Medical Aid in Dying: An Ethical Dilemma in Nursing

• Medical aid in dying is one of the more controversial topics in modern medicine.
• Regardless of your stance on the practice, a nurse must continue to provide compassionate care to every patient.
• Check out Nursing CE Central to learn more!

One of the biggest ethical dilemmas in nursing today is the topic of medical aid in dying; however, regardless of your stance, the patient must remain at the center of care.  

Wondering what a nurse’s role is in the medical aid in dying process? Let’s break it down. 

What Is Medical Aid in Dying?

According to the American Academy of Family Physicians (AFFP), medical aid in dying is “the practice of a physician providing a competent, terminally ill patient—at the patient’s request—with a prescription for a lethal dose of medication that the patient intends to use to end his or her own life.” 

The American Academy of Hospice and Palliative Medicine (AAHPM) outlines Oregon as being the first U.S. state to legalize the “Death with Dignity Act” for the terminally ill in 1997. 

Not only is medical aid in dying considered an ethical dilemma in nursing, as it can be seen as an abandonment of patient healing, but in modern medicine as a whole.  

Is It Legal Everywhere?

Non-profit organization, Death with Dignity National Center, has been actively advocating, lobbying, and campaigning for the legalization of the “Death with Dignity Act” on a national scale. 

However, as of now, the practice of medical aid in dying is only accepted in the following states: 

• California 
• Colorado 
• District of Columbia 
• Hawaii, Maine 
• New Jersey 
• New Mexico 
• Oregon 
• Vermont 
• Washington 

It is hard to determine if this ethical dilemma in nursing and medicine will ever be accepted by all states, as the debate has been an ongoing battle.  

Although the practice has been legalized in all the previously mentioned states, each has its own specific guidelines, protocols, and requirements that will need to be individually researched.  

Where Is the Line Drawn?

In some states, nurses may decline active participation in the implementation of medical aid in dying, but they remain responsible for the scope of end-of-life care practices, which includes providing information, managing symptoms, and other palliative interventions; this continues to be an ethical dilemma in nursing.   

Beyond the fact that nurses and NPs are not permitted to prescribe the medication typically administered in this end-of-life care process, there is a general lack of guidance and clarification given to them.

Nurses are challenged to define their practice in this role.

Unlike physicians, nurses are required to practice under the auspices of their employer, and they may have conflicting personal beliefs about the medical aid in dying process, which can impact their willingness to be actively involved.  

What Nurses Can Do  

If you agree or disagree, that is your choice.  

However, if you are living in a state where the medical aid in dying process is legal, there are several things you can do should you encounter a patient who wishes to begin the medical aid in dying process. 

At the American Academy of Nursing’s annual conference in 2018, the following information was presented; it is now in the published under the “Assisted Suicide/Aid in Dying: What is the Nurse’s Role?” section of the American Journal. Check it out: 

• Become educated on medical aid in dying so that you can provide valuable information to patients and their families. 
• Work to clarify the distinctions between your personal moral values and your professional obligations. 
• Keep an open dialogue between your patients and their families; this topic can be a struggle, so we must ensure that their needs and concerns are understood.  
• Learn how to have difficult conversations with patients and their families.  
• Request and support the development of guidelines, particularly in a hospice setting, for caring for patients at the end of life.  
• Ensure that your patients know that stopping aggressive treatment does not mean stopping care. Avoid terminology that may lead families to think that medical care would be stopped for patients. 
• According to the ANA, nurses have an obligation to provide all other appropriate supportive care to the patient during their end-of-life process.  

Although this topic is difficult to discuss and is an ongoing ethical dilemma in nursing, it is important that we continue to provide compassionate care to each and every patient we encounter, no matter their beliefs.  

Read More