Concerns about hastening death


“....a patient who is suffering from a terminal illness and who is experiencing great pain has no legal barriers to obtaining medication, from qualified physicians, to alleviate suffering, even to the point of causing unconsciousness and hastening death… - (WA v. Glucksberg 1997)." https://www.oyez.org/cases/1996/96-110


Currently, eight states and Washington, DC.in the United States have legalized physician-assisted suicide. Three states, Maine, Oregon, Washington, and D.C., refer to the statues as Death with Dignity Acts. Two states, California and Colorado, call the statutes End of Life Options Acts. Hawaii's law is called, Our Care, Our Choice Act, New Jersey, Aid in Dying for the Terminally ill Act, and Vermont, Patient Choice and Control at the End of Life Act.

Montana's Supreme Court in 2009 ruled nothing in their laws prohibits a physician from respecting a competent patient's request for medication hastening death. There have been some bills submitted to criminalize doctor-assisted deaths in Montana. So for no bills specifically for or against assisted suicide have passed.

Eight states and D.C. with Legal Physician-Assisted Suicide Acts
State

Date
Passed

Name of Act Designated
health
professional
Link to complete Act
CA 10/5/2015 End of Life Option Act (ABX2-15) Physician https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?
bill_id=201520162AB15
HI 01/01/2019 Our Care, Our Choice Act Physician; Advanced practice R.N.s able to practice medical aid in dying https://health.hawaii.gov/opppd/files/2018/11/OCOC-Act2.pdf
OR 10/27/2013 Death with Dignity Act Physician https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/
EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Pages/ors.aspx
VT 05/20/2013 Act 39 (Bill S.77 "End of Life Choices" Physician http://www.leg.state.vt.us/docs/2014/Acts/ACT039.pdf
WA 11/04/2008 Death with Dignity Act Physician https://app.leg.wa.gov/rcw/default.aspx?cite=70.245
ME 06/12/2019 Death with Dignity Act Physician https://www.mainelegislature.org/legis/bills/getPDF.asp?paper=HP0948&item=1&snum=129
NJ 08/1/2019 Aid in Dying for the Terminally Ill Act Physician https://www.nj.gov/health/advancedirective/documents/maid/
MAID_FAQ.pdf
D.C. 02/18/2017 Death with Dignity Act of 2016 Physician https://dchealth.dc.gov/sites/default/files/dc/sites/doh/page_
content/attachments/Death%20With%20Dignity%20Act.FINAL_.pdf

Four states, Nevada, North Carolina, Utah, and Wyoming, have no specific laws regarding assisted suicide. In 2019, in Nevada, there was an attempt to pass a Death with Dignity Act, which failed to meet the deadline for the full Senate passage. Citizen groups are continuing to work on passing that legislation.

The remaining states have laws against assisted suicide. Alabama, Massachusetts, and Wyoming prohibit assisted suicide by common law. In most states, without specific pro assisted suicide laws, charges anyone who helps with suicide with a felony charge or manslaughter.

Nurses need 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).

The question of providing pain medication to terminally ill patients even if it might shorten their lives, has been decided by the U.S. Supreme Court, the following is a concurrence written by Sandra Day O’Conner.

“…. a patient who is suffering from a terminal illness and who is experiencing great pain has no legal barriers to obtaining medication, from qualified physicians, to alleviate suffering, even to the point of causing unconsciousness and hastening death…” (Washington v. Glucksberg, 1997).” https://www.oyez.org/cases/1996/96-110 Washington v. Glucksberg, 521 U. S. 702, 723–724. Concurrence S. Day O'Conner (1997)

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 sedation to ease suffering when people are near death is appropriate.

To improve pain management, the state of West Virginia has enacted limitations on disciplinary sanctions or criminal punishment related to the 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 following 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

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


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