Palliative care and general hospital nurses' attitudes toward voluntary euthanasia

Euthanasia

Do the nurses working in palliative care view voluntary euthanasia more favorably than do the nurses working on general hospital unit?

The topic of voluntary euthanasia has sparked an intense debate on a global level. Palliative care nurses are faced with this ethical controversy every day on the job. As they care for those facing the end of their life, they must confront the issues quality of life and death with dignity on a daily basis. This gives palliative care nurses a unique perspective on the issue of voluntary euthanasia. Nurses in the general hospital unit do not face theses issues as often as palliative care nurses do. General hospital nurses are in an all out battle every day to preserve life, regardless of what it takes, even if it is just for one more day. These two nurses have different experiences concerning end of life issues. The purpose of this study is to examine the differences in attitude that exist between palliative care and general hospital nurses.

Theoretical Framework

Euthanasia is the practice of ending a life in a painless manner. There are many different techniques used in euthanasia, but these are not the issue in this research study. Euthanasia is a topic that can quickly divide a group into two opposing views. There are those who will quickly defend a person's right to make a conscious decision that their life is no longer worth living and take their own life. The other side will consist of those that feel life is precious and that every moment counts, even if it means severe pain for the patient. These two groups have various reasons for their opinions. Some are based on religion and some are based on personal experiences.

These issues divide the group, but one question increases the divide even more. The topic of assisted suicide can spark a frenzy. This is the practice of helping someone to end their life that no longer has the means to do it themselves. There are many legal and moral issues that come into play. It is not the purpose of this research study to take sides on these issues. It is simply to examine the opinions of two different groups of nursing students and its affect on their views on euthanasia.

The study will examine the issue using nursing students working in both palliative care and the general hospital setting. It is expected that these students will begin to form their opinions about euthanasia and quality of life issues early in their practice.

Hypothesis and Research Questions

The central research question of the study will ask, "Do nursing students working in a palliative care setting view euthanasia more favorably than those working in general hospital nuts?" In order to examine this issue more closely, the research will focus on the following hypotheses.

H1: Nursing students working in palliative care facilities will have significantly higher positive score regarding the favorability of euthanasia than nursing students working in a general hospital unit.

H0: The null hypothesis states that nursing students working in palliative care facilities will not have significantly higher positive score regarding the favorability of euthanasia than nursing students working in a general hospital unit.

This hypothesis would fulfill the requirements of the research study. However, it is the intention to develop a better understanding of how they developed their unique perspectives. Therefore, the research study will study the following additional research questions.

How do nurses from different specialties judge the acuity of the illness?

What level of acceptability do they attach to patient self-imposed euthanasia, as opposed to physician-assisted suicide?

What factors do they attach to quality of life?

What factors had the greatest impact on their viewpoint?

This hypothesis and set of research questions will help not only to answer the primary research question: they will provide an in-depth understanding of the processes involved in the formation of their opinions.

Rationale

This study will use a survey to explore the hypothesis and factors surrounding the research questions. It will focus on their response to the case of a terminally ill patient receiving a lethal dose of medication to hasten death. The patient will be unable to administer the dose themselves and the nurse will be placed in the hypothetical situation of administering the lethal dose. The study will explore their reactions to this issue.

Nursing students were chosen for this study, as they are just beginning to develop their sense of moral clarity in their professional careers. This study will examine several factors that influence the development of their choices. It is critical that nursing students develop a strong sense of their views and define their opinions regarding the matter of euthanasia so that they can better advocate for their patients.

Chapter 2: Review of Literature

The topic of euthanasia has received vast academic attention as society and practitioners struggle to defend their positions and develop standards of practice regarding the issue. One of the caveats in this type of topic is that one can often find considerable information on the subject, but much of it will be found to contain a considerable degree of bias. The following literature review will highlight recent works that directly address research into different specialties and their reactions to euthanasia.

Quality of Life/Death

Nurses in a palliative care situation reported experienced with hospice patients that had chosen to stop eating and drinking in an attempt to hasten their death. This study found that many of the patients in the study died within 15 days. They rated their death experience as being an 8 on a scale of 0-9 with 9 being the most favorable (Gasini et al., 2003). A survey of members of the American Association of Critical Care Nurses providing a "good death" was a major theme (Beckstrand, 2006). This study concluded that time constraints, staffing patterns, communication challenges, and treatment decisions that favored the physician's rather than the patient's needs were the main challenges that stood in the way of a death with dignity (Beckstrand, 2006).

A similar study to the proposed study was conducted in Belgium. This study compared the involvement of nurses in the care of patients requesting euthanasia. The study compared nurses in the general hospitals and a palliative care unit in Belgium. The study found that although, euthanasia was illegal in Belgium, nurses stated that they had an important role in caring for patients that had requested euthanasia. They experienced a spectrum of emotions ranging from conflict to frustration. They felt that these feelings hindered their ability to provide quality care (De Bal, 2006). In a study involving Dutch nurses, the nurse was typically the first person with whom the patient discussed their wishes for euthanasia (Van Bruchem-vande Schuer, 2008). In 15.4% of the cases, the nurses administered the medications themselves.

Chapter 3: Methodology

The purpose of this study is to examine differences in attitude among two groups of nursing students: one in the palliative care setting and one in the general hospital setting. The design will be a comparative study of the attitudes of these two groups of nursing students regarding the issue of euthanasia. The survey instrument will be developed specifically for this research study.

The sample population will consist of 200 nursing students in various stages of their internship. They will be divided into two groups of 100 students each. Equal numbers will from palliative care facilities and the others will be working in a general hospital critical care unit. Only student nurses will be considered, as the literature review suggests that experience has an affect on changing attitudes towards euthanasia. The only exclusion criteria will that nurses are still interns.

The setting of the study will be local palliative care facilities and general hospitals in the area, as needed to complete the number of surveys required by the study. The survey instrument will be devised specifically for this study. It will use the survey instrument from the study conducted by De Bal (2006) as a model, but it will differ to fit the current research setting and hypothesis.

The dependent variable in this study will be nurses attitudes towards euthanasia. It will be measured through their responses to the survey questions. The independent variable will be the setting in which the nurse is serving their internship. These setting will provide the test instrument by differing experiences that are unique to the hospital setting. All of the sample subjects will be interns, therefore length on time in the nursing profession serves as an additional independent variable in the study.

Validity of the survey instrument will be comparative to the De Bal study. Internal reliability will be established through a test-retest process. Cronbach's Alpha will be used as the standard for establishing reliability in the sample. These methods will be discussed in further detail in the final research study.

This research methodology will provide a comparison between nurses in two different environments. It will help to explore factors that may influence the development of their attitudes towards palliative care and euthanasia. The study will use setting as a means to explore the effect of atmosphere on the development of nursing opinions. This study will provide valuable information as to ways in which the experiences of dying patients may be improved through more effective and comprehensive training regarding end of life decisions.