Nurses' attitudes towards euthanasia
This essay will look at nurses' attitudes towards euthanasia, the current practice for advising patients about euthanasia and what impact this has on patient care. The main question this essay plans to answer is what are nurses' attitudes towards euthanasia? The Crown Prosecution Service Interim Policy for Prosecutors in respect of cases of Assisted Suicide released in September 2009 will also be discussed with the implications for nurses identified. A literature review will be conducted in order to analyse current practice. Through investigating current practice and research undertaken in this area a conclusion will be drawn and recommendations for future practice will be made.
The term euthanasia can be translated from the Greek word euthanatos meaning good death (Lecky 1929). Harris (2001) suggests euthanasia is a deliberate act carried out with the intention of ending a terminally ill person's suffering. Euthanasia has been decriminalized in the Netherlands since 2002(Bruchem-van de Scheur et al 2008), where procedures are carried out under strict guidelines. However in the United Kingdom, euthanasia is illegal and viewed as murder by the law. A number of attempts have been made by various organisations and prominent medical practitioners to make euthanasia legal. The Assisted Dying for the Terminally ill Bill was blocked by the House of Lords in 2006, this aimed to legalise physician-assisted suicide by prescription, and if necessary, provision of means of self-administration of medication.
An interest in the ongoing debate for the legalisation of euthanasia was developed through reading a newspaper article about Dr Philip Nitschke an Australian doctor who advocates the use of euthanasia for terminally ill patients. This topic was chosen for its relevance to palliative care and general nursing practice. It is also of interest due to personal experience of caring for patients who have enquired about these options.
Aranda et al (1999) suggest that the topic of euthanasia is currently receiving renewed attention worldwide with increased emphasis on the call for this practice to be legalised. There has been increased media interest in this topic in recent years. There have also been many cases of people seeking the right to end their lives through assisted suicide. A noted case is that of Debbie Purdy a right to die campaigner with multiple sclerosis who took her legal battle to the House of Lords in order to clarify the laws on assisted suicide. With the vast amount of information provided by the internet, television and media people are becoming more aware of their options. This may lead to more nurses being asked to provide advice or assist patients to fulfil their wishes.
With the ever developing role of nurses into nurse prescribers, Griffith (2007) suggests nurse prescribers are often required to assist with pain management for palliative patients. A study conducted by Bruchem-van de Scheur et al (2008) showed that in a study of one thousand five hundred and nine Dutch nurses in 37% of euthanasia cases, the nurse was the first person that the patient discussed their request for assisted suicide with. Davis et al (2008) suggest that nurses play an important role in end of life care and must be prepared to deal with a number of complex issues including euthanasia or assisted suicide. Bailk (2004) further supports this stating that nurses should use published frameworks to assist patients with decision making. Gastmans et al (2006) suggest that as nurses spend the greatest amount of time with terminally ill patients and families their personal attitude and perception of euthanasia is important. This is not only within the hospital or palliative care setting but also in the creation of health policies and legislation (Giacomini et al 2006).
A literature review was carried out using John Moore's university library and databases including Internurse, OVID, CINAHL and SAGE. Websites such as the Nursing Times, BBC News and The British Medical Journal online were used to search for relevant articles. In addition searches of government and governing bodies' websites for relevant guidelines on this topic were also conducted. The keywords used in this literature search included euthanasia, assisted suicide, nurses' attitudes, nurses' opinions and Assisted Dying Bill. A vast amount of literature was found using these keywords, the articles found were then analysed in order to obtain those appropriate for this assignment.
One article was that of Verpoort et al (2004) who reports that the attitudes of nurses varies dependent upon a number of factors including age, religion and nursing speciality. The arguments for and against euthanasia were discussed in detail within this article along with how they effected the nurses attitudes. This study found that nurses were discontented with the current situation and felt they needed more training in palliative care. Nurses also expressed that they felt unable to discuss their own feelings on euthanasia. Staines (2009) further supports this reporting that at the 2009 Royal College of Nursing conference nurses called for more support and guidance on dealing with this situation.
In July 2009 the Royal College of Nursing changed its stance on assisted suicide from opposed to neutral. However the Nursing and Midwifery Council (2009) opposed this stating that nurses and midwifes must practice within their Code of Conduct (NMC 2008) and within the context of national laws. They remind nurses that the law on assisted suicide has not changed. However neither the Royal College of Nursing or the Nursing and Midwifery Council have produced set guidance for nurses who are asked for information or assistance with euthanasia by patients or their families.
The Department of Health (DOH 2009) argues that nurses do not need to be provided with guidance as assisted suicide and euthanasia remain illegal. However with no clear guidance it is hard for nurses to understand what to do when presented with this situation. How much information is the nurse allowed to provide the patient with? And also by providing information can they be accused and prosecuted for assisting suicide? The fact that there are no clear guidelines may impact on the nurses' attitude towards euthanasia and patient care. Nurses may feel reluctant to provide information, fearing the possible consequences.
Stevens et al (1994) found that younger nurses tended to be more accepting of the concept of euthanasia than older nurses. They suggest that younger nurses are more likely to receive requests from patients for euthanasia. The study found that younger nurses were more likely to develop a positive attitude towards euthanasia but not necessarily a closer relationship with the patients requesting assistance. McInerney et al (1995) suggest that this may be due to younger nurses not being able to cope with the emotional or responsible aspect of the euthanasia process.
A study of Japanese palliative care nurses by Asai et al (2001) found that of the two hundred and seventeen nurses who participated in the study approximately half had been asked to assist in hastening death. This study further found that of the nurses surveyed a fifth would practice euthanasia if it were legalised in Japan. It is felt by the researchers that this result shows a positive attitude towards euthanasia. However in contrast Kitchener et al (1998) found that experience in palliative care had a negative effect on nurses' attitudes towards euthanasia. Marini et al (2006) suggest that this may be down to palliative care nurses being used to caring for terminally ill and dying patients on a daily basis. Matzo et al (2001) further support this suggesting that palliative care nurses deal with end of life decisions on a daily basis. Verpoort el al (2004) showed that attitudes towards different treatments in advanced disease were mostly contextual.
In contrast to earlier studies a survey by Gielen et al (2009) found that seventy eight percent of palliative care nurses questioned supported euthanasia. The researchers suggest that this attitude may be due to the existence of laws regulating voluntary euthanasia in Belgium were the study was conducted. It can be argued therefore that the nurses in this study see euthanasia as acceptable due to this act being permitted by law. They may also be more open to this as patients can not only ask for this openly but may also receive it. However a limitation of studies conducted on the attitudes of nurses is identified by Gielen et al (2009). They suggest that there are no studies which compare the attitudes of nurses in general, or towards euthanasia in different countries. They also suggest that a limitation of their study was there are limited other studies to compare their findings with. They suggest that more research needs to be conducted in other countries before any conclusion on how radically different Belgium nurses attitudes towards euthanasia are compared to other countries were euthanasia may not be legal .
A recent study of Greek nurses conducted by Patelarou et al (2009) found that Greek nurses hold a negative position on euthanasia and its legalisation despite one in three of the nurses having participated in euthanasia even though it is illegal in Greece. As this was the first study of Greek nurses attitudes towards euthanasia the researchers felt that further research is required in order to determine what factors influence the nurses stance against or for euthanasia.
A number of key factors were identified across all of the studies analysed. Age, nursing speciality and religion appeared to impact on the nurses' attitudes towards euthanasia. As discussed Stevens et al (1994) found that younger nurses were more accepting of the concept of euthanasia. This is further supported by Donnison (1997) who suggests that a more reform focused attitude is found among young people. Patelarou et al (2009) suggested that the negative attitude of Greek nurses to euthanasia may be partly down to the participant's religion. Many modern beliefs are built on ancient Greek Orthodox traditions according to Michalodimitrakis (2001). It can be suggested that this is also supported by classic physicians such as Hippocrates who stated that ‘To please no one will I prescribe a deadly drug nor give advice which may cause his death' (Emanuel 1994).
As it can be seen there are a number of different perspectives and attitudes of nurses towards euthanasia dependent on a number of factors identified within the studies analysed. The strengths and limitations of current practice will now be identified and discussed along with the impact of the new Crown Prosecution Service Interim Policy for Prosecutors in respect of cases of Assisted Suicide.
As it has been previously identified euthanasia is illegal and