Physician Assisted Suicide is a controversial aspect of nursing due to its moral and ethical beliefs of those it affects. Physician assisted suicide is when a terminally ill patient gets the assistance of a physician to aid them at a point in their illness when their life is nearing an end, to have a comfortable and peaceful death by assistance of sleeping pill or a concoction of medication that would induce death.
They will also receive information regarding their terminal illness and need to understand the process. “Instead of engaging in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life.
Physicians: (a) Should not abandon a patient once it is determined that cure is impossible. (b) Must respect patient autonomy. (c) Must provide good communication and emotional support. (d) Must provide appropriate comfort care and adequate pain control.” (AMA, 2020)
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Not all fifty states allow this, but some states have gotten on board and it is now legal for them such as, California, Colorado, Hawaii, Washington DC, Washington, Oregon, Vermont, New Jersey, and Maine. For some people with terminal illnesses, they will make the decision and move to one of these states if they are not living in one.
As a nurse the dilemma’s you will encounter will be ensuring your patient understands their rights, ensure they are educated on their illness and know the end of life process, keeping them comfortable until the decision is made to end their life.
But another conflict that could arise would be if the nurse providing the care has an ethical belief that would keep them from assisting the care or administering any life-threatening medications to end their life.
One of the states that has been on board since 1997 with assisted suicide is Oregon. Each state has certain protocols to follow and for Oregon are as such, “be over 18, be mentally competent, have a terminal illness that will lead to their death within 6 months and: Must request the medication twice.
There must be 15 days between each request – called a ‘cooling off’ period. Must make a written request to their doctor (known as the ‘attending doctor’). This must be witnessed by two individuals who are not primary care givers or family members. Can cancel the verbal and written requests at any time.
Must be able to take the life-ending medication themselves.” (Dignity in Dying, 2019) These situations are not taken lightly and each state utilizing it has very strict rules regarding it. The physician at any point can also always stop it if the patient appears to be ineligible for any reason.
Oklahoma does not honor physician assisted suicide, euthanasia, or what is considered mercy killings at this time. In Oklahoma, an advance directive is really important for persons to complete at time in their life when they can make that decision and put it on paper.
These decisions are such as, artificial feedings, hydration, and ventilators, all not considered suicide. Pain medications are viewed differently and not considered suicide, so therefore used to relieve pain and often times quicken a person’s death.
“When a person dies from having life sustaining treatment withdrawn, Oklahoma law doesn’t see it as either a homicide or a suicide nor does it violate the Assisted Suicide Prevention Act. That is, the doctor won’t be criminally charged with homicide for following a person or their health care representative’s decision to remove life support.” (Oklahoma Euthanasia Laws, 2016)
Death with dignity process is a very complex situation. It requires two physicians to confirm their residency, diagnosis of six months or less to live, prognosis, and mental capacity of their patient. It is not something that is taken lightly, and the statutes of the states require this process not only for the patient’s sake, but the physician’s providing the care to end the life of a human being.
These statutes also allow the patient to remain the driving force of the end of life discussions and decisions needing to be made. Physician assisted suicide allows the patient, not the government or religious beliefs, to make the decisions towards the end of life and how much pain should be endured at the end of life. Giving them the right to make these decisions helps them to feel as though they have some control of their life still in a difficult time.
End of life hospice care, being at home, and remaining out of the intensive care units in the hospital is the choice so many are making when they have been given a terminal illness. Studies have shown that “home is where most patients want to die, and even the discontinuation of ventilators or implantable cardiac devices can be done compassionately and effectively at home with hospice care.
This approach is more patient centered and a better use of resources when hospital care is not truly necessary. This is the control the medical profession can and should give patients and their families. Dying well requires science and an art of caring for the dying.” (Sulmasy et al., 2017)
When a co-worker chooses this line of nursing and it is against the belief of others in the field, it is in the best interest of the patient, other nurses, and the entire medical filed to respect their wishes and remain professional at all times. Educate yourself further and be mindful of feelings during these difficult times in a person’s life.
Be supportive of all, as this is what makes the medical field work, a diverse team of professionals working in the best interest of all the disciplines out there including, hospice, cardiac, pulmonary, orthopedic, oncology, pediatric, or any of the other areas in nursing today.
Each area is not for everyone, that is why it is so important to be supportive of one another and encourage each nurse to continue doing what they do on a day to day basis. Even if it is physician assisted suicide.
As a nurse it is important to understand and know your role when you are working in hospice care and dealing with end of life issues. Keeping your patient comfortable and knowing their wishes are very important at this time. Knowing if there is a DNR (do not resuscitate) in place and a living will, an advanced directive with their wishes spelled out in writing. These are typically done when the patient is coherent and is able to make these decisions with a clear mind.
Since Oklahoma is not a physician assisted suicide legal state, if a nurse were to participate in this while working in an end of life situation, he or she would be violating provisions of the Nurse Practice Act. “#13 “State practice laws” means a party state’s laws, rules and regulations that govern the practice of nursing, define the scope of nursing practice, and create the methods and grounds for imposing discipline.
State practice laws do not include requirements necessary to obtain and retain a license, except for qualifications or requirements of the home state.” (OBN, 2020) It is the nurse’s responsibility as well as the company he or she works for to provide policies and procedures and know what you can and cannot perform. If there is ever a question as to what a nurse can perform, always find out.
By violating any act of the Nurse Practice Act, a nurse will be held accountable to whatever it is he or she has done. Your license could possibly be suspended, and you may have to go before a board of nurses to be questioned and judged regarding your acts.
Depending on the severity of what the nurse has done, your license could have restrictions placed on it or possibly even revoked. Nurses work very hard for their license, so it is very important to always know your scope of practice.
If working in hospice care, make sure to know your position as a nurse so you can keep your patient as comfortable as possible to have a pain free death. Know your states that do allow physician assisted suicide and if this is an area you would be comfortable working in so you can be as effective as possible as an advocate for your patient.
Nursing school is a great achievement in one’s life and should not be taken lightly. Always follow your company’s policies and procedures and do not put yourself ever in a situation to get your license suspended or even taken away by the nursing board.
The Oklahoma Board of Nursing has a nurse practice act that has violations that can be violated and as nurse, it is your responsibility to know those and follow them. If at any point you are uncertain, always research and know your boundaries. A nurse’s license is something that requires great respect by all who choose the filed.
While working day to day in nursing, whichever area you might choose, you are always upheld to a higher standard to make the right decisions for your patient. Doing the right thing and following all procedures and protocols is required.
If you ever witness a co-worker doing something that is not part of procedure, it is your duty to always report anything of that nature to your immediate supervisor immediately. Even if you are friends and have developed a greater relationship than just as co-workers, you still have to set those feelings aside and report. It is a nurse’s ethical duty to do so.
Never should one’s life be taken for granted or lightly. It is one’s duty at end of life to research all their options and know their rights. If physician assisted suicide is decided upon, as nurses you respect each person’s decision and be a comfort and helping hand at the end. You will be remembered by family as the nurse who held their loved one’s hand and comforted them in their time of need.
As nurses, this is what it’s all about, making an impact on one’s life and their family. It may not always be joyous in nursing but if hospice, end of life, and working in a state where physician assisted suicide is allowed, you will be rewarded as you care for these patients on a day to day basis.
Physician assisted suicide is and remains one of the most controversial aspects of nursing. Some see this as murder but as nurses who work with death and dying understand the choices of these patients more than the outside person just looking in. It is never a time to judge but to ensure education and counseling are provided when this decision has been made. It is a nurse’s duty, as well as the physician to provide comfort, caring, and compassion during the most difficult time in someone’s life who has chosen physician assisted suicide.
