2. Krystenn Fowler, RN Ferris State University

3. Assisted Suicide: is the means to end a patient’s life is provided to the patient (i.e. medication or a weapon) with knowledge of the patient's intention. Euthanasia: often called "mercy killing", is the act of putting to death someone suffering from a painful and prolonged illness or injury. Aid in Dying: is an end-of-life care option in which mentally competent, terminally ill adults request their physician provide a prescription for medication that the patients can, if they choose, self-administer to bring about a peaceful death. (ANA Position Statements, 2013)

5. What role does a nurse have when it comes to assisted suicide? Be a good listener! Be Patient! Be caring! EDUCATE!

6. To learn about assisted suicide and the role a nurse has. To learn how to respond to a patient who requests assisted suicide. To learn how it may impact a nurse on a personal level.

7. Moral Distress Theory “Moral distress was first recognized among nurses, and certainly the majority of studies have focused on this population”(Epstein & Delgado, 2010). “Research on moral distress among nurses has identified that the sources of moral distress are many and varied and that the experience of moral distress leads some nurses to leave their jobs, or the profession altogether”(Epstein & Delgado, 2010)

8. Kant’s Ethical Theory “For Kant, the outcome of an action is not relevant to whether or not it is ethical. However, Kant himself was strongly against any form of suicide, and would have argued against euthanasia”. (Johnson, 2014)

9. Root Cause NURS E Heal Care AdvocateCompassionate Nurses are taught day one to be compassionate, caring, help heal, and advocate for their patients. A nurse may feel distressed when it comes to assisted suicide.

10. Resources Nurse Patient and Family COMMUNICATION Physician Social Worker

11. Policies Voluntary, written consent Mandatory reporting Performed only by physicians Second opinion and consultation (Pereira, 2011)

12. Consent? “In all jurisdictions, the request for euthanasia or assisted suicide has to be voluntary, well-considered, informed, and persistent over time. The requesting person must provide explicit written consent and must be competent at the time the request is made” (Pereira,2011).

13. Second Opinion “All jurisdictions except for Switzerland require a consultation by a second physician to ensure that all criteria have been met before proceeding with euthanasia or assisted suicide” (Pereira,2011).

14. Are nurses educated?  Explain the law as it currently exists.  Discuss and explore patient options with regard to end-of-life decisions and provide resource information or link the patient and family to access the services or resources they are requesting.  Explore reasons for the patient’s request to end his or her life and make a determination as to whether the patient is depressed and, if so, whether the depression is influencing his or her decision, or whether the patient has made a rational decision based on personal values and beliefs. (ANA Position Statements, 2013)

15. Are patients educated? Laws Resources Second opinion

16. Ethics “… nursing care is directed toward meeting the comprehensive needs of patients and their families across the continuum of care. This is particularly vital in the care of patients and families at the end-of-life to prevent and relieve the cascade of symptoms and suffering that are commonly associated with dying…Nurses may not act with the sole intent of ending a patient’s life even though such action may be motivated by compassion, respect for patient autonomy and quality of life considerations”. (ANA Position Statements, 2013)

17. Collaboration “The registered nurse collaborates with the healthcare consumer, family and others in the conduct of nursing practice”. (ANA Standards, 2014).

18. Communication “The registered nurse communicates effectively in a variety of formats in all areas of practice”. (ANA Standards, 2014) ).

19. Increase education for undergraduate, graduate, and doctoral-prepared nurses in developing effective communication skills in caring for patients with life threatening illnesses who request assisted suicide or euthanasia. Provide resources to help nurses manage their own distress and the distress of their patients when assisted suicide or euthanasia is requested. Encourage all nurses to complete pallitative care competencies so they know how to respond to end- of-life care. (ANA Position Statements, 2013)

20. Educate Communicate Know your resources Know the laws NURSE Collaborate

21. American Nurses Association (2013). Position Statements: Euthanasia, Assisted Suicide, and Aid in Dying. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position- Statements/Euthanasia-Assisted-Suicide-and-Aid-in-Dying.pdf Applied Ethics (2014). Ethical responses to euthanasia. Retrieved from http://www.rsrevision.com/Alevel/ethics/euthanasia/ethics.htm Epstein, E.G., Delgado, S., (Sept 30, 2010) "Understanding and Addressing Moral Distress" OJIN: The Online Journal of Issues in Nursing Vol. 15, No. 3, Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Courage-and- Distress/Understanding-Moral-Distress.html Johnson, Robert, "Kant's Moral Philosophy", The Stanford Encyclopedia of Philosophy (Summer 2014 Edition), Edward N. Zalta (ed.), Retrieved from http://plato.stanford.edu/archives/sum2014/entries/kant-moral/. Pereira, J. (2011). Current Oncology. Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070710/ Standards of Professional Nursing Practice (2014). ANA Standards of Practice. Retrieved fromhttp://www.ferris.edu/HTMLS/colleges/alliedhe/Nursing/Standards-of-Professional-Nursing- Practice.htm