Death with Dignity in Hospice Setting

[cuhome]

I previously worked for a religiously-based hospice, which was connected to a national religious organization with many hospitals and clinics across the US. When the Death with Dignity laws passed in my state, the entire hospice staff was required to attend a meeting, which was to educate staff on the organization's policy in regard to the new Death with Dignity laws. In short, we were told that 1) we could not discuss the new law with patients; and, #2) we could not provide information to patients/families regarding resources that they could access to get more information about the Death with Dignity laws. If we violated this policy, it was cause for immediate termination.

I believe that this violates our responsibility to provide informed consent to patients, which would include advising patients/famility of all medical options/resources available to them (of which I am aware). Regardless of the organization's official position and policy, if I was asked, I continued to give my patients/families the names and contact information that would empower them to get further information on their own about the new law and how it applied to them. I was not "found out". I believe it is an ethical duty on my part to provide this information to my patients/families.

I also contacted my state's attorney general, the nursing board, and the group "Compassionate Choices", regarding this organization's policy. Have you been in this situation, and how have you handled it? Do you think a medical entity has the right to withhold information about treatment options from patients/families, if the organization has a religious or ethical objection to those treatments?

[somenurse]

What is this "death with dignity" law you refer to? I have never heard of it.

[tewdles, RN]

I would like some additional information as well.

the agency process sounds unethical as heck...when is it correct to give only partial information to our patients relative to their care and health?

[cuhome]

The Death with Dignity Act is also known by some as Right to Die Act. It gives a patient who is terminally ill the right to seek assistance from a medical doctor to die. The Washington state act builds in requirements and safeguards, as follows:

The patient must be an adult (18 or over) resident of the state of Washington

The patient must be mentally competent, verified by two physicians (or referred to a mental health evaluation)

The patient must be terminally ill with less than 6 months to live, verified by two physicians.

The patient must make voluntary requests, without coercion, verified by two physicians

The patient must be informed of all other options including palliative and hospice care

There is a 15 day waiting period between the first oral request and a written request

There is a 48 hour waiting period between the written request and the writing of the prescription

The written request must be signed by two independent witnesses, at least one of whom is not related to the patient or employed by the health care facility

The patient is encouraged to discuss with family (not required because of confidentiality laws)

The patient may change their mind at any time and rescind the request

The attending physician may sign the patient's death certificate which must list the underlying terminal disease as the cause of death.

[cuhome]

Thanks, tewdles and JeanMarie, for responding to this. I think this is an important issue, and it will become of even greater importance to more individuals as time goes on. Please encourage your friends/co-workers to get involved in this discussion! Many heads are greater than one or two!! :)

[leslie :-D]

you are in a tough predicament because if you work for a privately owned company, they can dictate what you can or cannot do/say...

even when it violates pt rights.

that said, while i am a proponent of death w/dignity, i wouldn't randomly bring it up unless pt indicated an interest.

be careful, then again, thank you.

leslie

[St_Claire, ADN, RN]

A different situation, but I think it applies.

When I was pregnant my doctor was discussing various tests that might be ordered to determine the health of the fetus. Then she said, "if you choose to abort the fetus at any time I will not be able to perform the procedure because it goes against my personal beliefs."

I think all the options need to be presented then a statement about the company you work for would not be able to participate in that option.