Design: This qualitative study employed a phenomenological approach to understanding the nurse’s experience of being asked by a decisionally capable patient for AID.

Method: Ten nurses shared their stories about understanding and responding to requests for AID. They worked in the following settings: 4 in hospice home care, 3 in AIDS care, 2 in critical care, and 1 in neurology. All were interviewed twice, conversations were transcribed verbatim; textual analysis was based on van Manen’s guidelines for interpretive phenomenology.

Findings: Persistent requests for AID were uncommon, but when heard, participants’ responses included: refusing assistance, providing interventions that might secondarily hasten dying, accepting and not interfering with patient or family plans to hasten death, and intentionally providing direct AID. The meaning of a patient’s request for AID was often found to be the desire to experience a ‘good’ death. Participants described interventions used to facilitate ‘good’ deaths that included the following instances of hastening death: examples of opiate-related hastening death, misusing the principle of double effect to inappropriately justify hastening death, and other nursing actions thought to “knowingly” hasten death.

Conclusions: Few nurses in this study either unequivocally agreed or refused to help patients die. Most struggled to find morally and legally acceptable ways to help patients die well when faced with persistent requests for AID. None sought guidance from their professional code of ethic or colleagues; secrecy and collusion were routinely employed.

Implications: Nurses who care for dying patients need collegial support and opportunities to reflect upon and discuss their end-of-life care experiences with experienced colleagues in order to enhance the practice of thoughtful moral reflection.

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Sigma Theta Tau International
July 22-24, 2004