1. Whitney Ayers

2. 1.Upon completion of this seminar you should be able to define and differentiate between the terms euthanasia, and physician-assisted suicide. 2.Describe the laws and ethics regarding assisted suicide and the controversies surrounding the issue. 3.Identify two of the criteria that must be meet in order for someone to qualify for assisted suicide. 4.Identify and discuss ANA and QSEN quality and standards as they relate to assisted suicide. LEARNING OBJECTIVES

3.  Aging population  Patient Education  Quality of life  Ethics  Laws WHY IS THIS IMPORTANT ?

4. http://www.youtube.com/watch?v=Srdo5UYyTiU HOW TO DIE IN OREGON

6. INTERPERSONAL RELATIONS THEORY HILDEGARD PEPLAU

7. INTERPERSONAL RELATIONS THEORY

8. Stranger Teacher Resource Person Counselor Surrogate Leader ROLES OF A NURSE

9. Assessment  Data collection and analysis [continuous]  May not be a felt need Orientation  Non continuous data collection  Felt need  Define needs Nursing diagnosis Planning  Mutually set goals Identification  Interdependent goal setting Implementation  Plans initiated towards achievement of mutually set goals  May be accomplished by patient, nurse or family Exploitation  Patient actively seeking and drawing help  Patient initiated Evaluation  Based on mutually expected behaviors  May led to termination and initiation of new plans Resolution  Occurs after other phases are completed successfully  Leads to termination a

10. STAGE THEORY ELISABETH KUBLER-ROSS

12. http://www.youtube.com/watch?v=oIbdOyhxp18 THE FIVE STAGES OF GRIEF

14. According to the laws of the state of Oregon, a patient requesting a prescription for a lethal medication must be….. 1.An adult 2.Capable of taking medication 3.A resident of the state of Oregon 4.Has been determined by 2 physicians to be suffering from a terminal illness 5.Voluntarily expresses a wish to die 6.Makes written request for medication that will end life POLICY IN OREGON

15. A person who knows that an individual intends to kill themselves, and does anything with the intent to assist the individual in killing themselves is guilty of criminal assistance to the killing of an individual, a felony punishable by imprisonment for not more than 5 years or a fine of not more than $10,000.00, or both. POLICY IN MICHIGAN

16.  Decrease healthcare costs  Easy way out  Depression  Abortion  Animal Euthanasia  Killing babies with diseases ASSUMPTIONSCOMPARED TO.. ASSUMPTIONS

17. Brea is a 28 year old nurse on a medical surgical floor. This is her second day back from a 12 week maternity leave. Two of her co-workers have called in sick, leaving the floor under staffed. All employees are stressed and are just trying to keep up. Brea has 5 patients until someone can come in to cover the open shifts. One of her patients is actively dying and is consuming a lot of her time. No one has time to help her. Opal is an 87 year old patient who was diagnosed with terminal liver cancer 3 weeks ago. When her children came to visit they found her in agony and she begged them to just put her out of her misery so she could be out of pain. Earlier in the shift the cleaning person unknowingly unplugged the patients PCA and the battery was dead. Brea was so busy with her dying patient that she missed two doses of Opal’s pain medication. Opals call light was answered but the nurse was so busy she forgot to tell Brea that she was requesting pain medication. SCENARIO

18. ROOT CAUSE ANALYSIS Equipment Environment Nurse Staff Pt. in pain PCA unplugged Defective back- up battery for PCA Actively Dying pt 2 call-ins Lack of training Poor communication 3 days back from maternity leave Overworked with 5 pt

20.  Nurses lack of knowledge about assisted suicide  Lack of EOL training  Poor patient education  High potential for misinformation  Unnecessary patient anxiety LACK OF TRAINING

21.  Nurses form bonds with patients  Attitudes may be influences by personal feelings  Negative impact of the nurse-patient relationship  Loss of patient trust RELIGIOUS/WORLD VIEWS

22.  Less than 1/3 of Americans have a plan for end-of-life  Even patients with chronic conditions  Hard to talk about  RISKS  Ethical conflict  Inappropriate acute hospitalization  Unwanted interventions  Family burden LACK OF END-OF-LIFE PLANNING

23. EDUCATION EVIDENCE-BASED PRACTICE ETHICS PATIENT-CENTERED CARE physical comfort and emotional support QUALITY IMPROVEMENT Explain the importance of variation and measurement in assessing quality of care INFORMATICS Identify essential information that must be available in a common database to support patient care ANA STANDARDS QSEN COMPETENCIES RECOMMENDATION FOR QUALITY AND SAFETY IMPROVEMENTS

24. American Nurses Association. (2010). Nursing scope and standards of practice. In.Silver Spring, MD: American Nurses Association Clymin, J., Jablonski, A., Jacobson, D., & Feldt, K. (2012). Washington state death with dignity act: A survey of nurses’ knowledge and implications for practice part 2. Journal of Hospice and Palliative Care, 14(2), 141-148. http://dx.doi.org/10.1097/NJH.0b013e31823cc77a Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P.,... Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55(3), 122-131. Darr, K. (n.d). Physician-assisted suicide: legal and ethical considerations. Journal of Health Law, 40(1). Retrieved from http://www.healthlawyers.org/Publications/Journal/Documents/Vol%2040%20Issue%201/Physician- Assisted%20Suicide-%20Legal%20and%20Ethical%20Considerations.pdf Gielen, J., Branden, S., & Broeckaert, B. (2009). Religion and nurses’ attitudes to euthanasia and physician assisted suicide. Nursing Ethics, 16(3), 303-318. http://dx.doi.org/10.1177/0969733009102692 Humphry, D. (2005). Tread Carefully When You Help to Die. Retrieved from http://www.assistedsuicide.org/suicide_laws.html McLeod-Sordjian, R. (2014). Death preparedness: A concept analysis. Journal of Advanced Nursing, 70(5), 1008-1019. http://dx.doi.org/10.1111/jan.12252 Merritt, M., & Procter, N. (2010). Conceptualizing the functional role of mental heath-liasion nurse in multi-morbidity, Using Peplau’s Nursing Theory. Contemporary Nursing, 34(2), 158-166. http://dx.doi.org/10.5172/conu.2010.34.2.158 Patricelli, K. (2014). Stages of Grief Models: Kubler-Ross. Retrieved from http://www.amhc.org/58-grief-bereavement- issues/article/8444-stage-of-grief-models-kubler-ross ProCon. (2012). Michigan Laws on Assisted Suicide. Retrieved from http://euthanasia.procon.org/view.resource.php?resourceID=5076 Robley, L. R. (2009). Reigniting the debate over assisted suicide. Nursing: Critical Care, 15-17. Retrieved from www.nursing2009criticalcare.com REFERENCES

26. What are the stages (1-5) in Elisabeth Kubler-Ross’s stage theory? NUMBER ONE

27. According to Hildegard Peplau, what are two roles of the nurse? NUMBER TWO

28. If a person is charged with assistance to the killing of an individual in Michigan, what is the maximum number of years they can spend in prison? NUMBER THREE

29. What is three months from today? NUMBER FOUR

30. In Oregon, what are two things that must be accomplished in order for someone to qualify for assisted suicide? NUMBER FIVE

31. What was the name of the documentary I showed? NUMBER SIX

32. What is one assumption of assisted suicide? NUMBER SEVEN

33. Name one risk of having no end-of-life planning? NUMBER EIGHT

34. What was the name of the patient in my root cause analysis? NUMBER NINE

35. What is the major difference between euthanasia and assisted suicide? NUMBER TEN