Euthanasia and Assisted Suicide - Nurses And Patient Requests For Assisted Suicide

According to a national survey, one in five nurses who worked in adult critical care units have hastened a patient's death. In this survey, "The Role of Critical Care Nurses in Euthanasia and Assisted Suicide" (New England Journal of Medicine, vol. 334, no. 21, May 23, 1996), David A. Asch, MD, defined euthanasia and assisted suicide as circumstances in which a person performs an act with the specific intent of causing or hastening a patient's death. In this category Dr. Asch included intentional overdose of narcotics or other substances, or providing explicit advice to patients about how to commit suicide. Withholding and withdrawing life-sustaining treatment, such as removing a mechanical ventilator, were not included.

A total of 852 nurses responded to the survey. Sixteen percent (129 nurses) reported that they had participated in active euthanasia and assisted suicide at least once in their careers. Sixty-five percent of those nurses who participated at least once in active euthanasia or assisted suicide had done so three or fewer times, while 5 percent reported doing so more than 20 times.

Based on the responses, Dr. Asch estimated that at least 7 percent (58 nurses) had engaged in euthanasia or assisted suicide at least once without a request from either the patient or a surrogate. Eight percent (62 nurses) indicated having done so at least once without a request from the attending physician. These 62 nurses further indicated some instances in which they practiced euthanasia or assisted suicide following an attending physician's explicit request, or with the physician's advance knowledge.

Reasons given by the nurses for practicing euthanasia or assisted suicide included concern about the overuse of life-sustaining technology; a sense of responsibility for the patient's welfare; a desire to relieve suffering; and a desire to overcome the perceived unresponsiveness of physicians toward that suffering.

Some experts questioned the accuracy of the survey's results and considered the survey questions ambiguous. Others claimed that the interpretation of euthanasia and assisted suicide was questionable in cases in which the dispensing of pain-relieving medicine resulted in death. Many nurses expressed concern that publicizing the results of the study would undermine the patients' and families' trust in nurses who work in intensive care units.

Individually and as members of professional associations, nurses continue to grapple with questions about end-of-life care and patient requests for assisted suicide. To assist all nurses in providing competent and compassionate care for the dying, the Oncology Nursing Society (ONS) published a position paper and practice guidelines, "The Nurse's Responsibility to the Patient Requesting Assisted Suicide," in January 2001. (Oncology nurses care for terminally ill patients more often than nurses in other clinical settings.)

The ONS guidelines encourage nurses to engage in frank discussions with patients requesting assisted suicide, while actively seeking to identify and address patients' previously unmet needs. Although ONS guidelines definitively prohibit nurse involvement in assisted suicide, the professional society also cautions nurses to "resist the inclination to abandon terminally ill patients who request assisted suicide." The guidelines advise that, "In state(s) where assisted suicide is legal, the nurse may choose to continue to provide care or may withdraw from the situation after transferring responsibility for care to a nursing colleague."