Annotated Bibliography: Assisted Suicide

ANA Center for Ethics and Human Rights. (2013). Euthanasia, assisted suicide, and aid in dying (ANA Board of Directors, Ed.). Position Statements, 1-11. Retrieved from http://nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements/Euthanasia-Assisted-Suicide-and-Aid-in-Dying.pdf

According to the ANA (2013), assisting in suicide and in 1994, the American Nurses Association (ANA) embraced position statements on euthanasia and assisted suicide originated by the Task Force on the Nurse’s Role in End-of-Life Decisions, Center for Ethics and Human Rights. Euthanasia is in violation of the Code of Ethics for Nurses with Interpretative Statements because nurses are obligated to deliver “humane, comprehensive, and compassionate care that respects the rights of patients but upholds the standards of the profession in the presence of chronic, debilitating illness and at end-of-life” (p. 1). The Code declares that “Suicide is the act of taking one's own life. In assisted suicide, the means to end a patient’s life is provided to the patient (i.e. medication or a weapon) with knowledge of the patient's intention. Unlike euthanasia, in assisted suicide, someone makes the means of death available, but does not act as the direct agent of death” (p. 3). There are three elements of euthanasia: voluntary, involuntary, and non-voluntary (ANA, 2013). When euthanasia is voluntary, it is the patient’s request. If it is involuntary, the patient does not request it. Lastly, euthanasia may be a non-voluntary wish if the patient is incapacitated and unable to offer consent, so the family may make the request. In regards to Hospice Care, death is inevitable, so nurses provide comfort to patients with medication and offer emotional support. Essentially, nurses understand that “Palliative care affirms life and neither hastens nor postpones death” (ANA, 2013, p. 3). Accordingly, in spite of patients’ suffering or their wishes, euthanasia contradicts the nurse’s code. Therefore, nurses do not have to comply with their patients’ requests, but they are ethically bound to tell their patients and families their rationale regarding assisted suicide or euthanasia. Palliative sedation requires nurses to provide medications that are designed to alleviate pain and “lower the patient’s level of consciousness to the extent necessary” (ANA, 2013, p. 5). This source is required for my research, so I can employ the code’s guidelines. 

Denier, Y., Gastmans, C., De Bal, N., & Dierckx de Casterlé, B. (2010). Communication in nursing care for patients requesting euthanasia: A qualitative study. Journal of Clinical Nursing, 19(23-24), 3372-3380. doi: 10.1111/j.1365-2702.2010.03367.x

The authors describe nurses’ euthanasia care process for terminal patients based in hospitals in Flanders. They assert that research shows that communication is an essential component for good euthanasia care. However, the actual quality and process of the euthanasia care remains unclear. Denier et al. (2010) emphasized that “Nurses are continually associated with patients … [so,] They are a vital link between the patient, the family, the physician and other care providers” (p. 3373). In their qualitative study, Denier et al. (2010) asked nurse participants to describe communication as they cared for patients requesting euthanasia, and participants said that communication was based on several levels such as active listening, providing information, and initiating conversation that did not pertain to euthanasia (Denier et al., 2010). Using a Grounded Theory Design, for a 20 month period, they interviewed Belgium nurses and found that the care process is complex as nurses communicate with patients and families and must consider a variety of moral and psychological issues from all involved. This article adds to the growing body of literature on nursing care for patients requesting euthanasia. The findings revealed that communication is the vital component of good-quality euthanasia care and support. This article is important to my research because it offers guidelines for nurses. 

Ersek, M. (2004). The continuing challenge of assisted death. Journal of Hospice & Palliative Nursing, 6(1), 46-59. doi: 10.1097/00129191-200401000-00014

Assisted death continues to be a controversial debate for hospice and palliative care clinicians. The author reveals that team members or nurses often have a variety of positions that determine if they are “pro” or “con.” The author’s intention was to provide a discussion that provided ethical, legal, sociocultural, psycho-spiritual, and personal aspects of euthanasia or assisted suicide. The author provides information from relevant studies that addressed nurses’ perspectives. The author suggests that if nurses are not well-informed, they will be unable to properly communicate with their patients or their family members when it comes to the right to die. This article provides other perspectives and guidelines that may be helpful if nurses ever find themselves in this predicament. 

Fenigsen, R. (2012). Other people's lives: Reflections on medicine, ethics, and euthanasia. Issues in Law & Medicine, 28(1), 71-87. Retrieved from http://www.ebscohost.com/biomedical-libraries/cinahl-plus

For the last 30 years, opinion polls in Holland conducted in have shown an increase in public acceptance of euthanasia by the public. The author compare Holland's attitude towards American attitudes and found that most Americans oppose euthanasia. The author reported that resistance to euthanasia is more powerful than in Holland, but since several states have legalized it, the same developments have begun. In Holland the author states that the publicize mercy killings in order to demonstrate that some patients are desperate to relieve suffering. The author concludes that "The right to die is forcefully emphasized, as if dying were indeed a right and not a sad necessity. The theme of dignity is widely exploited. We are told that to be assisted by medical technology entails loss of dignity, as if the dignity of honest, caring, courageous people, our parents and spouses, could somehow be drained out of them through medical devices. And we are told that the way to die in dignity is to let yourself be killed by a professional" (p.73). This article provides evidence that legalization of euthanasia and assisted suicide may come up in a nurse's career, so nurses need to stay informed.

Robley, L. R. (2009). Reigniting the debate over assisted suicide. Nursing 2009 Critical Care, 15-17. Retrieved from http://www.nursing2009criticalcare.com

The author recommends nurses should stay informed in order to contribute clarity and information regarding assisted suicide. Because the U.S. population is aging and our country is undergoing a healthcare reform, the euthanasia and assisted suicide debate will continue. She noted that Oregon's law instituted safeguards because they are one of three states that have legalized physician assisted suicide law: 1) "The person must make several requests for assisted suicide, with at least 15 days between the first and last request. 2) Two physicians must determine that the person is competent. 3) The person must be provided with information regarding Hospice" (p. 15). Oregon doctors wrote 88 prescriptions for lethal medications and 60 patients ended their lives. The author also revealed that Oregon nurses, and Washington, don’t assist with suicide, but care for patients who elect assisted suicide in the same way they care for all their patients. This source is important for my research because it demonstrates that whether or not a person expresses a wish to die, nurses have to continue to care for the patients the same way they would care for the others.