Assisted Suicide

Nurses General Nursing

Published

Specializes in A and E, Medicine, Surgery.

The BBC ran a thought provoking programme on assisted suicide last night. It centred on the mother of a 31year old daughter who was chronically sick with ME. The mother helped her daughter take an opiate overdose and she died. After she died the mother was charged with assisting her murder. In the UK the current position is that it is not illegal to attempt to or to take your own life but it is illegal to assist someone. There are lots of grey areas and a number of UK citizens have travelled to a clinic in Switzerland called Dignitas in order to end their lives.

The Mother's case raised concern because although her daughter was chronically sick she did not have a terminal illness. She did go to trial and was found not guilty. The daughter had made it expressly clear that she wanted to die.

The goverment has now drawn up a set of guidelines which give the CPS more flexibility in whether they charge a relative or not. It takes into account patient wishes, type and outcome of illness, and whether anyone will financially gain by there death.

For me the whole area is an ethical nightmare. As nurses our registration says that we do everything in our power to treat and maintain life but we also have a duty to ensure dignity at death.

Without SAFE guidelines there are so many grey areas one: man with motor neurone disease said that currently he will have no choice but to end his life earlier than he would like because he will need to make that decision whilst he still has use of his hands in order to not involve his family.

Anyway my interest is what happens in other countries and also what are the thoughts of other nurses on this matter. I can honestly say I don't know what to think - on the one hand I think life is precious and we should do everything to preserve it but on the other if it was my terminally ill relative in pain and suffering I might feel differently.

Really interested in thoughts views and experiences. :)

Specializes in ICU, ER, EP,.

It is heartbreaking that my beloved dog had a peaceful death and it is rare to see such in my iCU. While I speak for only myself, it is my belief that here in the states we are fearful of the "slippery slope". ie... at what point do we draw the line.

A simple health care reform bill that required MD's to have end of life discussions (talking about advanced directives), had many afraid of "death squads". (thinking we'd allow our eldery to die or refuse them treatment). Now that directive alone has created a hot mess here in the states and everyone has lost sight of the issue.... the discussion for advance directives needing to be a standard.

We have many doc's that simply don't ask because of lack of interpersonal skills or worse, own beliefs. This muddy's the water. Many of my ICU patients don't have a single doctor discuss end of life wishes until their 90 year old contracted nursing home grandmother arrives intubated on multiple pressers and I start the talk. Then they look in shock and say "grandma wouldn't want that"... great now they have to decide to withdraw life support, even worse for family and my patients to suffer through.

So long story not so short... It's my belieft that we have alot of work to do with simply allowing patients a peaceful death, let alone assisted suicide. We're simply not there yet.

Anyone with other or opposite thoughts like to chime in on assisted suicide? Great post!

Specializes in A and E, Medicine, Surgery.

Always said I would have DNR tattoed across my chest to save any confusion :)

Really interested in the points you have raised Zookeeper - thankyou

Specializes in pulm/cardiology pcu, surgical onc.

In my state assisted suicide is legal but good luck finding an MD who will prescribe. If I was chronically ill and in pain or terminally ill I would want the choice.

Specializes in ER/ICU/Flight.

Great topic, cuts straight to the core. People are afraid of "death panels", yet they're not afraid of being abducted in a UFO (which, in my opinion is a much more likely event). I guess it speaks of the irrational fears that some people have, and even more so to the need some people have to impose their own version of morality on others.

It is a shame that many times an animal can have a more dignified death experience. My grandfather died of liver mets (at age 93), he was in an hepatic coma for the last several days of his life. When I asked how much analgesic he was getting, the reply was "none, it's prn and he hasn't requested it". I spoke with my family (mom and grandma are both RNs and my grandad was a cardiologist), we came to the agreement to load him up. He was obviously uncomfortable and at the very end of his life. After a large bolus, he passed away in about 15 minutes.

I tell family members in similar situations something to the effect of: it's only going to stay the same or get worse. It's not going to get better and you have to decide how much you can take/how much you think they would want to go through. There should be some sort of recourse to allow this, but we get back to imposing morality (I'm a practicing Christian but I still feel this way).

We flew to a car wreck but the car burst into flames before we arrived. when we landed the fire department told us the sole occupant was deceased. He had been extricated from the vehicle and had 3rd to 4th degree burns covering his entire body, extremely gruesome....then his eyes opened and he started to make this inhuman sound. It was bone chilling. He was going to die in a few minutes and we had to make a decision about the end of his life, we made it as comfortable as possible and I think every responding unit needed to restock MSO4 afterwards.

It all gets back to dignity. As nurses we are charged with maintaining it and I'd have to say the occasions are about split between times I've had a moral opposition to dragging out an inevitable death at the orders of a physician. Makes for tough reflection on the way home.

I'd love to hear other people's thoughts and thanks to the OP for sharing the television show and provoking an insightful discussion.

Specializes in Critical Care.

I actually did a paper on this topic in my medical ethics class in nursing school. As someone already pointed out, the slipper slope is one of the arguments against it. Along with the fact that killing another human, even assisting is wrong. For those who think that the slipper slope will happen here's your argument against it.

"Oregon is the only state in the USA where PAS legal. The Death with Dignity Act (DWDA), was passed in1997. It states specific criteria that must be met in order for a person to request assistance in ending their life. Since the enactment of the DWDA over 10 years ago, the slippery slope, that many believed would happen, has not occurred. Between 1997 and 2001, there have been 141 lethal prescriptions written in Oregon. Of the 141 written, only 91 patients have filled these prescriptions to end their lives. This is hardly enough evidence to prove the presence of a ‘slippery slope’

- I personally think that it should be legal in more places than it currently is. Our patients have the right to refuse or to even sign out AMA. As long as the patient is competent and understand the consequences of their action i believe that they should be able to make a decision to allow themselves to die. In oregon at least the person requesting to be assisted in their death must be first evaluated by 2 doctors and deemed competent.

- I also think that people think this is a form of euthanasia. Euthanasia and assisted-suicide are actually differnet and should be defined so people know what they are talking about.

"Euthanasia, when literally translated means ‘good death,’ and is defined as merciful killing, allowing hopelessly sick or injured persons to die in a relatively painless way. During euthanasia it is usually a doctor or another health care provider who is actually administering the lethal drugs to the patient. In contrast, with PAS, a physician only indirectly assists in the suicide. The doctor supplies the patient with a lethal agent to be self-administered. When people make the decision to remove someone from life support machines, the intent is said to be “…the relief of the patient’s suffering and/or honoring the patients right of self determination with the cause of death being a patients underlying medical condition…(Darr, 2007).” However, in the case of actively hastening death (PSA), the “…intent of the actor is said to be to end the patient’s life and the cause of death is said to be the acts of the person and/or the patient (Darr, 2007).”

Well You are more than entitled to form your own conclusions. Me personally I think that it should be legal in more places. I think people who know that they are terminal and know that they have no hope for recovery should be able to make a decision on the destiny of their own life. I don't think it's our place stop them from doing so. I know that this go against the heart of nursing and patient advocacy, but I think it's an issue that alot of people are afraid to talk about.

Specializes in LTC.

At the LTC where I work end of life discussions occur frequently. DNR/CPR is discussed with resident and family on admit or significant change of condition. Alot of people have their living wills done to inform us and their family of their wishes if they cannot at that time. We have many residents with the order for comfort measures, no hospitalization or may send to ER if traumatic event.

I personally don't believe in assisted suicide for whatever reason. I guess I am looking at it from the family side too. What would happen if all family members were not ok with the decision? How do they deal with the fall out when the deed is done? How will they view the caregiver who assisted? My mom committed suicide 10 years ago and it changed my perspective.

Specializes in PICU, NICU, L&D, Public Health, Hospice.

I work with terminally ill patients daily. IMHO, we are not prepared to take any sort of national stand on assisted suicide. The public is poorly educated on issues surrounding this topic and too many people stand to be taken advantage of by those who would seek to profit from the deaths of the chronically ill.

I can't speak for other countries, but I feel the American culture has a strong, deep fear of death. We'd rather see a human slowly & painfully die for years than accept that some (sane) people do have a good reason for wishing to end their lives. I don't think there's any cure for American's death-phobia.

I feel that sane adults should have the right to decide. Their life ultimately should belong to them and not to governments or strangers.

We could argue that some people would profit from these deaths, but there are also people who profit from forcing them to stay alive... brain dead, on ventilators for years, body slowly shutting down. And what we don't consider is the toll, both emotional and financial, it takes on the family when someone has a good reason for going but is forced not to. Everyone has said their goodbyes and is at peace, but the courts and the lawyers demand the doctors do everything to go against the person's wishes.

Perhaps a good question would be: how do we get the public learning and talking about this? Is there any hope, or will the news media just sensationalize it?

We give our pets the option of "humane" treatment at end of life attempting to prevent further suffering...it makes sense on the surface to do that for ourselves. Yet, there are many more variables that aren't quite as simple as our pets. Family dynamics play a big part i.e. what is the motivation for assisted suicide, is it warranted or just the "easiest way out"? Does the patient want it for themselves, or to keep their loved ones from having to take care of them.. many many questions not including the healthcare provider who, no matter what may not want to be involved. After all, our philosophy is to help heal as best we can. IMO if a non-partisan committee, not affiliated with family, or even the institution, if the patient is in one, were gathered these issues could be addressed on a case by case basis.

Possibly social services, a doctor (not the patients though that doctor could join), nurse, legal representation such as a lawyer, the patient's religion would also play a part, a representative of the institution, and one of the family/patient if able...all to have a certain time limit to have a majority consensus would make it a viable option.

Specializes in Critical Care.

bubbly,

there is no one that assists the person per se. The person requesting PAS (physician assisted suicide) is merely given the means to do so. The patient themselves must administer the fatal dose of medication in order to go thru with it. The only true assistance that the person gets is in getting the medication that is it. The act is up to them. There is a study that was conducted out in oregon and it had statistic on people who sought out PAS, those who got the perscriptions and those who actually did the deed.

"Between 1997 and 2001, there have been 141 lethal prescriptions written in Oregon. Of the 141 written, only 91 patients have filled these prescriptions to end their lives. This is hardly enough evidence to prove the presence of a ‘slippery slope’ "

Specializes in being a Credible Source.
Along with the fact that killing another human, even assisting is wrong.
That is not a fact... that is your value judgment.
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