Assistance in dying: The nurse's experience

Little is known about how nurses understand and respond to patient requests for assistance in dying (AID). In this inquiry, AID included either assisted suicide or active euthanasia. This interpretive phenomenological study explored how nurses understood the meaning of a request for AID and determined their response. Ten nurses agreed to describe what that experience was like. Eight were women, all were Caucasian, middle-aged, well educated, and very experienced (ranging from 6--30 years). They worked in diverse settings: 4 in hospice home care, 3 cared for persons with AIDS, 2 worked in critical care, and one was an expert neurology nurse. Each participant was interviewed twice, the conversations were transcribed verbatim, and the texts were analyzed for themes. Four major themes that emerged from the text. Being Open to Hear and Hearing the Request described what it was like to actually hear such a request. Unlike the hospice nurses, the non-hospice participants considered this an uncommon experience in their professional lives. Interpreting and Responding to the Meaning of the Request described the steps nurses took to uncover what was really meant by the request. They frequently found that patients wanted help to experience a 'good' death---as defined by the patient. When describing interventions used to facilitate good deaths, they acknowledged occasions when death was hastened---often indirectly and unintentionally, and occasionally directly. Some nurses appealed to the principle of double effect for justification, but many struggled to explain how they distinguished morally acceptable instances of hastening death from those deemed unacceptable. Responding to Persistent Requests described a continuum of responses that included: refusal, respecting and not interfering with patient or family plans to hasten dying, and providing varying amounts and kinds of AID. Their responses were context-driven rather than rule-directed; they did not refer to the profession's position statements or code of ethics. They did not consult or collaborate with colleagues. Reflections included participants' thoughts about these experiences and speculation about future responses. Many described years of keeping silent because they feared professional or legal sanctions. Nurses must be prepared to respond to patient requests for AID.