Euthanasia: Incorporating a Theory


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Incorporating a Theory

Management of terminally ill patients is pretty demanding. Clinicians taking care of these patients are always passed with several questions. How can I be most helpful to this patient? What is the most appropriate manner of delivering news of a terminal diagnosis? However, the most important of all these questions that they ask themselves is how they can develop a thoughtful and reasonable plan for end of life care? It is for this reason that I chose the Lewis’s theory of change as the most crucial theory of euthanasia.

Despite proposing that euthanasia is the best approach for patients nearing their end of life, I strongly believe that health officials should equip themselves with necessary skills for managing these patients before they may request for euthanasia.

In today’s world, hospital settings are receiving a high number of patients who are put under palliative care. Most of these patients tend to engage in poly-pharmacy where they are prescribed more than four drugs. The probability of medical errors to occur in such hospital settings is high. Such errors usually lead to disturbing consequences not only on the patient but also on the nurse.

The occurrence of such errors can however be minimized significantly through the incorporation of technology that promotes patient care and saves time for the busy nurses. An example of an approach that can be used is the Bar-Coded Medication Administration (BCMA). This technology entails the use of scanning devices to contrast bar codes installed in patients with codes that display the prescribed drugs, electronically identifying the possible errors against the medical records, hence decreasing the occurrence of medication errors drastically.

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However, implementation of change in practice is usually associated with production of anxiety or fear of failure in nurses resulting in resistance to this change process. It is for this reason that Kurt Lewis’s theory of change comes in handy. Most healthcare institutions have used this model to study human behavior and how it is related to change as well as the patterns of resistance to the change.

The model determines forces that inhibit change implementation and factors that drive the change process. By identifying these two forces, health care organizations can then work towards strengthening the positive driving forces and find solutions to the impeding forces.

Kurt Lewis Theory Incorporation

This theory is made up of three stages; unfreezing phase, moving phase, and the refreezing phase.

  1. Unfreezing phase

During this stage, round table discussions can be conducted with the aim of teasing out the supporting and impeding forces. This will be essential particularly in identifying the challenges that should be overcome. Some restraining forces in this facility may include; lack of computer experience, staff resistance against the use of computerized devices, dislike of the new system, and the cases of workarounds. BCMA is implemented successfully without instances of dangerous workarounds with maximum investment in the results.

 On the other hand, the driving forces may include; enough financial investment, proper time management, support from top level managers, and potential ease of use.

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  •  Moving Phase

This phase involves the actual change including planning and implementation of the project. Bar code implementation may require corporation from various teams such as the clinical information services, information technology (IT), pharmacy, clinical nurse educators, program managers, and administrators. A project leader should also be chosen to oversee and assess all phases of this project. Some of the challenges that can be encountered during this stage include the rediscovery of workarounds. However, they can be solved through provision of further education.

  • Refreeze Phase

This is the final stage. Here the there should be ongoing support of the clinicians on the frontline. All stakeholders should also be accorded technological support to a point where the change is deemed complete and all users have familiarized themselves with the technology and are comfortable with it. Once the process is fully functional, an analysis and summary of the challenges encountered, successes met, and problems encountered should be done for future reference. Any project of this magnitude can realize massive success once the Kurt Lewis theory of change is implemented.

Review of Literature

Euthanasia is a clinical practice that is carried out usually in terminally ill patients such as cancer patients who are suffering severe pain. Thienpont enlightens that, it can be conducted either through administration of a lethal injection or blocking a patient’s feeding tube (Thienpont et al, 2015). However, this subject of euthanasia has raised heated debates on whether it should be conducted or not. Math and Chaturvedi conducted a research to seek views on whether it should be executed or not.

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From their study, they learned that some proponents of euthanasia argued that terminally ill patients occupy valuable space in hospital beds. They also argued that the long term palliative care accorded to the patients is a huge waste on medical resources. However, others opposed these views saying that it is not fair to kill someone just on petty grounds that hospital beds are needed by others. 

Terminally ill patients can be provided other avenues such as special hospices or homes where they can be taken care of. They even went further and stressed that if caring for the terminally ill is a waste then it would be just for the medical practitioners to deny medication to the elderly who are nearing the end of their life as well. To them, the description of hospice care as a waste of medical resources was rather harsh and families of terminally ill patients cannot agree to this statement.

According to Bauman and Dang, the best approach of managing patients with chronic diseases such as cancer or dementia is through hospice and palliative care (Bauman and Dang, 2012). Hospice care involves cooperation among several health officials from nurses, mental health professionals, clergy men, and to social workers all of whom act towards achieving a common goal, that is, providing the needs of chronically ill patients. Furthermore, they help in assisting family members who are constantly involved in the patient care process.

These officials work around the clock including weekends and holidays to offer their patients with a 24/7 care and assistance which they require desperately. According to Shah and Mushtaq, these specialists listen to and address the complaints of not only the patients but also the patient families (Shah and Mushtaq, 2014). They also provide counseling services and use advanced medical procedures and technology.

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According to Compas, et al, majority of these hospice and palliative care specialists help patients in patients’ homes so that these patients can spend the remaining time of their life with their loved ones and friends (Compas, et al, 2010). They can also assist patients at nursing homes, hospitals, and assisted living centers. These specialists are typically registered nurses (RNs) most of which hold a bachelor’s or a master’s of science degree in nursing. Their training involves

Carrying for terminally ill patients is accompanied with emotional circumstances that physicians usually find difficult to respond to (Leiva, 2010). Clinicians should therefore before be assisted from all specialties in attending their patients. Research has proven that even the most thoughtful health officials struggle with issues that arise when managing dying patients. This does not necessarily refer to assisted suicide of the patients under palliative care but rather to the overall emotional climate that encompasses this process whereby all that can be done medically has been done.

The most important attribute for such clinicians is being a straight shooter. Usually, patients and their families request that clinicians should be straight shooter. This actually means that they should use the truth when the patients and the families require it most. This may not cure or bring any form of happiness. However, being honest signifies that the clinician can be counted on to describe exactly the difficult times to be faced and offer solutions to these challenges.

Omipidam emphasized that it is important for physicians to understand that ethnicity and culture play a crucial role in management of patients in some communities (Omipidam, 2013). Therefore, physicians are advised to enquire from patients if they would like to receive information and make decisions or if the family wants to take care of the issues.

Moreover, physicians should maintain routine hospital calls. Just as it is crucial not to desert a patient to a consultant, it is equally important to ensure that regular visits to the terminally ill patients are maintained. The family as well as the patient should be well informed acutely of the frequency and the duration of the visits. The research conducted by Boudreau proved that physicians have a tendency of changing their schedules and shorten visits once the patients enter the last stages of illness (Boudreau, 2011).

One does not need to be a practitioner to correctly understand what this distance behavior has on the family and the patient. Maintaining frequency and duration of the visits will increase the understanding of the family, patient, and the physician.

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Most terminally ill patients suffer from depression (Katon, 2011). As a result, physicians should be well skilled in managing such psychological issues. Stuck and Nobel implied in their study that engagement of creative arts such as music engagement, expressive writing, and visual arts can be used to improve health outcomes (Stuckey and Nobel, 2010). This is because they help in enhancing an individual’s emotions, moods, and other psychological states.

Some of the countries that have legalized the proposed change- euthanasia include Netherlands and Belgium. Pereira ascertains that one of the main reasons for undertaking this policy was to relieve pain and suffering among terminally ill patients. However, Ncayiyana opposes this practice citing reasons that it does not show dignity and respect to human life (Ncayiyana, 2012).

The author offers alternative solutions saying that improvements on medication have been done to promote patients quality of life and ensure that their deaths are as humane as possible. The scholar argues that a person in sedation state still is still biologically alive and has the right to live until his/her natural death.

In some cases, patients request for euthanasia. However, Schüklenk,  confirms that several organizations such as the European Court for Human Rights have since ruled that no one has a recognized right to die whether with the aid of a third person or a public authority (Schüklenk, et al, 2011). He debates that if people were given the right to take their life, then people that are critically injured or the very old would have been compelled to request their death.

Hickman and Douglas oppose the idea that relatives can call for euthanasia to spare themselves the miseries of watching their loved ones go through agony and severe pain (Hickman and Douglas, 2010). Nevertheless, they have no right whatsoever to end life of the patients despite them being relatives.

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A survey conducted by Bennett et al on 200 doctors and 400 nurses, indicated that almost 94% of the nurses and 95% of the doctors viewed hospice care to be very important for patients with life-threatening conditions. Almost all these doctors and nurses wanted hospice care to be made readily accessible. They also agreed that the general public should have more information regarding hospice palliative care and end-of-life care training should be fundamental in medical and nursing education (Bennett et al, 2010).

However, the surprising fact from this survey was that 72% of the doctors and 28% of the nurses revealed that medical professionals do not enough concerning palliative care. This indicated the existing gap of knowledge that is used in support terminally ill patients. According to Bennett et al, basic medical education is not sufficient for hospice care training.

The environment, values, and culture in clinical settings and other places of care should encourage and promote greater openness and discussions about end of life. Policy makers in the field of healthcare should also seek ways of supporting and creating more opportunities and avenues for nurses to employ in their practice of hospice care in whichever specialty they are in.

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Bauman, L. & Dang, T. T. (2012). Helping patients with chronic illnesses overcome barriers to self-care. The Nurse Practitioner, 37(3), 32-38. 

Bennett, H. D., Coleman, E. A., Parry, C., Bodenheimer, T., & Chen, E. H. (2010). Health coaching for patients with chronic illnesses. Fam Pract Manag, 17(5), 24-29.

Boudreau, J. D. (2011). Physician-assisted suicide and euthanasia: Can you even imagine teaching medical students how to end their patients’ lives? The Permanente Journal, 15(4), 79–84.

Compas, B. E., Jaser, S. S., Dunn, M. J., & Rodriguez, E. M. (2012). Coping with chronic illness in childhood and adolescence. Annual Review of Clinical Psychology, 8, 455–480.

Hickman, R. L., & Douglas, S. L. (2010). Impact of chronic critical illness on the psychological outcomes of family members. AACN Advanced Critical Care, 21(1), 80–91.

J. Katon, W. (2011). Epidemiology and treatment of depression in patients with chronic medical illness. Dialogues in Clinical Neuroscience, 13(1), 7–23.

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Math, S. B., & Chaturvedi, S. K. (2012). Euthanasia: Right to life vs right to die. The Indian Journal of Medical Research, 136(6), 899–902.

Ncayiyana, D. (2012). Euthanasia: No dignity in death in absence of an ethos of respect for human life. The South African Medical Journal, 102(6), n.p.

Omipidam, B. A. (2013). Palliative care: An alternative to euthanasia. BMJ Supportive and Palliative Care, 3(2), 229.

Pereira, J. (2011). Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls. Current Oncology, 18(2), 38–45.

Schüklenk, U., Delden, J. J. M., Downie, J., Mclean, S. A. M., Upshur, R., & Weinstock, D. (2011). End-of-life decision-making in Canada: The report by the Royal Society of Canada Expert Panel on end-of-life decision-making. Bioethics, 25(1), 1–4.

Shah, A., & Mushtaq, A. (2014). The right to live or die? A perspective on voluntary euthanasia. Pakistan Journal of Medical Sciences, 30(5), 1159–1160.

Stuckey, H. L., & Nobel, J. (2010). The connection between art, healing, and public health: A review of current literature. American Journal of Public Health, 100(2), 254–263.

Thienpont, L. Verhofstadt, N., Loon, T., Distelmans, W., Audenaert, K., & Deyn, P. (2015). Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: A retrospective, descriptive study.  BMJ Open, 5(7), n.p.

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