NURS 4420 – Senior Seminar

Date of discussion: March 3, 2015
Students leading discussion: Tumu Asuao, Yana Stepanova
Discussion topic: Physician Assisted Suicide vs. End of Life Sedation

Importance/impact of discussion topic on professional nursing practice and healthcare:
Many deaths are preceded by a decision to limit the use of medical technologies. That is true for the patients who rather stay home then spend final days in the hospital. And, it is also true for the patients in ICU where the inevitable event happen after the decision to withdraw or withhold the life support occur. The decision is usually made when the cure or survival with a good quality of life is no longer possible. Clinicians and the patients' significant others usually worry that medications used to treat pain at the end of the life might also accelerate death. Intentionally hastening death is neither ethical nor legal. However, there are the cases when the use of medical technology is limited or discontinued and it is still unclear where the line is drawn between controlling symptoms and expediting death.
In the 1990’s, Dr. Jack Kevorkian, a proponent of the Physician Assisted Suicide (PAS), raised important questions about care of the terminally ill and their right to die with dignity (Friend, 2011). PAS, a controversial end of life practice, involves a physician, at the request of the patient, providing a lethal dose of medication to the patient to self-administer (Raus, Sterckx, & Mortier, 2011). Another controversial and relatively new end of life practice is a form of euthanasia called continuous sedation (CS). It may also be referred to as Palliative Sedation (PS). In this practice, the physician uses sedatives to reduce or take away the consciousness of the patient in anticipation of imminent death. This practice received much attention when a U.S. Supreme Court ruling noted that the availability of CS made legalization of physician-assisted suicide (PAS) unnecessary, as CS could alleviate even the most severe suffering (Raus et al, 2011). The clinical and ethical question becomes, what is the best option for a dying patient?
Many doctors hesitate to give dying patients adequate pain relief because of the fear that high doses of painkillers such as morphine will cause respiratory depression and/or death. It is both legal and ethical for physicians to administer drugs such as opiates and benzodiazepines to treat suffering, even if death may be hastened, but it has to be under the intent that the physician is relieving symptoms and not shortening life (Goldstein, Cohen, Arnold, Goy, Arons & Ganzini, 2012).
Continuous or Palliative Sedation is considered an acceptable and effective treatment for dying patients with refractory symptoms, which are those that cannot be adequately controlled despite aggressive efforts to identify a tolerable therapy that does not compromise consciousness (Patel, Gorawara-Bhat, Levine, & Shega, 2012). This type of therapy is available in hospice care settings but not universally available where most patients in the United States die, hospitals. One of the barriers to using this end-of-life therapy is the lack of standardized policy that ensures appropriate use and optimal patient care and safety across care settings (Patel et al, 2012)
The ethical considerations in the subject of end-of-life decisions on the part of the patient as well as the Power of Attorney (POA) are too many to count. In considering assisted suicide