Ethics Nursing Assisted Suicide

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expected to die within 6 months, the patient must be free of depression and found mentally competent, make two verbal requests to the physician at least 15 days apart and sign a written request that is signed in front of two witnesses that are not related to the patient by blood, marriage, adoption, or heir to any portion of the patient’s estate. The witness also cannot be a healthcare provider from the facility in which the patient is being treated nor the prescribing physician. Requirements of the prescribing physician are the physician must be licensed in Oregon, there must be a second physician consulting and both the prescribing and the consulting physician must agree on the patient’s prognosis and diagnosis, the patient must undergo a psychiatric evaluation and the physician must recommend that a next of kin is notified (Harris, 2014).

Washington’s Death with Dignity Act also requires that 48-hour pass between the patient’s written request and the time the physician writes the prescription. The law also states that the individual’s insurance company must determine if the insurance company will pay for the cost of the visit and the prescription. Federal funding cannot be used for these services. Washington law states that participation in this act is not considered suicide. Therefore, “participation should not affect insurance benefits that pertain to suicide.” The Washington law also has added requirements for reporting, “physicians must report the prescriptions written to the Department of Health, Pharmacist must be informed of the medication’s planned use and report medications dispensed to the Department of Health, Information collected by the Department of Health related to this act is not public record and will only be released as summarized data in the annual statistics report.”

As a result of the changing legislation nurses in each state in which assisted suicide is legal should undergo training to further educate themselves on the legislation. For example, a survey conducted in Washington found that 70% of the 582 nurses surveyed did not know that a facility could prohibit a physician from participating in the Death with Dignity Act, 53% of the nurses surveyed did not know that the patient must be a legal resident of Washington in order to participate in the Death with Dignity Act, and 60% incorrectly believed the patient had to be in hospice care in order to participate in PAS. These are all important points that a patient might have questions about and as nurses we must be able to educate patients.

The ANA states, “The American Nurses Association (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 (ANA, 2001; herein referred to as The Code), the ethical traditions and goals of the profession, and its covenant with society. Nurses have an obligation to provide humane, comprehensive, and compassionate care that respects the rights of patients, but upholds the standards of the profession in the presence of chronic, debilitating illness and at end-of-life (American Nurses Association, 2013).” Although the ANA states that nurses are prohibited from participating in euthanasia and assisted suicide it does not define what participation means. As nurses, we cannot prescribe medications and in assisted suicide the patient is self-administering the medication. The Code of Ethics states a nurse has the responsibility to provide information that is accurate and complete. When a patient asks what their end of life options are, if a nurse provides information on PAS as one of their options is that in violation of the Nurse’s Code of Ethics? I do not think so, because in states that PAS is legal the patient has the right to know all of their options, regardless of the nurse’s moral beliefs and the beliefs of the American Nurse’s Association. The federal government has let individual states determine if PAS is legal in their state. Therefore, if a law has been passed legalizing the end of life option the nurse has an ethical obligation to inform the patient. As stated in Provision 1.4 The Right to Self- Determination, “Nurses offer information and advice to patients in ways that exercise compassion, affirm patient dignity, and recognize the uniqueness of the patient as a person (Fowler, 2015).” Patient’s autonomy and right to self-determination is at the core of healthcare.

The ANA empowers nurses to be advocates for our patients and practice with nonmaleficence. Nurses advocate for their patients by, “participating in assuring the responsible and appropriate use of interventions in order to optimize health and wellbeing of those in their care.” This includes acting to minimize unwarranted, unwanted, or unnecessary medical treatment and patient suffering (Fowler, 2015).” The last sentence is very important it states that a nurse should act to help minimize patient suffering, in my opinion this is the definition of nonmaleficence. For a terminally ill patient already suffering, I think it is cruel to make them choose between starving themselves or being sedated. Both of these options prolong the suffering of not only the patient but the patient’s family. It is unethical to tell patients they have a right to make all the decisions regarding their healthcare, but when it comes to end of life decisions refusing to let them control the way they die. If a person has less than 6 months to live, why should they be put through the ordeal of having their body deteriorate to a point in which the time they have left is a period of suffering or a period in which they are not of sound mind. I believe that patients who are terminally ill should live the last months of their lives as peaceful and pain free as possible. If it has been determined that the patient is not depressed and they meet the criteria to decide whether they want to participate in an assisted suicide they should be able to. After all they are the ones who will be suffering, perhaps they want their last days on earth to be happy and peaceful and not full of “what if’s” and the paid and misery that may lie ahead.

It is difficult to say what should be done when faced with a patient whom is unresponsive and unable to communicate their wishes. This is why advanced directives are so important. Life is unpredictable and having an advanced directive provides not only physicians with information about what medical treatments should be pursued, but also can help ensures that your end of life wishes are followed.