End of Life Dilemmas in Nursing: Issues with Euthanasia and How to Approach Them
A friend of mine had the unfortunate experience of having to make a decision about withdrawing health care from his terminally ill wife. Even without revealing too much detail about the case the description of this incident is rather disturbing. His wife had been treated for breast cancer, but several months later it was found that the cancer had spread to her lungs and brain. Upon returning from treatment one evening she began to experience hallucinations and became very confused. He took her to a local ER, where she was combative, confused, and delirious. He was immediately asked by the ER physician if he wanted her put on life support as her condition was terminal, and he asked that she be put on life support until he could discuss his options with his wife's oncologists (who were from a larger University Hospital). However, he was encouraged by the physicians and nurses not to put his wife on life support and was made to feel uncomfortable regarding his request, but he was insistent. However, as it turned out once she was sedated and did not require assistance breathing and she was kept sedated and placed in a private room. Having been informed by her physicians that his wife's condition was most likely terminal, he decided not to have his wife placed on life support if needed and he discussed his decision with his wife's nurse. He also mentioned that he did not want her to suffer. However, there was no advanced directive or POA agreement completed. Nonetheless, following this statement, a nurse administered a morphine IV push to his wife and she passed away within minutes.
In contrast to the above incident, the American Nurses Association (ANA) Position Statement (2010): Registered Nurses' Roles and Responsibilities in Providing Expert Care and Counseling at the End of Life explicitly states "…it is never ethically permissible for a nurse to act by omission or commission, including, but not limited to medication administration, with the intention of ending a patient's life" (ANA, 2010, pg 2). Earlier position statements have also upheld this statement. For example, the 1994 ANA Position Statement on Active Euthanasia and the 1994 ANA Position Statement on Assisted Suicide clearly state that nurses are not to take an active role in terminating a patient's life (either by omission or commission). Nurses play a key role assisting patients at the end of their lives. They should be capable of providing comfort, care, guidance, and relief from suffering. The relief from suffering can include physical, emotional, spiritual, or existential interventions. Nurses should be prepared to provide these forms of support to patients and to their families, but it is quite clear that it becomes and ethical violation when the nurse personally extends their role to include terminating the patient's life. Moreover, there are obviously legal concerns here; however this paper will discuss the ethical implications only. Certainly in cases where patients have DNR or AND orders, nurses are not violating their code of ethics when following these procedures. Moreover, the withdrawal of therapies that would prove inadequate or burdensome treatment to a terminally ill patient or acquiescing to a POA request to withdraw treatment do not violate the ANA position statements (in fact the position statement supplies references to support this). However, in the above case there is a clear violation of ethics.
It is clear that nurses who let their personal opinions dictate their professional activities are not acting ethically. For instance, should a Muslim nurse refuse to allow a patient to eat a ham sandwich? Empirical research has indicated that despite the above ANA position statements, many nurses maintain personal favorable opinions regarding assisted suicide or euthanasia that result in unethical behaviors. For instance, in a much cited study Asch & DeKay (1997) analyzed data from 852 critical care nurses regarding their attitudes and practices. Findings indicated that a surprising 19% of the nurses reported that they had engaged in euthanasia and a minority of nurses (30%) believed that euthanasia is unethical. Those nurses that were older, had stronger religious convictions, or worked on cardiac care units were less likely to report having engaged in euthanasia; however, the effects of age and…