A proposed new law allowing euthanasia and assisted suicide would put both nurses and vulnerable patients at risk says Julie Maher, RN, BA, MA. She is postgraduate co-ordinator and senior lecturer, postgraduate certificate in Hospice Palliative Care, Whitireia Community Polytechnic, Porirua, New Zealand. Julie is also a Member of NZHPA.
Labour MP and health spokesperson Maryan Street has drafted a proposed new law – the End of Life Choice Bill. If the bill becomes law, there are serious implications and consequences for nurses and patients alike. The bill, and its implications, need to be considered and debated by the nursing profession.
Euthanasia and assisted suicide have been highlighted by the New Zealand media due to several recent high-profile legal cases here. Generally, the media portray these cases from a one-sided perspective, with limited exploration of the implications for the vulnerable or for health professionals.
The purpose of the bill is to give individuals a choice to end their life under certain circumstances and receive medical help to do so. These circumstances include that a person making the request must be mentally competent as agreed by two doctors; that the person suffers from a terminal illness which is likely to cause death within 12 months, or from an irreversible physical or mental condition that, in the person’s view, renders his or her life unbearable. (1)
The New Zealand Medical Association, the Australia and New Zealand Society of Palliative Medicine and, more recently, Palliative Care Nurses New Zealand (PCNNZ) Society have all responded with position statements opposing the draft bill. PCNNZ said that, as a professional nursing group, it “believes assisted dying in any form is incongruent with the underlying ethos and practice of palliative care and nursing.” The society also argues that skilled palliative care should be made available to all who require it: and be publicly funded and available in hospital, at home (provided by primary health care teams) and in residential aged-care facilities and hospices.
Education is a key component of the palliative care nurses’ position statement – they believe patients should be made aware of their options for hospice and palliative services, and they advocate for education for nurses and health professionals to attain the necessary qualifications and skills in the principles and practice of palliative care. (2)
As a registered nurse who has worked in a variety of clinical settings, including 12 years in nursing education, teaching palliative care, I want to encourage the nursing voice to emerge and engage in this debate. Where Physician Assisted Suicide (PAS) is practised, doctors have a transparent role, namely providing the prescription, whereas on the surface nurses may appear to play a minor role. However, where PAS is practised, nurses have been found to have a more extensive role and face legal and ethical issues which can challenge their professional status. (3)
Nurses put in compromising position
This has the potential to place nurses in compromising and vulnerable positions if the End of Life Choice Bill becomes law. Many New Zealand nurses may not realize the full extent of these implications for their professional practice, nor the potential impact on vulnerable people. For many nurses, PAS challenges our values and beliefs, both professionally and personally.
Most nurses have been exposed to some very difficult experiences of death and dying in both their professional and personal lives. However, the law must not be changed in response to a small number of high-profile, challenging and tragic cases – a view supported by professor of palliative medicine, Baroness Ilora Finlay of Llanduff, a peer who chairs the United Kingdom All Parliamentary Group on Dying Well, which promotes palliative care and opposes euthanasia.
Ethical debates on euthanasia and assisted suicide usually focus on the domain of doctors, with little input from nurses. Yet it is a situation that affects nurses greatly. Nurses are often confronted with a request for euthanasia. (3) They are at the bedside of patients at all hours of the day and night, and they are in a privileged position to share intimate moments with their patient, particularly when they are contemplating their end of life. Euthanasia and assisted suicide present a dilemma for nurses, causing conflict between the patient’s right to choose (autonomy) , and the nurse’s ethical duty of care based on the principles of beneficence (to do good) and non-maleficence (to do no harm).
Palliative care has much to offer
Ending one’s life is not the only option for a patient who is terminally ill. Palliative care has much to offer patients, to meet their physical, mental, spiritual, emotional, social and cultural needs. The nurse, along with other members of the inter-professional team, is obligated to provide the impeccable assessment, to relieve the symptom burden, and to provide compassionate care and comfort. Very often, when these are addressed, patients’ requests for assisted suicide are mitigated.
Nurses lead busy lives and often feel overburdened with commitments to work, children and aged parents, professional development, study and more. It is hard to find time or energy to react to political developments, whether in your professional nursing field or at a national level. However, if you do not want this proposed law forced on your practice, exposing the weak and vulnerable, then speak up before it is too late.
It is vital that nurses voice their concerns in this public debate, as this issue directly affects their practice. Nurses also need to be assertive advocates – not for the End of Life Choice Bill, but for improved quality of, and access to, palliative care for all people at the end of life. This is a public safety issue requiring urgent action by nurses.
- Street, M (2012) End of Life Choice Bill www.parliament.nz/en-NZ/?document=5OHOH-MEMBILL090-1 Retrieved 15/09/12
- Palliative Care Nurses New Zealand Society (2012) Position statement on euthanasia and assisted dying. http://pcnnz.co.nz/position-statement-xidc99475.html. Retrieved 15/09/12
- Trowel, F. (2009) Exploring the nursing implications of physician-assisted suicide in the Uk. Nursing Times:105:30. www.nursingtimes.net/exploring-the-implications-of-physician-assisted-suicide-in-the-uk/5004645.article. Retrieved 15/09/12
Article published originally in Kaitiaki New Zealand Nursing Journal October 2012