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The Ethical Issues Confronting Nurses’ Participation in the Death with Dignity Act.
Abstract
Background: On March 4th, 2009 and May 25th, 2013, respectively, Washington state and Vermont joined Oregon State in the enactment of the Death with Dignity Act. On December 31st 2009, Montana State Supreme Court ruled that a terminally ill, competent patient has a legal right to die with dignity, under Article II, Sections 4 and 10 of the Montana Constitution.
Findings: In the states that enacted the Death with Dignity Act, terminally ill patients and their families turn to nurses for information regarding the Death with Dignity Act. In a survey of 1,678 hospice nurses in Oregon, all the nurses reported that at least one terminally ill patient has asked them for information on the Death with Dignity Act in the past year. Despite the numerous request for information on Death with Dignity Act, the law did not define the participatory roles of nurses in physician-assisted death. Nurses were not educated on the details of the law when it was passed. Nurses lack the knowledge of the ethical and legal issues with regards to the Death with Dignity Act. A survey of 528 nurses in Washington State, found that only 7% (42) received detailed education on the Death with Dignity Act when the law was enacted. Seventy percent of the nurses (374) lacked detailed information on the policies and procedures adopted by their healthcare facilities in handling patients’ request for physician assisted death. Fifty-three percent (285) of the nurses involved in the survey did not know whether the Washington State Nurse Practice Act permits them to be present to support patients during the administration of lethal medication. Moreover, 47% of the nurses (351) did not know the procedure for administration of the lethal medication, and were not sure if the medication could be administered by the patients or the nurse. Nurses were excluded by the health care providers in making the decision to participate or abstain from the Death with Dignity Act. On the other hand, the American Nursing Association Code of Ethics has no guideline for defining nurses’ participation in the Death with Dignity Act. The ANA considered nurses’ participation in physician-assisted death a violation of the 1994 Code for Nurses with Interpretative Statement and the ethical mandate of the profession. However, the 1994 code of ethics lacked explicit definition of what it considered participation in physician-assisted death. The ANA has no guideline for defining the scope of nurses’ role in caring for terminally ill patients in the states that enacted the Death with Dignity Act. Consequently, the nurses in these states experience ethical distress and professional conflicts in responding to terminally ill patients’ request for physician-assisted death.
Conclusion: Inadequate knowledge of the ethical and legal mandate surrounding the Death with Dignity Act, and lack of ANA guideline for nurses’ participation in the Death with Dignity Act have resulted in ethical distress among nurses in the states that enacted the law. These ethical distresses have impeded the ability of nurses to help terminally ill patients in making end of life decisions
Recommendations: Nurses need to be educated on the details of the law in order to provide patients with unbiased and accurate information necessary for end-of-life decision-making. In the states that enacted the Death with Dignity Act, the health departments and health facilities should sponsor programs for education of nurses on the law. Details of the law should be included in nurses’ orientation programs and nursing school curriculums. The ANA Ethics Code Revision Committee should review the position statement on physician-assisted death in the 2014 American Nurses Association's revised Code of Ethics for Nurses with Interpretive Statements to address issues in the Death with Dignity Acts .The ANA should develop an explicit guideline that will define the scope of end-of-life nursing care for terminally ill patients in the states that have enacted the Death with Dignity Act.