Nurses are people of compassion and are motivated by mercy and kindness. Legalizing assisted suicide means that sick and disabled people, who don’t always ask to die, are? Everyone has a right to refuse any type of care or medication. We can say no to therapies, drugs, feeding tubes and life-extending machines. Assisted suicide changes the role from healers and protectors of the sick and the disabled. This is an occupation that should be shielding people from harm not causing it. Nursing is a calling dedicated to caring for people who are vulnerable. Anyone should be able to find comfort and relief from the staff, doctors, nurses, and caregivers. There are many definitions for the word terminal. For example, Jack Kevorkian who participated in the deaths of more than 130 people before he was convicted of murder said that a terminal illness was any disease that curtails life even for a day (Marker, 2010).
Assisted suicide remains one of the most complex, controversial issues in the healthcare arena. Many nurses must not only confront their personal feelings on the issue, but also determine what their roles should be. Nurses are constantly caught in the middle of the debate on assisted suicide. If nurses do not morally agree with assisted suicide, they must choose whether or not to remove themselves from the clinical team. In all states besides Oregon, assisted suicide is illegal. While it still happens in other states, nurses involved in assisted suicide could jeopardize their professional licenses. Families sometimes wonder if their loved one died because of the terminal illness or if the cause of death was related to the use of medications given during care. Normally, most patients die due to their terminal illness and the medications given are simply to control pain or other distressing symptoms. Nurses need to be alert to detect these sometimes unspoken questions in family members and to provide explanations about the medications and treatments given during care (Panzer, 2000).
In 2007, two Portland, Oregon nurses admitted to the Oregon State Board of Nursing that they administered massive doses of morphine and phenobarbital to a woman dying of cancer with the intention of causing her death. The state Board of Nursing was alerted to the nurses’ action, but took more than a year investigating and did not report the incident to police. (White, 2007) Nursing, like most health-care professions, is grounded in a desire to help those in distress. Health-care personnel are typically conditioned to favor action, doing something, over nothing. The problem is finding effective ways for nurses to express their genuine care and compassion. If they feel unable to provide effective relief of pain and suffering, a small percentage of nurses may find assisting death an attractive option that speaks of mercy and compassion.
According to David B. McCurdy, “more than a year ago, a New England Journal of Medicine report sent tremors through the health-care community by claiming that up to 20 per cent of critical-care nurses had performed euthanasia or assisted suicide. In the extensive discussion of the physician’s role, it is ironic that the question of nurses’ involvement or that of any non-physicians has receded into the background”. Physician assisted suicide could be considered ethical in certain situations to others. Compassion and beneficence are required, they are also desired. Every caregiver wants to help his patient, deliver treatment with excellence, compassion, and the intent of beneficence. Helping patients die contradicts the healing role.
It is important to remember the principles of nursing, no matter what is going on with your patient. The following is a brief review and relevance of the principles.
Autonomy: The nurse allows a patient to maintain character, values, and uniqueness, regardless of the nurse’s own values. The nurse helps the patient to understand the nature, extent, and possible outcome of treatment so the patient can make health care decisions based on information provided in an easily understood manner. The nurse has the responsibility to continue to provide information to the patient and to evaluate the patient’s understanding of that information in order to satisfy the moral obligation of maintaining the patient’s autonomy.
Freedom: This enables the patient to function independently and be allowed to freely make informed decisions in an autonomous manner. The nurse cannot interfere with the patient’s desires or actions.
Beneficence: The nurse has a moral obligation to do good, and the patient has a right to expect that he or she will derive some benefit from that good. This obligation also includes preventing harm and reducing the risk of harm. This is not done merely by instructing the patient as to what is good or not good for him or her, but rather providing the information that will enable the patient to reduce the risk of harm or prevent harm from occurring by making informed choices about the best approach; the one that will do good.
Nonmalfeasance: The nurse has a moral obligation to avoid harm to the patient. The nurse’s primary obligation is to the patient, always. Ignoring the treatment and efforts required to protect the patient’s well-being or allowing actions that will cause harm to the patient is unacceptable.
Veracity: In order to function in an autonomous manner and make health care decisions, the patient expects the nurse to provide truthful information. Without the truth, the patient cannot make informed decisions based on reason, and his or her rights to do so have been violated.
Confidentiality/privacy: This moral obligation endorses the theory of self-ownership and privacy; the patient has the right to expect that the nurse will guard against the unwarranted or unethical release of information about the patient. This principle protects the patient from harm that may be caused by breach of confidentiality or privacy.
Fidelity: The nurse is obliged to stay faithful to the agreement or the understanding reached with the patient regarding the care to be given. This allows the patient to be able to predict his or her environment, based on the expectations of the established trustworthy relationship.
Justice: The nurse is required to treat all people fairly without regard to socioeconomic status, personal attributes, or nature of the patient’s health problems.
In some circumstances which have been documented and confirmed by the courts, some physicians and staff have given medications in dosages which were either inappropriate or given in larger dosages than that needed by the patient, resulting in adverse reactions and in some cases, even death. Accidental administration of an overdose of any medication is one thing, but intentionally overdosing a patient is in a very different category of action. Intentionally overdosing a patient so as to cause death may be termed active euthanasia and if involuntary, we would call it murder.
Violations of the standards of care occur when a patient is given a medication that he or she is allergic to and which he directly refuses. A patient always has the right to refuse a medication, even if the medication is appropriate. Some state regulations governing hospice specifically mandate that a hospice patient has the right to refuse a medication or treatment without risking being discharged from the hospice. A basic principle of health care is informed consent. Consent of a patient means that the patient accepts the procedure, medication or treatment plan. If a patient does not consent, then a physician or nurse cannot continue to impose a procedure, medication or treatment against the patient’s will.
Dr. Jack Kevorkian brought the idea of assisted suicide to the forefront of public debate in the late 1990s and the public rejected his views. However, a small portion of the public still favors the use of assisted suicide. In some cases, health care workers have unilaterally decided to administer assisted suicide to willing or unwilling victims. An unwilling suicide is not suicide but rather is labeled murder by the courts. Administering potassium chloride as an agent for causing death was one method popularized by Dr. Jack Kevorkian, who was found guilty of violating the law and is now residing in jail (Panzer, 2000).
Just because a patient has a terminal illness does not lessen the value of that person’s life. A patient may be elderly, sick and weakened. However, no one knows with certainty exactly when a terminally ill patient would die. Some patients die within days, others within weeks and some within months or even years. Cases of seemingly miraculous recoveries have been documented. Hospice regulations do not normally allow for the performance of assisted suicide in a hospice program. Performing assisted suicide is illegal in all states except for Oregon. Any individual who informs you that a hospice has a right to perform assisted suicide is misinformed.
A method of mercy killing or euthanasia is defined as a method of hastening death by physicians, nurses and even family members is by administering overly high dosages of narcotics, sedatives or antidepressants when the patient has no need for them. Giving high dosages of narcotics when the patient is not in pain or does not have a symptom requiring the use of that narcotic is inappropriate and may cause death. The most serious adverse effect of giving inappropriately high doses of narcotics, sedatives and antidepressants is respiratory depression. Respiratory depression can be so severe that breathing stops altogether resulting in death.
Morphine is commonly given for severe pain in terminal illnesses, especially in cancer pain. In the case of severe pain, extremely high doses of morphine or other narcotics may be necessary to control that pain and have been determined to be safe to administer under the careful supervision of the physician and hospice staff. Morphine is also given for other reasons which people may not understand.
In the case of overly high dosages of narcotics, sedatives and antidepressants, family members may be the only protection left for a medically comatose patient. Medically comatose refers to a patient that would not normally be comatose at that time due to his illness, but who has been placed into a coma, nonresponsive and nonarouseable mode, by medications being given. The patient can no longer speak for himself, and the family is the only advocate left for that patient. If the patient was willing to sleep during the very last days of his life, then administering high doses of sedatives might be acceptable if the situation warranted it. However, there are physicians and nurses who believe in administering high doses even when the patient is not willing and receptive to those doses.
Research studies published in medical journals confirm that a small percentage of health care professionals, including physicians, admit to having hastened a patient’s death. It is reasonable to conclude that a larger number have hastened death and that some physicians are not willing to admit what they routinely do in secret. The ethics of physician assisted suicide is currently being actively debated throughout our nation (Panzer, 2000).
In the case of a patient who definitely does not wish to die and who is actively euthanized against his wishes, that is an even more serious question of medical ethics, morals, and law. If you or someone else is aware of a situation where the physician, nurse or other family member is giving dosages of medication which have been directly refused, someone needs to directly confront that physician, nurse or family member and ask them to explain their actions.
The American Nurses Association stands against active euthanasia. The American Nurses Association, the major professional nursing association in the United States has stated: “The American Nurses Association (ANA) believes that the nurse should not participate in active euthanasia because such an act is in direct violation of the Code for Nurses with Interpretive Statements (Code for Nurses), the ethical traditions and goals of the profession, and its covenant with society. Nurses have an obligation to provide timely, humane, comprehensive and compassionate end-of-life care.” Also, The American Medical Association opposes physician assisted suicide. The American Medical Association, one of the largest physician organizations in our nation has taken the following official position on physician assisted suicide: “…the American Medical Association strongly oppose[s] any bill to legalize physician-assisted suicide or physician-assisted death because physician-assisted suicide is fundamentally inconsistent with the physician’s role as a healer.” (Panzer, 2000)
There are a significant number of physicians that approve of euthanasia and physician assisted suicide. In hospice care there are some physicians who do not prescribe adequate pain medications to properly control the pain of patients with severe pain. It is also common knowledge in the industry that there are some physicians who are extremely aggressive in treating pain with narcotics. Being aggressive in treating pain is admirable and exactly on target when it comes to hospice care and its reason for being. However, it is also common knowledge that some physicians step over the line and are willing to push a patient into death by hastening its arrival through the use of high doses of sedatives and narcotics.
Some family members who have been approved and appointed by the terminally ill patient as their representative for medical decisions feel that they have the right to do anything. However, the regulations regarding the administration of medications do not allow medications to be given in a manner contrary to the physician’s orders. Nor does a medical power of attorney allow the representative to intentionally go against the conscious wishes of the terminally ill patient. Even if morphine or other narcotics are ordered to be given for pain, that does not mean that the family member can give whatever dose they want to give. If death results when a family member gives an over dosage of narcotic, the family member may be held responsible for that death, rather than the physician.
The role of the health care professional in general and the nurse in particular, in assisting the suicide of a patient continues to be controversial. While the official ethics statements of health care professional organizations continue to condemn their members’ participation in a suicide, respected members of the medical and ethical communities, as well as patient advocates, argue strongly and effectively for the moral appropriateness of providing such assistance. Certainly, the issue will continue to be visited not only within professional bodies but in state legislatures. It is necessary that each nurse examine their own personal beliefs and consciences prior to the start of our practice.