Nursing Ethics

Reigniting the debate over assisted By Lois R. Robley, RN, PhD

The debate about has come back • Two physicians must determine that the person into the news with the recent arrests of four mem- is competent. bers of the Network, a Georgia-based • The person must be provided with information group accused of assisted suicide in the death of a about hospice. Georgia man in 2008. The group also faces charges In 2008, according to the state’s Web site, 88 pre- of assisted suicide in , stemming from a 2007 scriptions for lethal medications were written under case that may have involved a patient who wasn’t the provisions of Oregon’s law, and 60 patients ended Tterminally ill and may have had impaired judgment their lives.3 and questionable mental health at the time.1 A similar law was approved in the state of The aging U.S. population and healthcare reform Washington and took effect March 5, 2009.4 Montana means that the debate about assisted suicide and voters also approved an assisted suicide law last year, natural death will only intensify. As nurses, we need but the court ruling legalizing the practice is under to be well-informed in order to contribute clarity appeal. Assisted suicide is illegal in most states. and information to this debate. , as you know, comes from the Greek eu meaning well and thanatos meaning death, and Untangling the terminology translates as “dying well” or a “good death.” Most Among the terms being used in the debate are assist- people would describe a good death as one that’s ed suicide, euthanasia, aid in dying, and the right to peaceful, painless, lucid, and provides the oppor- die. Assisted suicide, as understood nationally and as tunity for the expression of love and family pres- defined in Oregon’s Death with Dignity Act, is the act ence. of providing prescription In ethical parlance, medication to a terminally the term euthanasia is ill patient at his request for divided between active the purpose of effecting a Assisted suicide remains euthanasia and passive peaceful death. The patient a controversial, emotional, euthanasia. Active requesting aid in dying must and moral issue. euthanasia denotes have full capacity to make instances when some- medical decisions, make the one takes direct action request himself, and admin- (for example, a lethal ister the medication himself.2 The medication pre- injection) to bring about a patient’s death. Passive scribed, usually a sedative/hypnotic, causes deep euthanasia denotes refusal to intervene to prevent sleep, leading to eventual cessation of respiration. a patient’s death. Suicide, differing from assisted suicide, is the Because of the concern that passive euthanasia taking of one’s own life without the assistance of involves long-term suffering, the greatest question another person. the public and nurses face is whether forgoing inten- Oregon’s law, which technically is a physician- sive therapy to allow a natural death is preferred assisted suicide law, has many safeguards in place over other ways of dying. to ensure adherence to the intent of the law: • The person must make several requests for assist- Compassion or aid? ed suicide, with at least 15 days between the first Persons often seek aid in dying when their lives and last request. are fraught with pain and other physical symptoms,

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depression, and loss of dignity. In those circum- REFERENCES stances, they may turn to a group such as the Final 1. Rubin P. Death wish. Phoenix New Times News. August 22, 2007. http://www.phoenixnewtimes.com/2007–08–23/news/death-wish. Exit Network. 2. State of Oregon. Oregon Death with Dignity Act. http://oregon.gov/ According to its Web site, Final Exit Network DHS/ph/pas/ors.shtml. provides only counseling, training, and support. 3. State of Oregon. 2008 Summary of Oregon’s Death with Dignity Trained members of the network respond to Act. http://www.oregon.gov/DHS/ph/pas/docs/year11.pdf. 4. State of Washington. Washington Death with Dignity Act. http:// requests from person seeking a way to end their wei.secstate.wa.gov/osos/en/Documents/I1000-Text%20for%20web.pdf. self-proclaimed painful lives. Final Exit Network 5. Final Exit Network. http://www.finalexitnetwork.org. says that it only helps competent individuals 6. American Nurses Association. Code of Ethics for Nurses. Washington, who wish to know how to end their own lives, DC: American Nurses Publishing; 2001. 7. American Nurses Association. Ethics and human rights position and lists inclusion and exclusion criteria on its statement: assisted suicide. Silver Spring, Md; American Nurses Web site.5 Association: 1994. http://www.nursingworld.org/MainMenuCategories/ HealthcareandPolicyIssues/ANAPositionStatements/EthicsandHuman Members of the network follow directions from Rights.aspx. the 1991 book by , Final Exit: The 8. Robeznieks A. Survey shows heightened focus on pain at death. Practicalities of Self-Deliverance and Assisted Suicide Am Med News. 2004;47(32):14. for the Dying to counsel persons who wish to com- 9. Tilden VP, Tolle SW, Drach LL, Perrin NA. Out-of-hospital death: advance care planning, decedent symptoms, and caregiver burden. mit suicide. These guides often are present at the J Am Geriatr Soc. 2004;52(4):532. time of the suicide, but according to the network, Lois R. Robley is a professor of nursing at Kennesaw State University’s WellStar merely provide a compassionate presence and don’t School of Nursing in Kennesaw, Ga. assist the patient. Because assisted suicide is a felony in Georgia, members of Final Exit could face jail time if convicted. Provide the most current Where nursing stands Prevention and Rehabilitation As a nurse, you need to know the professional techniques in cardiovascular and pulmonary care. stance on assisted suicide and the underlying reasons why the debate continues. The American Nurses Association’s (ANA’s) Code of Ethics for Nurses calls for providing sup- JCRP keeps you in touch in a way that’s portive care to dying patients, and intervening clear and concise. to enable the patient to live with as much physi- This is the journal to turn to first cal, emotional, social, and spiritual well-being as for evidence-based, peer-reviewed possible.6 However, an ANA position statement research most appropriate for nurses. on assisted suicide states that nurses shouldn’t You’ll stay current on … participate in assisted suicide, but should always • cardiovascular disease work toward comprehensive care of the ill and prevention and management 7 dying. Nurses in Oregon, and now Washington, • cholesterol therapies don’t assist with suicide, but care for patients • diet and exercise for cardiac who elect assisted suicide in the same way Continuing rehabilitation they care for all patients, with dignity and education opportunities now included! • oxygen uptake on-kinetics compassion. • effect of sleep disorders on An interesting byproduct of the Oregon law heart conditions, and more. has been an increase in use of hospice and Official Journal of the American Association of To subscribe, greater attention and expectations of patients Cardiovascular and call TOLL FREE 1-800-638-3030 or go to about symptom control and improved pain Pulmonary Rehabilitation NursingCenter.com or LWW.com/nursing. management.8,9 and The Canadian Association of Cardiac Assisted suicide remains a controversial, emo- Rehabilitation tional, and moral issue. By understanding the © 2007 Wolters Kluwer Health/Lippincott Williams & Wilkins arguments on all sides, you can be an informed F7NCK772 A7K772ZZ professional voice in the debate. ❖ www.nursing2009criticalcare.com September l Nursing2009Critical Care l 17