Letters to the Editor

Aid-in-dying discussion requires knowledge, insight

By: William A. Ankoma, RN student, Pierce College Puyallup

Dear Editor,

Physician-assisted suicide (aid-in-dying) is a new era of ethical conundrum about which public opinion and policy has evolved quite rapidly such that professional organizations and individual clinicians are still evolving their positions. Depending on the side you find yourself, valid points have been made to support varying arguments.

Physician-assisted suicide is a type of voluntary euthanasia that occurs when patient with decision-making capacity authorizes physicians to take their lives (Butts & Rich, 2020). Proponents for assisted-suicide base their arguments on the respect for patient’s self-determination (an enshrined provision statement 1.4 of ANA code of ethics), assistance to have full access to full range of care options at the end of life and consideration that medical aid-in-dying is a last of autonomy.

Opponents against this dilemma base their arguments on the sacredness of life, the potential conflict with professional care values and a fear of an ethical slippery slope where increased acceptability of assisted-suicide may impact perceptions of a ‘’life worth living’’ (Olsen et al, 2017). The conflict of this issue is well supported in ANA’s position statement which recognizes that medical aid-in-dying is a controversial topic that encompasses a plurality of views (ANA, 2019).

In addition, the Hospice and Palliative Nurse’s Association expresses their views with this statement, “Nurses employed in states where aid in dying is legal may experience significant moral and ethical conflict’’ (HPNA, 2017).The advancement in medical technology that prolongs life comes with ethical and legal problems over patients’ autonomy, quality of life and death further intricate this dilemma. With the possibility of meeting this dilemma in practice inevitable, what is expected of nurses?

According to ANA code of ethics with Interpretive statements 2015 Provision 1.4, nurses have a moral obligation to respect human dignity and certain patient’s rights, especially patient self-determination. We have an obligation to deliver high-quality compassionate, holistic and patient-centered care including end-of-life care. One needs not to be judgmental but support patient’s preferences and values including end-of-life choices.

Nurses are, however, prohibited ethically from administering assisted-suicide medications. Our sole duties will be assessing the context of a medical aid-in-dying request for contributing factors, advocating optimized palliative and hospice care and knowing about aiding-laws in the practicing state (ANA, 2019). The profession expects us to remain objective, knowledgeable about this evolving trend and protect the confidentiality of the patient who has made this end of life choice.

Interpretive statement 1.2 of the ANA ethics code supports the natural continuum of life with this proclamation “nurses establish relationship of trust and provide nursing statements according to need, setting aside any biases or prejudices. Such considerations must promote health and wellness, address problems and respect patient’s decisions (ANA, 2015). However, respect for a patient’s decision does not require that one agrees with or support all patient’s choices, thus the nurse is not required to compromise his/her integrity in the provision of self-care. Such situations may result in the nurse experiencing moral distress.

When a particular decision is morally objectionable to the nurse, whether intrinsically so or because it may jeopardize a specific patient, family, community or nursing practice, the nurse is justified in refusing to participate. However, according to Provision 5.4, “Conscience-based refusals to participate exclude personal preferences, prejudices, biases, convenience or arbitrariness” (ANA, 2015).

This ethical dilemma is an evolving topic and healthcare professionals will continue to find conflicting arguments. Until researched and pragmatic procedures are put in place, nurses owe a sole responsibility of providing holistic care by providing available resources for end of life care. We should have invaluable experience, knowledge and insight into effective and compassionate care at the end of life (ANA, 2019).

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