor opposition nor support to VAD yet focusing on tolerance, particularly for other people's views (Philip et al., 2023). The Society of New Zealandand Australiafor Geriatric Medicinehighlighted complexities with regard to the challenge of vulnerableclients, particularlythe risks denoting prognosis as well as the capacity for making informed decisions.

Natural Law

Within the month of June 2019, Voluntary assisted dying (VAD)had been legalized within the Victorian State of Australia. Patients have been assisted by physicians in ending their lives specifically by offering medications for self-administration purposes at their competent and voluntaryrequest (NSW Health, 2023). Adult citizens of Australia or permanent residents have been provided allowance by the Victorian Act to obtain the capacity of decision-making within the ultimate months or weeks of life comprising an incurable and serious conditionthat results in causing unbearableand enduringsufferingand might not be relieved sufficiently for selecting the VAD option.

Conclusion

For clients dealing with SPMI around Australia and receiving VAD services, the ethical considerations can be found multifaceted and difficult to understand and evaluate. As it has been elaborated within the ethical statements outlined, the decision for ending a life particularly remaining in the clinical professional hands cannot be considered relevant to the decision undertaken by an individual who is committing suicide by following an autonomous way. Within contemporary society, it is usually not showcased by physicians with their social-emotional history and medical chart of patients extending over a life process. Instead of that, they are pressured to form a decision by considering their current history. Health practitioners are obliged to utilize mental health laws and regulations in Australia where the clinical understanding is neither too wide nor contextualized toward surrounding the life history of the individual obtaining the moral responsibility in promoting a lethal result for their patients.

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