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Views on physician-assisted suicide > In “Physician-Assisted Suicide: A Nurse’s Perspective” (March, 2014),* the author recommends that nurses sort out their personal beliefs regarding physicianassisted suicide (PAS) in order to best serve their patients’ needs. I contend that nurses’ negative visceral reaction to PAS arises from our understanding of our professional duty to adhere to the Hippocratic admonition to “do no harm” to our patients. Patients asking for PAS may really be asking: “Am I a burden to you?,” “Will you effectively manage my pain and fears?,” and “Am I a person of worth and dignity even when I’m sick and disabled?” In response, PAS tells the patient: “You’re a burden,” “We have nothing to offer you to make you calm and comfortable,” and “You lost your dignity when we couldn’t cure you.” The medical and nursing professions have much more than PAS to offer our dying patients and we have the professional obligation to do so. —DOROTHY FUCHS, MA, RN Whitehouse Station, N.J.

Elizabeth A. Ayello, PhD, RN, ACNS-BC, ETN, FAAN, FAPWCA, President, Ayello, Harris & Associates, Inc.; Faculty, Excelsior College School of Nursing, Albany, N.Y.; Senior Adviser, The John A. Hartford Institute for Geriatric Nursing and Program Director, Education Essentials, New York, N.Y. Michael R. Cohen, ScD, MS, RPh, President, Institute for Safe Medication Practices, and Member of the Sentinel Event Advisory Group for The Joint Commission, Horsham, Pa. Yvonne D’Arcy, MS, CRNP, CNS, Pain Management and Palliative Care Nurse Practitioner, Suburban Hospital-Johns Hopkins Medicine, Bethesda, Md. Michael W. Day, MSN, RN, CCRN, Trauma Nurse-Coordinator, Sacred Heart Medical Center and Children’s Hospital, Spokane, Wash. Cheryl Dumont, PhD, RN, CRNI, Director, Nursing Research and Vascular Access Team, Winchester Medical Center, Winchester, Va. Martha M. Funnell, MS, RN, CDE, Codirector of the Behavioral, Clinical and Health Systems Intervention Research Core, Michigan Diabetes Research and Training Center; Research Investigator in the Department of Medical Education; and Adjunct Lecturer, School of Nursing, University of Michigan, Ann Arbor, Mich. Peg Gray-Vickrey, DNS, RN, Provost and VP for Academic and Student Affairs, Texas A&M University-Central Texas, Kileen, Texas. Elizabeth Heavey, PhD, RN, CNM, RN-BSN Program Director, Associate Professor of Nursing, The College at Brockport, State University of New York, Brockport, N.Y.

> As a hospice nurse, I’d like to see patients receive more education on choosing hospice care. Hospice enables patients to be home, have their pain controlled, and die peacefully. In studies across the board, only 30% of qualified patients receive information on hospice services.1 This would give terminally ill patients an ethical choice that nurses can feel comfortable with. —CAROL HARDISON, RN N.C. REFERENCE 1. Hospice Action Network. Hospice in the nursing home. 2013. http://hospiceactionnetwork.org/ linked_documents/get_informed/issues/nursing_ home/NH_Fact_Sheet.pdf.

> I’ve cancelled my subscription to Nursing2014 because of this article on physician-assisted suicide. Here’s the bottom line, in

my humble opinion. PAS has no place in the healthcare world and nurses shouldn’t even entertain the “what if?” This topic has no business in a prominent nursing journal. We are a trusted profession, and that trust should never be breached. —I. CEPLECHA, BA, RN > Nurses have a high calling to be healers, comforters, and consolers. A nurse taking the Florence Nightingale Pledge vows to “abstain from whatever is deleterious...and will not take or knowingly administer any harmful drug...With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.”1 The article on PAS (called doctorprescribed suicide or DPS in some

Jeanne Held-Warmkessel, MSN, RN, ACNS-BC, AOCN, Clinical Nurse Specialist, Fox Chase Cancer Center, Philadelphia, Pa. Frank Edward Myers III, MA, CIC, Infection Preventionist III, UC San Diego Health System, San Diego, Calif. Bill Pruitt, MBA, RRT, AE-C, CPFT, FAARC, Senior Instructor and Director of Clinical Education, Cardiorespiratory Sciences, School of Allied Health, University of South Alabama, Mobile, Ala. Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, FAAN, Vice President of Informatics Healthcare Information and Management Systems Society Chicago, Ill. Susan Simmons, PhD, RN, ARNP-BC, Family NP, College Park Family Care Center, Overland Park, Kan. Linda S. Smith, PhD, MS, RN, CLNC, Faculty Affiliate, Idaho State University, Pocatello, Idaho Kristopher T. Starr, JD, MSN, RN, Attorney at Law, Ferry, Joseph & Pearce, P.A., Wilmington, Del.; Staff RN, Emergency Department, Christiana Care Health System, Newark, Del.; Adjunct Nursing Faculty, Excelsior College, Albany, N.Y.; Supplemental Nursing Faculty, University of Delaware, Newark, Del. Jeff Strickler, MA, RN, CEN, CFRN, NE-BC, Director, Emergency Services, University of North Carolina Hospitals, Chapel Hill, N.C.

* Individual subscribers can access articles free online at http://www.nursing2014.com. Send comments by e-mail if possible to [email protected]. Please, no attachments. Or send them to Letters Editor, Nursing2014, Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103. Please include your name, credentials, complete mailing address, e-mail address (if applicable), and daytime phone number. Letters are edited for content, length, and grammar. Submission of a letter will constitute the author’s permission to publish it, although it doesn’t guarantee publication. Letters become the property of Nursing journal and may be published in all media. DOI-10.1097/01.NURSE.0000446647.10618.b1

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jurisdictions) left many unanswered questions about what the practice actually entails and how it’s implemented. Regardless of the PAS/DPS laws, which are fraught with many ethical problems, all nurses should be aware of the American Nurses Association (ANA) position statement issued on April 24, 2013. In part, it states that the ANA “prohibits nurses’ participation in assisted suicide and euthanasia because these acts are in direct violation of Code of Ethics for Nurses with Interpretive Statements, the ethical traditions and goals of the profession, and its covenant with society.”2 Nurses also have an obligation to educate themselves on PAS/DPS

laws, how they’re implemented, and what the ramifications are when a lethal dose of barbiturate is prescribed, obtained, and ingested. For example, potential consequences include gastrointestinal distress (such as nausea and vomiting) and failure to die. In Vermont where I work, nurses, pharmacists, and others who might be involved have no immunity from prosecution. There’s no way to verify the patient takes the lethal dose, nothing to dictate what happens to the lethal dose once it leaves the pharmacy, and no validation on the death certificate.3 Palliative care is about more than medication. It’s about holding a hand, singing a song, and being present. It’s

a rich privilege to care for patients as they breathe their last breath. May we remember the high calling we have as nurses to provide compassionate and respectful care to those who are nearing their final breath. —LYNNE CAULFIELD, RN Vermont Alliance for Ethical Healthcare Brattleboro, Vt. ■ REFERENCES 1. American Nurses Association. Florence Nightingale pledge. http://nursingworld.org/FunctionalMenu Categories/AboutANA/WhereWeComeFrom/ FlorenceNightingalePledge.aspx. 2. American Nurses Association. Euthanasia, assisted suicide, and aid in dying. 2013. http://www.nursing world.org/MainMenuCategories/EthicsStandards/ Ethics-Position-Statements/Euthanasia-AssistedSuicide-and-Aid-in-Dying.pdf. 3. No. 39. An act relating to patient choice and control at end of life. Requirements for prescription and documentation; immunity. http://www.leg. state.vt.us/docs/2014/Acts/ACT039.pdf.



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Views on physician-assisted suicide.

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