Proponents of assisted suicide have been so successful in decriminalizing it that, today, one in five Americans lives in a jurisdiction that allows the practice. Proponents want doctors’ and nurses’ professional associations to reject the Hippocratic oath’s command to “do no harm” in favor of making suicide just one more therapeutic option for sick or despairing terminally ill patients.
The American Nurses Association, whose venerable pedigree dates back to 1896, is the latest group to consider abandoning its traditional opposition to assisted suicide. A change in the ANA’s longstanding opposition to assisted suicide would rock the entire healthcare profession in the United States. It would also have enormous consequences for all Americans, given this organization’s lobbying power and prestige.
The ANA recently proposed a draft statement titled “The Nurse’s Role When a Patient Requests Aid in Dying” that would drop its 123-year-old opposition to assisted suicide.
It’s telling that the word “suicide,” with all its dark connotations, appears nowhere in the document. “Aid in dying,” a euphemism right out of the assisted suicide lobby’s playbook, replaces it. The draft statement’s authors blithely skirt the extraordinary reversal of age-old medical ethics and laws against helping patients act on suicidal ideations. Instead, the authors assert that patient self-determination is a nurse’s primary concern and a nurse’s response to his or her patient should be “non-judgmental” and affirming, even when a patient is bent on self-destruction.
The authors of the ANA draft statement state this even though they acknowledge later in the document that the vast majority of terminally ill patients turn to suicide out of fear — fear that their diagnosis will rob them of their autonomy, their dignity, their ability to participate in the things they enjoy. The statement’s authors even admit that these are all concerns that hospice nursing is designed to address, and that hospice nurses do address them with great competence each day.
In fact, end-of life palliative care is effective at reducing a patient’s pain and physical distress, and the tender attention of a good nurse can create an atmosphere of calm and acceptance even in the most tragic sickrooms.
The authors add that they are opposed to euthanasia — though in taking this stand, they disregard their aforementioned principles of patient self-determination and being strictly nonjudgmental. They’re firmly opposed (for now, at least) to the direct killing of their patients. “Euthanasia is inconsistent with the core commitments of the nursing profession,” they write, “and profoundly violates public trust.”
That’s still the right position, yet in practice there is no real moral distinction between euthanasia and assisting in a suicide. In euthanasia, a nurse administers the fatal poison, placing the pills in her patient’s mouth or injecting the drugs into the willing victim’s bloodstream. In assisted suicide or “aid in dying,” a nurse would hand the patient the pills and watch as he or she swallows them. In the first instance, the nurse commits the fatal act. In the second instance, she is the accomplice. Morally, both acts are repugnant.
The ANA’s past statements on euthanasia and assisted suicide were spot-on. They prohibited assisted suicide, whether direct or indirect, “because these acts are in direct violation of [the] Code of Ethics for Nurses…ethical traditions and goals of the profession and its covenant with society.”
Anyone who has ever benefited from the warm attention of a competent and tender nurse — anyone who has watched in gratitude as a hospice nurse helped a family through the difficult process of natural death — understands the value of this covenant. It’s a promise to accompany and comfort. It’s a tradition of nursing, a noble tradition, that the American Nurses Association should preserve, even as activists fight to make assisted suicide just another therapy for those who suffer and despair.
Dr. Grazie Pozo Christie is a Policy Advisor for the Catholic Association.
