This essay discusses with regard to the ethical issue associated with the concept of assisted suicide. Nurses in particular play an important role in an assisted suicide process, taking into account that they are typically present throughout the experience. The fact that some come to develop strong connections with patients and that they regard the idea of life as something that they need to fight for can make it difficult for them to keep their spirits during such a process.
Ethical Issue of Assisted Suicide
The American Society of Registered Nurses [ASRN] ( 2010) defines "physician-assisted suicide" as the facility to a patient by a medical health professional of the means of ending his or her own life. Assisted suicide is an issue of great importance to nurses. This issue echoes their values and beliefs as a commonality. In the same time it calls for a clear and precise response as a profession, and challenges individual nurses to think about their own moral views (Daly et al., 1997). The history of the debate and the compelling moral arguments regarding issues such as patient autonomy, quality of life, acting in the patient's best interest or the right to death attest to the complexity of the issue and also suggest that it will not soon be resolved.
There is much controversy with regard to nurses and the role they play in the assisted suicide discussion. "A nurse may be involved in assisted suicide by providing or administering the means of death in his or her capacity as a health care professional, by assisting a physician in doing so, or by tacitly approving the actions of another health care professional by failing to stop or report a physician-assisted suicide of which he or she is aware" (ASRN, 2010, p.1). As a consequence, nurses are often involved in assisted suicide and thus need to be prepared to deal with the series of concepts that come along with performing such an act.
The American Nurses Association's [ANA] Code of Ethics for Nurses regulation for assisted suicide condemned this act as unethical and inappropriate for nursing care (King & Jordan-Welch, 2003). ANA's strong position is that nurses have the obligation to relieve sufferance but to cause no harm. However, ANA did make a clarification regarding patient's refusal of treatment which is extremely burdensome for the patient, as being ethically and legally permissible (ANA, 2001).
Despite the increased attention that this issue had received during the last 20 years, there is little written by nurses or empirical work that is focused on nurses. According to King and Jordan-Welch (2003) several research studies emphasized the divided opinions that exist among nurses regarding ANA's position. For example in a study by Leiser et al. (1998) cited by King and Jordan-Welsh (2003) conducted a survey on 215 nurses where over 50% of them agreed that assisted suicide was appropriate for relieving suffering. Moreover, Asch (1996) cited by King and Jordan-Welch (2003) reported a 19% of nurses who responded that they had either participated or performed assisted suicide. According to Asch the nurses attributed their actions to frustration with medical technologies practices that maintain life without concern for the wish or the amount of suffering endured by patients.
The fact that there is limited information to provide individuals with a more specific understanding on the topic is certainly confusing. To a certain degree, it is probable that the general feeling that nurses are not necessarily actively involved in treating a patient influenced many to ignore the role that these people play in actually helping patients.
The legal issues of this debate are also complicated, especially by the fact that several states have enacted, or been asked to enact legislation that would make assisted suicide legal. Currently, Oregon, Washinton and Montana are the only states that approve laws allowing physician-assisted suicide ( King & Jordan-Welch, 2003).
Furthermore if one puts this issue under scrutiny of a right-based ethical reasoning model it can be argued that each individual has to right to decide what is best for himself, has the right to claim autonomy on decisions regarding his life. In accordance to this view Lachman (2010) stated that patients see a good death as right that nurses, in their obligation to relieve sufferance should upheld. However, "in order to honour a patient's autonomy, nurses must be sure that a patient's choices are informed (i.e., that the patient understands the consequences of his or decision) and not the product of pressure or coercion" (Cutcliffe & Links, 2008). Of course, the question of what means a good death then rises and if is there such a phenomenon as a rational or appropriate suicide that can be demanded as a truthful right.
One of the most important reasons why people are inclined to see ethical reasoning in medicine as being no different from any other type of ethical dilemma is that they are unable to understand the complexity of such a situation. This is also because medical educators find it problematic to relate to the issue, taking into account that ideas are likely to differ depending on the case. As a consequence, looking from the perspective of someone who is not familiar with the topic is likely to generate even more dilemmas. A nurse who is involved in an assisted suicide process is probable to come across intense emotions and he or she thus needs to be able to deal with these respective emotions. In some cases nurses and patients develop special connections and this further aggravates the situation when considering that they are then required to take part in the suicide of a person whom they came to feel close to.
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