Assisted Suicide

Assisted Suicide

Shenna Meredith, RN ObjectivesTo understand the definition of assisted suicide.To understand the law as well as the ANA perspective in regards to assisted suicide.To be able to define the difference between palliative care and assisted suicide.To gain knowledge of nursings role in patient care and ethics in regards to assisted suicide.

DefinitionsPhysician Assisted SuicideSuicide is the act of taking one's own life. In assisted suicide, the means to end a patients life is provided to the patient (i.e. medication or a weapon) with knowledge of the patient's intention. Active Euthanasia Euthanasia, often called "mercy killing", is the act of putting to death someone suffering from a painful and prolonged illness or injury. Active euthanasia means that someone other than the patient commits an action with the intent to end the patient's life, for example injecting a patient with a lethal dose of medication. Palliative CareCare designed to provide relief from pain and suffering rather than to cure.(ANA, 2012)

Assessment of the Healthcare EnvironmentThe fact that assisted-suicide is illegal in the State of Michigan does not mean that it is not still a controversial issueMany medical professionals will attest that assisted-suicide does take place (Meier, et al., 1998). There is a lack of knowledge in regards to the difference between assisted-suicide and palliative care (Arnstein & Robinson, 2011). Legal & Ethical ImplicationsLegalIllegal in all states exceptOregonWashington MontanaEach state has its own legal precedent and ramificationsMichigan law states;750.329a Intent to assist individual in suicide; prohibited conduct; felony; exception; effect of common law offense. Sec. 329a.(1) A person who knows that an individual intends to kill himself or herself and does any of the following with the intent to assist the individual in killing himself or herself is guilty of criminal assistance to the killing of an individual, a felony punishable by imprisonment for not more than 5 years or a fine of not more than $10,000.00, or both:(a) Provides the means by which the individual attempts to kill himself or herself or kills himself or herself.(b) Participates in an act by which the individual attempts to kill himself or herself or kills himself or herself.(c) Helps the individual plan to attempt to kill himself or herself or to kill himself or herself.(2) This section does not apply to withholding or withdrawing medical treatment.(3) This section does not prohibit a prosecution under the common law offense of assisting in a suicide, but a person shall not be convicted under both this section and that common law offense for conduct arising out of the same transaction (Legislative Council, State of Michigan, 2009).

EthicalANA The American Nurses Association (ANA) believes that the nurse should not participate in assisted suicide. Such an act is in violation of the Code for Nurses with Interpretive Statements (Code for Nurses) and the ethical traditions of the profession. Nurses, individually and collectively, have an obligation to provide comprehensive and compassionate end-of-life care which includes the promotion of comfort and the relief of pain, and at times, foregoing life-sustaining treatments (ANA, 1994).AMA Physician-assisted suicide is fundamentally incompatible with the physicians role as healer, would be difficult or impossible to control, and would pose serious societal risks (AMA, 1996)

ResourcesNurses can look to the ANA for professional ethical standards, expectations, and support (ANA, 1994).Ethics committees within hospitalsPalliative care nurses for education and information

Quality & Safety IssuesPatient rights and safetyLimits and boundariesPatient centered careOffer palliative Legal ramifications for RN, MD, and organization

Root Cause AnalysisHospitals should have in place strict policy guiding RNs handling of assisted-suicide within Michigan.Due to its legal ramifications, discovering why it would take place, should not occur. Nursing TheoryPeaceful End of Life TheoryCornelia M. Ruland & Shirley M. MoorePatient & family focusedProcess is defined by those actions which promote positive outcomes Being free from painExperiencing comfortExperiencing dignity and respectBeing at peaceExperiencing a closeness with significant others and those who care

Secondary TheoryPrinciplismBeauchamp & ChrildressFour main principlesAutonomyNon-MaleficenceBeneficenceJusticeThree rulesSubstantive rulesRules of truth telling, confidentiality, privacy, fidelity, and rules pertaining to the allocation and rationing of health care, omitting treatment, physician-assisted suicide, and informed consentAuthority rulesWho may or should perform actionsProcedural rulesProcedures to be followed(Pennsylvania State University, n.d.)

Inferences and Implications/ConsequencesAssisted-suicide is a highly debated topic in the United States (Gastmans, Lemiengre, & Dierckx de Casterle, 2006).Legal now in three states, legislative initiatives to legalize assisted-suicide in other states is currently pending (ProCon.org, 2012).A number of professionals argue that assisted suicide should be a patients choice and abides by the patients right to autonomy (Lachman, 2010).Others argue, including both the ANA and AMA, that abiding by a patients request for assisted-suicide strictly goes against medical ethics and the obligation to do no harm (Pies, 2012).In Michigan it is Illegal to participate in assisted-suicide (Legislative Council, State of Michigan, 2009).

Palliative Care: An AlternativeProvides care to patients with serious illnesses at the end-of-lifeSymptom managementPain reliefStress reliefComfortThe ANA states that withholding or withdrawing life-sustaining therapies or risking the hastening of death through treatments aimed at alleviating suffering and/or controlling symptoms are ethically acceptable and do not constitute assisted suicide (ANA, 1994).Quality & Safety ImprovementsAlthough assisted-suicide remains a highly controversial issue, recommendations includeFollow the ANA Code of Ethics for NursesDevelop a hospital wide education initiative regarding the indication and utilization of palliative careImplement an ethics committee and create a organizational plan for dealing with assisted-suicide

QSENPatient-centered careWork with patients to create plans of care that are defined by the patient Work to address ethical and legal issues related to patients rights to determine their care Support patients in their decisions even when the decision conflicts with personal values SafetyUse best practices and legal requirements to report and prevent harm Encourage a positive practice environment of high trust and high respect (AACN QSEN Education Consortium, 2012)

ANAAssisted-suicide can have a direct correlation into a number of ANA nursing standards. Standard # 7 - EthicsContributes to resolving ethical issuesDelivers care in a way that preserves and protects patients autonomy, dignity, and rightsUses the ANA Code of Ethics for Nurses as a guide to practice by.Standard # 15 - Resource UtilizationUtilizing hospital based ethics board and membersPalliative care nursesStandard # 13 - CollaborationCommunicates with patient, family, and healthcare providers regarding patient care and the nurses role in providing that care.Facilitates an interdisciplinary process with other members of the healthcare team. (American Nurses Association, 2010).

ConclusionAlthough legal in 3 states, assisted-suicide remains an highly controversial ethical issue within the medical field.

ANA at this time does not support assisted-suicide.

Palliative care, including pain and comfort management is ethically endorsed by the ANA

ReferencesAACN QSEN Education Consortium. (2012, September 24). Graduate level QSEN competencies. Retrieved from AACN: http://www.aacn.nche.edu/faculty/qsen/competencies.pdfAMA. (1996). Opinion 2.211 - Assisted suicide. Retrieved from American Medical Association: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2211.page?American Nurses Association. (2010). Nursing scope and standards of practice. Silver Spring, MD: Nursesbook.org.ANA. (1994, December 8). Assisted suicide. Retrieved from Nursingworld.org: http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements/prtetsuic14456.htmlANA. (2012). Assisted suicide. Retrieved from Nursingworld.org: http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements/prtetsuic14456.html

Arnstein, P., & Robinson, E. (2011, August). Is palliative sedation right for your patient? Nursing 2011, 50-54.Gastmans, C., Lemiengre, J., & Dierckx de Casterle, B. (2006). Role of nurses in institutional ethics policies on euthanasia. Journal of Advanced Nursing, 54(1), 53-61.Lachman, V. (2010). Physician-assisted suicide: Compassionate liberation or murder? Medical Sugical Nursing, 19(2), 121-125.Lautrette, A., Ciroldi, M., Ksibi, H., & Azoulay, E. (2006). End of life family conferences: Rooted in the evidence. Critical Care Medicine, 34(11), S364-S372.Legislative Council, State of Michigan. (2009). Section 750.329a. Retrieved from Michigan Legislative Website: http://www.legislature.mi.gov/ (S(yhco5xuezn5zve45cowuuq2l))/mileg.aspx?page=getObject&objectName=mcl-750-329a

Meier, D. E., Emmons, C.-A., Wallenstein, S., Quill, T., Morrison, R., & Cassel, C. K. (1998). A national survey of physician-assisted suicide and euthinasia in the united states. The New England Journal of Medicine, 338(17), 1193-1201.Pennsilvania State University. (n.d.). Theoretical approaches to health care ethics. Retrieved from PennState: The College of Health & Human Development School of Nursing: http://www.personal.psu.edu/dxm12/n458/theoretical_approaches.htmPies, R. (2012). Physician-assisted suicide: Why medical ethics must sometimes trump the patient's choice. Retrieved from PsychCentral.com: http://psychcentral.com/blog/archives/2012/10/07/physician-assisted-suicide-why-medical-ethics-must-sometimes-trump-the-patients-choice/ProCon.org. (2012, May 16). State laws on assisted suicide. Retrieved from ProCon.org: http://euthanasia.procon.org/view.resource.php?resourceID=000132Sprung, C. L., Ledoux, D., Bulow, H.-H., Lippert, A., Wennberg, E., Baras, M., . . . Group, E. S. (2008). Relieving suffering or intentionally hastening death: Where so you draw the line? Critical Care Medicine, 36(1), 8-13.