1 RUNNING HEAD: Assisted Suicide Assisted Suicide: Ethical or Not in the World of Nursing? Kathrine Lambright Medical University of South Carolina Nursing 385: Professional Nursing and Nursing Practice
Assisted Suicide 2 Assisted Suicide: Ethical or Not in the World of Nursing? A home health care nurse pays a visit to on elderly patient whom we will call John. This was a patient she saw frequently and so upon her arrival she immediately began her assessment of the patient. While performing the assessment she laughed and joked with him, played catch up on his family and topics of interest to John. This was a normal visit for the two and so upon completion of the assessment and all goodbyes were said, the nurse bid John farewell. The goodbyes in actuality turned out to be the last goodbye exchanged between the pair forever. The following day the patient surrounded himself with family and loved ones and ingested a lethal dose of drugs. These allowed John to fall into a deep sleep and never wake again. The lethal dose he took was obtained from a prescription he had received from his physician (Farella, 2000). The above scenario is an excellent example of Physician Assisted Suicide (PAS). PAS is when a physician writes a prescription for either a lethal dose of a medication or a lethal drug to allow a person to take their own life (Mathes, 2004). This differs from euthanasia in that with PAS the person has to take his or her own life with only the means to do it provided whereas euthanasia provides the means as well as someone to actually perform the death (Mathes, 2004). The media has most certainly brought much debate to an already sensitive issue. On one hand, there are moral convictions that oppose this practice and on the other hand one may find religious opposition. Little however, is reported in the media about how these practices impact the roles of healthcare workers. Physicians operate under the Hippocratic Oath in which they are to try not to provide harm to a patient. Nurses also have a similar code of ethics in which they are to be an advocate for the patient and do what is in the best interest of the patient. The ethical dilemmas swirling around PAS for nurses should be thoroughly considered.
Assisted Suicide 3 PAS can be a violation of the majority of the ethics which govern nursing. These include autonomy, beneficence and advocacy (Potter &Perry, 2009). It would seem by the name Physician Assisted Suicide that it is the physician who carries out the duty, yet in practice it is the nurse caring for the patient who has the most active role in assisting patients walk through this momentous decision (Mathes, 2004). Through autonomy, nurses commit themselves to ensuring their patients are involved in all decision making aspects of their care and treatment (Potter &Perry, 2009). With PAS it can become an internal struggle within the nurse who cares for the patient to use their best judgment as to what is right. Through traditional treatment of patients, nurses rarely have to question their own religious and moral beliefs to care for a patient. There are usually various treatments or drugs and all the nurse has to do is offer the options that are relevant and support the patient in whatever choices they make regarding their treatment. PAS can put a nurse in the position of having to be party to something she finds morally and/or religiously wrong. If a nurse is caught in this cross hair, it can prove very troubling for them to make a choice between helping a patient maintain their place as having final say in their care and doing something that the nurse feels goes against what he or she feels is right. Beneficence is when one ensures the patient s best interests remain more import than the self-interest of the nurse involved(potter &Perry, 2009). This can be especially difficult due to PAS having blurred lines as to whether it is in one s best interest to take their own life or not. If one doesn t feel it is in the patient s best interest to do so, then assisting in the process of PAS can be seen as a grave breach of the commitment given through beneficence. Being an advocate for a patient also means that it is a nurse s duty to stand up for the patient and report any unethical, illegal acts or treatments or practices that can provide harm to
Assisted Suicide 4 the patient (Potter, P. &Perry, A., 2009). With PAS being legal in some states, yet seen as morally wrong or unacceptable to many, how does the nurse who is in the middle choose the best way for them to remain an advocate to the patient while maintaining their moral values and keeping within the confines of the law? With all of this debate concerning PAS, it is a true dilemma trying to figure out how to solve concerns over nurses playing a role in PAS. Nurses generally have 1 of 2 options when faced with this situation in their professional careers. The first option is to assist the patient to the best of their ability in support of their choice to utilize PAS. Though they may not be in agreement with the decision, he or she may be able to offer their support and understanding in the attempt to allow autonomy. The other option for a nurse is to utilize their own conscience and do what is right for them and refuse to assist in a PAS (Mathes, 2004). This can be a personal choice that will allow the nurse to maintain their personal beliefs and still allows the patient to maintain autonomy. The refusal to participate can and should be done without casting negative judgment on the patient who chooses to end their own life. Each of the options can provide benefits as well as cons. The first choice to assist the patient can be positive because it allows the nurse the ability to help the patient maintain autonomy and can even be seen as the practice of beneficence. The con is that it can lead to a loss of faith in nursing professionals who are seen as those who help people heal and improve their health. They can be seen as unethical and not true to their role off helping patients as well as even murders for aiding and assisting in PAS. Refusal to participate can be equally viewed as good because it can be seen as the nurse remaining impartial though allowing patients and healthcare workers who share the same beliefs as the patients to participate in this practice. This too however, can be viewed negatively as it can be seen as a refusal to participate in an important
Assisted Suicide 5 part of one s treatment in which a patient may truly feel a desire to have the nurse they have bonded with to be a full and active participant and supporter of their wishes and goals for treatment. In the major debate of whether nurse participation in PAS is ethically right or, not there is no right or wrong answer. This is something that will have to be confronted by each nurse on a personal case by case basis. Each nurse will have to look deep within themselves in regard to their own beliefs on death and suicide. They will need to decide this in order to come to a decision in how they can most effectively help patients while at the same time not compromising their own personal and moral convictions. This debate is a an issue that will most likely continue until the end of time, but nurses have to decide for themselves the best way to remedy this issue and hopefully there will be a general consensus of what is the best possible choices when confronted with PAS (Mathes, 2004).
Assisted Suicide 6 References Farella, C. (2000). Assisted Suicide: What Role for Nurses? Retrieved from http://www.consciencelaws.org/examining-conscience-background/assist/backassist02.html. Mathes, M. (2004). Assisted Suicide and Nursing Ethics. MEDSURG Nursing, 13(4), 261-264. Potter, P. & Perry, A. (2009). Fundamentals of Nursing, (7 th Ed). St. Louis: Mosby Elsevier.
Assisted Suicide 7 Florence Nightingale Pledge Appendix A: Florence Nightingale Pledge This modified "Hippocratic Oath" was composed in 1893 by Mrs. Lystra E. Gretter and a Committee for the Farrand Training School for Nurses, Detroit, Michigan. It was called the Florence Nightingale Pledge as a token of esteem for the founder of modern nursing. I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care. From American Nursing Association webpage. Website retrieved from is located at: http://www.nursingworld.org/functionalmenucategories/aboutana/wherewecomefrom_1/fl orencenightingalepledge.aspx. Accessed October 10, 2009.