ONS States Position on Patients Requesting Assisted Suicide

PITTSBURGH—In 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 assisted suicide.

 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 found.

 Nurses should not use judgmental language in the presence of the patient, family, significant others, and professional colleagues.

 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 customer.service@ons.org.