Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-12-03T19:51:20.545Z Has data issue: false hasContentIssue false
  • English
  • Français

Assisted Suicide: The Challenge to the Nursing Profession

Published online by Cambridge University Press:  01 January 2021

Diane K. Kjervik
Get access Rights & Permissions [Opens in a new window]

Extract

Nursing prides itself on a commitment to caring for patients and their families. Daily, nurses support patients and their families as they face life-threatening disease and injury and help them through the painful decisions to initiate or remove ventilators, artificial nutrition and hydration, and other life-sustaining technology.

The opinions of the Second and Ninth Circuit Courts of Appeals, in Compassion in Dying v. State of Washington and Quill v. Vauo, strike at the heart of the nursing value system. If the United States Supreme Court upholds either opinion, physicians will be legally allowed to help patients die, and nurses will be called on to assist with this process, just as nurses have assisted with electroconvulsive treatment, abortion, and other controversial procedures. Advanced practice nurses (APNs), who are licensed to prescribe drugs, may also be allowed by law to assist patients to end their own lives.

Type
Article
Information
Journal of Law, Medicine & Ethics , Volume 24 , Issue 3 , Fall 1996 , pp. 237 - 242
Copyright
Copyright © American Society of Law, Medicine and Ethics 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Compassion in Dying v. State of Washington, 79 F.3d 790 (9th Cir. 1996) (en banc).Google Scholar
Quill v. Vacco, 80 F.3d 716 (2d Cir. 1996).Google Scholar
Active euthanasia is defined as the deliberate act of someone other than the patient taking action to put to death the patient who is suffering from painful and prolonged injury or illness.Google Scholar
Assisted suicide is defined as the act of making available a means of suicide to a patient, knowing the patient's intent to use the means.Google Scholar
American Nurses Association, Position Statement on Assisted Suicide (Washington, D.C.: American Nurses Association, 1994); and American Nurses Association, Position Statement on Active Euthanasia (Washington, D.C.: American Nurses Association, 1994). The ANA position statements have been endorsed by other nursing organizations including the American Association of Critical-Care Nurses. Scanlon, C., “Euthanasia and Nursing Practice—Right Question, Wrong Answer,” N. Engl. J. Med., 334 (1996): 1401-02. The Oncology Nursing Society endorses the ANA position statements on assisted suicide and active euthanasia. ONS News, 10, no. 7 (1995): 4. The Hospice Nurses Association also endorses the ANA position on assisted suicide. Amenta, M. Shubert, V. Wagner, C., “HNA Position Statements,” Fanfare, 8, no. 3 (1994): 12.Google Scholar
American Nurses Association, Position Statement on Active Euthanasia, id. at 2.Google Scholar
American Nurses Association, Position Statement on Assisted Suicide, supra note 5, at 1.Google Scholar
Id. at 4.Google Scholar
Price, D.M. Murphy, P.A., “Assisted Suicide: New ANA Policy Reflects Difficulty of Issue,” Journal of Nursing Law, 2, no. 2 (1995): 53–62. David Price and Patricia Murphy note that the task force members “returned to their first draft with a mandate to make it more hospitable to nurses who, in general terms or in highly specific circumstances, feel that assisted suicide may be occasionally justifiable or even a logical extension of the duty of fidelity.” Id. at 55. It is worth noting that the Oregon Nurses Association, one state constituent of the ANA, issued a very different position statement that emphasizes both patients' and nurses' values, and emphasized that the nurses' role is to “share relevant information about health choices that are legal and to support the patient and family regardless of the decision the patient makes.” Also, nurses are to transfer care to other nurses if they personally object to the patient's choice to die; and if such a transfer is impossible, nurses have “the responsibility to provide for ongoing end of life care.” See Oregon Nurses Association, “ONA Provides Guidance on RN's Dilemma… Position Statement on the Nurses' Role in the Death with Dignity Act,” Oregon Nurse, 60, no. 2 (1995): At 12.Google Scholar
Volker, D.L., “Assisted Suicide and the Terminally Ill: Is There a Right to Self-Determination?,” Journal of Nursing Law, 2, no. 4 (1995): 37–48.Google Scholar
Compassion in Dying, 79 F.3d at 834.Google Scholar
Volker, , supra note 10, at 45–46.Google Scholar
Young, A., “Professional Integrity and Assisted Suicide: A Nursing View,” Bioethics Forum, 10, no. 2 (1994): 11–13.Google Scholar
Fowler, M., “The Terror and Darkness of Dying: On Caring, Not Killing,” American Nurse, 28, no. 5 (1996): 5.Google Scholar
Id.Google Scholar
Id.Google Scholar
Slippery slope is defined as the act of making it easier over time to allow or even encourage others, especially vulnerable groups or individuals, to “choose” death.Google Scholar
Kowalski, S.D., “Assisted Suicide: Is There a Future? Ethical and Nursing Considerations,” Critical Care Quarterly, 19 (1996): 45–54; Dewolf Bosek, M.S. Jezuit, D., “The Nurse's Role in Assisted Suicide,” Medsurg Nursing, 4 (1995): 373–78; Kovach, C.R., “Euthanasia: Let Nursing's Voice Be Heard,” Journal of Gerontological Nursing, 18, no. 4 (1992): 5; Coyle, N., “The Euthanasia and Physician-Assisted Suicide Debate: Issues for Nursing,” Oncology Nursing Forum, 19, no. 7 (1992): 41–46; Whitfield, S., “Going Gently into that Good Night,” Nursing Times, 83, no. 45 (1987): 30.CrossRefGoogle Scholar
Aroskar, M.A., “Nursing and the Euthanasia Debate,” Journal of Nursing Law, 2, no. 2 (1995): 35–37. See also DeBroff, K., Should the Nurse be Allowed to Assist Patient Suicide? (Baltimore: American Association of Nurse Attorneys Foundation, 1992): At 14: “Nurses are not void of emotion or morals; to expand the role of the nurse to include the assistance of patient suicide expects the nurse to function as a robotic provider of care or death, whichever the patient desires.”Google Scholar
Asch, D.A., “The Role of Critical Care Nurses in Euthanasia and Assisted Suicide,” N. Engl. J. Med., 334 (1996): 1374-79. This study has been criticized by the ANA for its confusion of euthanasia, assisted suicide, active euthanasia, and “justified end-of-life interventions, such as increasing morphine dosages to manage pain.” See American Nurse, 28, no. 4 (1996): At 9; and Scanlon, , supra note 5, at 1401. See also Kuhse, H. Singer, P., “Voluntary Euthanasia and the Nurse: An Australian Survey,” International Journal of Nursing Studies, 30 (1993): 311–22. Kuhse and Singer's work has been criticized for its superficiality and the failure of the survey to decipher the level of understanding respondents had of the issues, in Pollard, B. Winton, R., “Why Doctors and Nurses Must Not Kill Patients,” Medical Journal of Australia, 158 (1993): 426–29. See also Stevens, C.A. Hassan, R., “Nurses and the Management of Death, Dying and Euthanasia,” Medicine & Law, 13 (1994): 541–54.Google Scholar
McInerney, F. Seibold, C., “Nurses' Definitions of and Attitudes Towards Euthanasia,” Journal of Advanced Nursing, 22 (1995): 171–82 (offering views of nurses in Australia); Davis, A.et al., “An International Perspective of Active Euthanasia: Attitudes of Nurses in Seven Countries,” International Journal of Nursing Studies, 30 (1993): 301–10 (offering views of nurses in Australia, Canada, People's Republic of China, Finland, Israel, Sweden, and the United States); Young, A.et al., “Oncology Nurses' Attitudes Regarding Voluntary, Physician-Assisted Dying for Competent, Terminally Ill Patients,” Oncology Nursing Forum, 20 (1993): 445–51 (offering views of nurses in the United States); Stewart, C.S. Paulus, G.S., “Effect of Parental Socialization on Student Nurses' Attitudes Toward Euthanasia,” Death Studies, 9 (1985): 395–415 (offering views of nurses in the United States); Nagi, M.H., “Clinical Imperatives versus Ethical Commitments in Euthanasia: The Perspectives of Nurses,” Loss, Grief & Care, 4 (1990): 99–128 (offering views of nurses in the United States); and “Euthanasia: What You Think?,” Nursing Times, 84, no. 33 (1988): 38–39 (offering views of nurses in England).CrossRefGoogle Scholar
Wilkes, L. White, K., “Euthanasia: A Comparison of the Lived Experience of Chinese and Australian Palliative Care Nurses,” Journal of Advanced Nursing, 18 (1993): 95–102.CrossRefGoogle Scholar
Kelner, M. Bourgeault, I. Wahl, J., “Regulation and Legislation of the Dying Process: Views of Health Care Professionals,” Death Studies, 18 (1994): 167–81.CrossRefGoogle Scholar
Passive euthanasia is defined as the act of letting nature take its course.Google Scholar
Shuman, C.R.et al., “Attitudes of Registered Nurses Toward Euthanasia,” Death Studies, 16 (1992): 1–15.CrossRefGoogle Scholar
Kelner, M. Bourgeault, I., “Patient Control over Dying: Responses of Health Care Professionals,” Social Science and Medicine, 33 (1993): 757–65. The study sample included twenty physicians and twenty nurses.Google Scholar
Compassion in Dying, 79 F.3d 790.Google Scholar
Id. at 802.Google Scholar
Id.Google Scholar
Id. at 801.Google Scholar
See Volker, , supra note 10; Young, , supra note 13; and Fowler, , supra note 14.Google Scholar
Gorlin, R., ed., Codes of Professional Responsibility (Washington, D.C.: Bureau of National Affairs, 3rd ed., 1994): At 385. The language used in discussion of human dignity is somewhat equivocal. At one point, the ANA Code for Nurses states: “Nurses therefore must take all reasonable means to protect and preserve human life when there is hope of recovery or reasonable hope of benefit from life-prolonging treatment” (id. at 386). At another point: “The nurse does not act deliberately to terminate the life of any person” (id. at 387). Acting deliberately to terminate life is clearly active euthanasia, but assisted suicide could be considered a nondeliberate act on the part of the nurse, and therefore acceptable.Google Scholar
“The Death of Nancy Cruzan,” PBS Frontline: Documentary Consortium (Corporation for Public Broadcasting, Mar. 24, 1992). See also Davis, , supra note 27. Davis discusses interactions between nurses and comatose patients, and uses the Missouri nurses' reaction to the withdrawal of nutrition from Nancy Cruzan as an example of caring relationships. See id. at 10.Google Scholar
Compassion in Dying, 79 F.3d 790.Google Scholar
Id. at 827.Google Scholar
Id. at 820.Google Scholar
Id. at 839. The court states: “Those who believe strongly that death must come without physician assistance are free to follow that creed, be they doctors or patients. They are not free, however, to force their views, their religious convictions, or their philosophies on all the other members of a democratic society, and to compel those whose values differ with theirs to die painful, protracted, and agonizing deaths.”Google Scholar
The Code for Nurses provides a conscience clause that states: “If ethically opposed to interventions in a particular case because of the procedures to be used, the nurse is justified in refusing to participate. Such refusal should be made known in advance and in time for other appropriate arrangements to be made for the client's nursing care.” See Gorlin, , supra note 33, at 387.Google Scholar
Quill, 80 F.3d 716; and Gorlin, , supra note 33, at 387. The Code for Nurses states: “The nurse adheres to the principle of non-discriminatory, non-prejudicial care in every situation and endeavors to promote its acceptance by others.”Google Scholar
80 F.3d at 729.Google Scholar
See Gorlin, , supra note 33.Google Scholar
80 F.3d at 728.Google Scholar
Id. at 721.Google Scholar
Johnson, Weiler, , supra note 27, at 263.Google Scholar
Haddad, A.M., “Physician-Assisted Suicide: The Impact on Nursing and Pharmacy,” Of Value, 24, no. 4 (1994): 1, 6.Google Scholar
Davis, , supra note 27, at 10.Google Scholar
Morse, J.M. Carter, B., “The Essence of Enduring and Expressions of Suffering: The Reformulation of Self,” Scholarly Inquiry for Nursing Practice: An International Journal, 10, no. 1 (1996): 43–60.Google Scholar