PITTSBURGHIn its most recent position statement on
assisted suicide, the Oncology Nursing Society (ONS) calls for continued dialog
on any and all ethical dilemmas, such as assisted suicide. The statement
emphasizes the caring component of nursing and calls for effort to improve
compassionate and competent care for the dying.
The Society defines assisted suicide as "any act that
enables the patient to self-administer medication for the intent of ending his
or her life."
The statement acknowledges that "a terminal illness can
include intense physical symptoms as well as loss of control, depression,
hopelessness, and fear of unrelieved symptoms. This potential ‘loss of self’
requires that nursing intensify its efforts to ensure that the dying are cared
for by compassionate, sensitive, and knowledgeable individuals who will attempt
to understand the patient’s needs."
The position paper offers a number of guidelines to help nurses
deal with clinical situations in which they experience personal and
professional tension and ambiguity surrounding a patient’s request for
While the ONS recognizes that "physical suffering
may not always be alleviated, and only the dying individual can be the judge of
what is a tolerable or acceptable level of personal suffering," its
position is that nurses must "uphold the ethical mandates of the nursing
profession while simultaneously seeking to understand the meaning of a patient’s
request for assisted suicide."
Nurses should frankly discuss with the patient the
rationale for an assisted suicide request, conduct a thorough nonjudgmental
multidisciplinary assessment of a patient’s unmet needs, and promptly
initiate intensive interventions for previously unrecognized or unmet needs.
Nurses are obligated to tell patients that they are
unable to assist in suicide, yet may listen compassionately to patient requests
and reaffirm that they will not abandon the patient.
Nurses should "resist the inclination to abandon
terminally ill patients who request assisted suicide." Abandonment is
defined as withdrawing, physically or emotionally, from the patient.
Refusal to assist the patient does not constitute abandonment,
according to the statement. However, if the nurse wishes to withdraw from the
care of that patient, care must continue until a suitable replacement can be
Nurses should not use judgmental language in the
presence of the patient, family, significant others, and professional
In states were assisted suicide is legal (and to date,
it is legal only in one state, Oregon), nurses "may choose to continue to
provide care or may withdraw from the situation after transferring
responsibility for care to a nursing colleague." A nurse may also remain
with a patient who elects assisted suicide, if both patient and nurse are
comfortable with this arrangement.
To receive a complimentary copy of the position statement
"The Nurse’s Responsibility to the Patient Requesting Assisted
Suicide," contact ONS Customer Service at 412-921-7373 or via email at firstname.lastname@example.org.