Views on physician-assisted suicide
In “Physician-Assisted Suicide: A Nurse's Perspective” (March, 2014),* the author recommends that nurses sort out their personal beliefs regarding physician-assisted suicide (PAS) in order to best serve their patients' needs. I contend that nurses' negative visceral reaction to PAS arises from our understanding of our professional duty to adhere to the Hippocratic admonition to “do no harm” to our patients.
Patients asking for PAS may really be asking: “Am I a burden to you?,” “Will you effectively manage my pain and fears?,” and “Am I a person of worth and dignity even when I'm sick and disabled?”
In response, PAS tells the patient: “You're a burden,” “We have nothing to offer you to make you calm and comfortable,” and “You lost your dignity when we couldn't cure you.”
The medical and nursing professions have much more than PAS to offer our dying patients and we have the professional obligation to do so.
As a hospice nurse, I'd like to see patients receive more education on choosing hospice care. Hospice enables patients to be home, have their pain controlled, and die peacefully. In studies across the board, only 30% of qualified patients receive information on hospice services.1 This would give terminally ill patients an ethical choice that nurses can feel comfortable with.
Hospice Action Network. Hospice in the nursing home. 2013. http://hospiceactionnetwork.org/linked_documents/get_informed/issues/nursing_home/NH_Fact_Sheet.pdf.
I've cancelled my subscription to Nursing2014 because of this article on physician-assisted suicide. Here's the bottom line, in my humble opinion. PAS has no place in the healthcare world and nurses shouldn't even entertain the “what if?” This topic has no business in a prominent nursing journal. We are a trusted profession, and that trust should never be breached.
Nurses have a high calling to be healers, comforters, and consolers. A nurse taking the Florence Nightingale Pledge vows to “abstain from whatever is deleterious...and will not take or knowingly administer any harmful drug...With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.”1
The article on PAS (called doctor-prescribed suicide or DPS in some jurisdictions) left many unanswered questions about what the practice actually entails and how it's implemented.
Regardless of the PAS/DPS laws, which are fraught with many ethical problems, all nurses should be aware of the American Nurses Association (ANA) position statement issued on April 24, 2013. In part, it states that the ANA “prohibits nurses' participation in assisted suicide and euthanasia because these acts are in direct violation of Code of Ethics for Nurses with Interpretive Statements, the ethical traditions and goals of the profession, and its covenant with society.”2
Nurses also have an obligation to educate themselves on PAS/DPS laws, how they're implemented, and what the ramifications are when a lethal dose of barbiturate is prescribed, obtained, and ingested. For example, potential consequences include gastrointestinal distress (such as nausea and vomiting) and failure to die.
In Vermont where I work, nurses, pharmacists, and others who might be involved have no immunity from prosecution. There's no way to verify the patient takes the lethal dose, nothing to dictate what happens to the lethal dose once it leaves the pharmacy, and no validation on the death certificate.3
Palliative care is about more than medication. It's about holding a hand, singing a song, and being present. It's a rich privilege to care for patients as they breathe their last breath. May we remember the high calling we have as nurses to provide compassionate and respectful care to those who are nearing their final breath.
American Nurses Association. Florence Nightingale pledge. http://nursingworld.org/FunctionalMenuCategories/AboutANA/WhereWeComeFrom/FlorenceNightingalePledge.aspx.
American Nurses Association. Euthanasia, assisted suicide, and aid in dying. 2013. http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements/Euthanasia-Assisted-Suicide-and-Aid-in-Dying.pdf.
No. 39. An act relating to patient choice and control at end of life. Requirements for prescription and documentation; immunity. http://www.leg.state.vt.us/docs/2014/Acts/ACT039.pdf.
—DOROTHY FUCHS, MA, RN
Whitehouse Station, N.J.
—CAROL HARDISON, RN
—I. CEPLECHA, BA, RN
—LYNNE CAULFIELD, RN
Vermont Alliance for Ethical Healthcare Brattleboro, Vt.
* Individual subscribers can access articles free online at http://www.nursing2014.com.