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Assisted Suicide Issues

The Supreme Court heard two right-to-die cases which have moved through the courts.

Definitions of assisted suicide are:

Assisted suicide is generally understood as occurring when one person provides the means (e.g., medication or weapon) for another person to commit suicide
Active euthanasia is the direct action of one person to end another person’s life.

Nurses will be involved in this issue in many ways including families asking what they should do, other nurses expressing their opinions, to physicians increasing morphine drip dosages but delegating nurses to administer. A multi-site study published reports of ICU (intensive care unit or critical care) nurses describing frequent involvement with assisting patient death in their care of critically ill patients. Read this report and the editorials written about the study. Read books or other writings on this topic. Sugested books from groups working on this issue include: Final Blessings, Tibetan Book of the Dead, How We Die, or Dying Well.

It is important for nurses to know both sides of this issue - and to have thought through their own point of view just as those in the editorials have. Read the opposing points of view in the comparison table below and other assigned readings on the topic then complete the assignment to use your consultant or collaboration skills in working with other nurses on this topic. You will need to separate your own point of view on any specific aspect of this ethical/legal issue when you are in a consultant or collaboration role with others. In the last text boxes below describe the skills of thoughtful contemplation of your own point of view, recognition of beliefs that may be different than your own, understanding legal aspects of an ethical dilemma, that you have gained by reading, thinking and participating in this assignment.

For Against
The two cases were brought by a patients' rights group called Compassion in Dying. The cases were brought by seven physicians and six terminally ill patients - who later died from diseases including AIDS and cancer. Dr. Kevorkian has no connection to these cases. Opponents, an ideologically diverse group ranging from the federal administration, health care administrators to various religious groups. They are equally adamant that assisted suicide - even when voluntary and done by a patient's own hands - would cross the moral border into state-sanctioned killing.

You have been asked by a group of nurses to collaborate or consult with them on developing policies on assisted suicide. How would you begin assisting these nurses?

San Francisco-based Ninth Circuit declared in a expansive ruling, that assisted suicide is a "fundamental right" protected by the Constitution's 14th Amendment's due-process clause (which traditionally means the state needs compelling reasons to deprive "any person of life, liberty or property"). The Second U.S. Circuit Court of Appeals based its decision on the 14th Amendment's equal-protection clause.

For Against
Federal appellate courts struck down laws in New York and Washington state banning physician-assisted suicide. At least 40 other states have similar laws that are being reversed. In 1990, the Supreme Court recognized the constitutional right to forgo unwanted medical treatment. However, opponents believe there is a distinction between stopping life support systems of patients considered "brain dead" and providing lethal dosages of medications to dying patients.

What are your thoughts about the legal aspects of this issue?

Emotional reactions often dominate discussion of assisted suicide, but the issue was argued before the Supreme Court as a constitutional clash between ethical and legal principles of personal autonomy and the state government's obligation to preserving life.

For Against
The appeals courts ruled that a person terminally ill and mentally competent has a constitutional right to receive lethal drugs from a doctor to hasten death. Opponents see a moral and legal difference between an active act by a physician to provide lethal mechanisms and passively letting nature take its course so that the underlying disease causes death.

Your thoughts?

For Against
Patients and health care professionals who see the need for laws allowing assisted suicide argue "We don't see this as suicide. These people feel their self is being destroyed by their illness. They view death as a form of 'self-preservation'. People have a right to end their pain and suffering." Some law professors have stated obliterating the difference between active and passive suicide assistance opens the constitutional arguments for giving lethal mechanisms to any person who doe not have a terminal illness. Potentially groups like frail elderly and children would be vulnerable or coerced into assisted suicide when they may have depression or pain that is treatable.

 

Now it's time to debate.