A new occurrence in the health care field is the slow, steady legalization of physician-assisted death. Instances of individuals tired of waiting who take matters into their own hands appear in headlines every few months. Some of the most famous cases have sparked legalization processes in both Quebec and Oregon. Physician-assisted death is also a public conversation — countless sites host polls and threads of comments where civilians can share their thoughts on physicians, patients, and assisted death.
Only physicians, patients, and death.
None of the developing legislation, government recommendations, or health care authority policies acknowledge other members of the health care team. Nurses, social workers, and occupational and physical therapists have not been designated any sort of formal role in the process. This leaves the rest of the care team, such as RNs, in limbo. Physician-assisted death cannot be ignored, but where can we rightfully (and legally) participate?
Legislation currently exists to protect physicians from section 241(a) of Canada’s Criminal Code, which states, “Every one who counsels a person to commit suicide, whether suicide ensues or not, is guilty of an indictable offence and liable to imprisonment not exceeding fourteen years.” Nurses are personally liable under this section of the Code, which means that we cannot engage in any sort of dialogue regarding physician-assisted death with our patients for fear of violating the law. The College and Association of Registered Nurses of Alberta (CARNA) currently recommends that any inquiry or mention of physician-assisted death be referred to the physician.
One of the primary ethical and professional responsibilities of RNs is to provide complete, unbiased information to patients to enable them to make autonomous decisions. We engage in open, honest, therapeutic dialogue with patients from the moment they enter our care, and this is part of what makes nurses some of the most trusted healthcare professionals. RNs also provide care and support 24 hours a day, often making them the professional body in the room when a patient might be considering ending their life. It is detrimental to the patient’s trust in nurses and dismissive of the RN’s knowledge and competency to be forced to reply to an inquiry with, “I can’t talk about that with you. I’ll tell the physician to come by.”
RNs need a defined role throughout the entire process of physician-assisted death — we have valuable assessment skills and interview skills to complement the physicians, and the gift of time spent with patients that simply does not occur in the MD role. We may be the ones to notice that a patient doubts their decision, or the first health care professional approached with a request for more information regarding assisted death. RNs need the opportunity to advocate for, provide information to, and support their patients regarding all end-of-life options without fear of imprisonment.
The same protective legislation that exists for physicians needs to exist for registered nurses. Continuing education must be provided so that nurses are aware of the information patients and families will need, strategies for challenging conversation, and support for nurses experiencing moral distress and burnout. The care team is no longer just the physician.