Page 79 – American Nurse

Should nurses have a role in this end-of-life choice?

A COUPLE OF YEARS AGO, a close friend of mine died. She was in her 80s and had a serious but not imminently terminal problem—and she placed a high value on independence. She had just broken her femur (after several other bone breaks) and had multiple medical problems, making independence highly unlikely.

She decided to take matters into her own hands. She stopped her medications, refused to eat, and drank only a little now and then to ease the discomfort of thirst. The only assistance she had was the nursing care she needed to keep her comfortable. She died 4 days later after talking to all the people who were important to her. My opinion is that refusing to take her medications did the most toward hastening her death.

She didn’t ask anyone’s permission and she didn’t involve anyone else in her decision-making, avoiding many of the ethical and legal concerns associated with physician–assisted dying or other palliative measures of last resort. She said, “God did not intend for me to live like this…and there is no religion that forbids it.”

Indeed, if you involve no one else, no one’s idea of morality is involved. I will add that she died very peacefully. She wasn’t sad, though some of us around her were because we knew we would miss her, but we all knew that the decision was hers alone to make. However, as soon as you involve others in your decisionmaking, and particularly if you involve the law, things get decidedly more complex.

And, of course, there is always the chance of abuse when you involve the law. For example, my column in June was about a supervising nurse at a large hospice provider who participated in a fraud scheme that included overdosing patients for profit. And in New Jersey, terminally ill adults will now be able to ask for medical help to end their lives, but Republican state senator Robert Singer, an outspoken critic of the bill, noted that “The bill has a lot of loopholes…. We are so concerned about opioids, and not trusting doctors with opioids. But now we are willing to trust them with this.”

Other jurisdictions that allow physician-assisted suicide (also referred to as medical aid in dying) are California, Colorado, Hawaii, Maine, Oregon, Vermont, Washington, and the District of Columbia. In addition, at least 19 other states are considering physician-assisted suicide bills. So, assisted suicide is a rapidly growing trend. And nurses had better know where we stand on this issue (and why we stand there), how to protect patients from undue influence, and how to protect ourselves from unwarranted accusations. We also need to know how to protect ourselves, our patients, and others from the greedy influence of illegal maneuvering to save money, time, and even effort.

In June 2019, the American Nurses Association released a position statement, “The nurse’s role when a patient requests medical aid in dying,” that provides guidance on this important issue. It’s a worthwhile read.

Some years ago, when writing on this topic, I suggested that nurses and physicians and other health professionals shouldn’t be involved in killing, even voluntary suicide (including physician-assisted suicide). It’s not our role, and from what I’ve seen in my 50+ years in nursing, we’re more likely to neglect dying patients than to give them extra care. What I’m proposing is that we invent a new professional who’s carefully prepared and supervised, whose primary role is to assist patients and their families as they consider and perhaps receive truly terminal care. What do you think?