Concerns about hastening death


Currently, five states in the United States have legalized physician-assisted suicide. Oregon, Vermont, Washington and California have legalized physician assisted suicide through legislation. Montana has legalized physician-assisted suicide requiring court ruling.

Five States with Legal Physician-Assisted Suicide
State
Date Passed
How Passed (Yes Vote)
Residency Required?
Minimum Age
# of Months Until Expected Death
# of Requests to Physician
California
Oct. 5, 2015
End of Life Option Act (ABX2-15)
Yes
18
Six or less
Two oral (or least 15 days apart) and one written
Montana
Dec. 31, 2009
Montana Supreme Court in Baxter v. Montana (5-4)
Yes
*
*
*
Oregon
Oct. 27, 1997
Death with Dignity Act
Yes
18
Six or less
Two oral (at least 15 days apart) and one written
Vermont
May 20, 2013
Act 39 (Bill S.77 "End of Life Choices"
Yes
18
Six or less
Two oral (at least 15 days apart) and one written
Washington
Nov. 4, 2008
Death with Dignity Act
Yes
18
Six or less
Two oral (at least 15 days apart) and one written

Four states, Nevada, North Carolina, Utah and Wyoming, have no specific laws regarding assisted suicide. The remaining states and DC have laws against assisted suicide. In many states anyone who assists with a suicide can be charged with a felony charge and/or manslaughter.

It is important for nurses to know the legal position of assisted suicide in their states These rulings can change quickly requiring continuous monitoring.

Concern that pain medication might hasten death

Healthcare workers, as well as the patient and family members, must deal with the legal and ethical issues involved in end of life care. Some healthcare workers feel conflict over the issue of giving analgesia or sedation that may hasten death. They are concerned that giving such treatment is a form of assisted suicide. However, there is no conclusive evidence that providing treatment hastens death. In fact, it may do the opposite by relieving physiologic stress (Gopal, 2015).

In 1991, the American Nurse Association stated that it is ethically justified to give pain medication to achieve control of pain, even at the expense of life. Additionally, in 1997 the United States Supreme Court differentiated palliation from assisted suicide, noting that the use of sedation to ease suffering when people are near death is appropriate.

In an effort to improve pain management, the state of West Virginia has enacted limitation on disciplinary sanctions or criminal punishment related to management of intractable pain. Nurses "shall not be subject to disciplinary sanctions by a licensing board or criminal punishment by the state for administering pain-relieving controlled substances to alleviate or control intractable pain, if administered in accordance with the orders of a licensed physician." Many other states have also sought to protect medical professionals by enacting similar laws. Knowing your state's laws will enable you to confidently assist patients to manage their pain.

Most religious groups, according to a recent Pew research study, denounce suicide or assisted suicide. However, they support the patient’s right to stop treatments that are excessive or extraordinary. See this report for description of specific religious groups. http://www.pewforum.org/2013/11/21/religious-groups-views-on-end-of-life-issues/

Some religious groups, including the Catholic Church, support the use of pain medication even if it unintentionally hastens death.

Here is a quote in the brochure published by the Daughters of Charity Health System.

"I can use medications and treatments that bring comfort and relieve pain, even if they indirectly and unintentionally shorten my life."
http://www.rcda.org/Offices/pastoral_care_ministry/pdf/Advance_Directive_Guide.English_only.pdf

It is important for nurses to know what religious beliefs are held by the patients and their family members. It is helpful to remember that whether the patient dies in pain or in comfort, the patient is dying, and that cannot be reversed. However, death can and should occur without suffering and that can be ensured by appropriate palliative care. It's helpful to everyone concerned if the patient completes an advance directive. Then, family, as well as healthcare providers, know that the treatment they are providing is what the patient wants.


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