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Definition of assisted death/death with dignity:

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Definition of assisted death/death with dignity:

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Assisted death, also known as death with dignity, refers to an end-of-life option governed by state legislation that allows certain people who are terminally ill, and mentally competent to voluntarily and legally request and obtain medications from their healthcare provider to end their life in a peaceful, humane, and dignified manner (Downie et al., 2022).

Assisted dying proponents focus on respect for autonomy, self-determination, and forestalling suffering (Downie et al., 2022).

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Why is assisted death a contemporary healthcare issue?

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Why is assisted death a contemporary healthcare issue?

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Assisted death is a highly controversial moral healthcare issue in many countries due to ethical, legal, political, religious, and practical complexities.

Assisted dying is an emotionally and ethically challenging subject, which understandably receives varying degrees of acceptance among different global jurisdictions.

Discussion regarding withholding or withdrawing treatment and requesting assisted death has emerged in association with the simultaneous expansion of palliative care across the world.

It is currently legal in different forms and with varying levels of accessibility in Austria, Belgium, Canada, Columbia, Germany, Italy, Luxembourg, the Netherlands, New Zealand, Portugal, Spain, Switzerland, and parts of Australia and the United States (West et al., 2024).

Elsewhere in the world (United Kingdom, Scotland) assisted death remains illegal and can be considered under criminal laws of murder, prosecutable through various legal routes (Dige et al., 2022).

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What is the problem, situation, or concern?

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What is the problem, situation, or concern?

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Part of the problem is the ethical complexity surrounding assisted dying, which often leads to a lack of acceptance among physicians, healthcare systems, and lawmakers.

Physician-assisted dying refers to a physician adding a person to die by providing medications for self-administration so the patient may end their own life. This is in contrast to euthanasia, which refers to a physician (or nurse) administering medication to end the patient’s life. Assisted dying is a general term that incorporates both physician-assisted dying and voluntary active euthanasia (West et al., 2024).

Advances in both life-prolonging treatments and palliative care in recent years are inextricably intertwined with this complex topic, resulting in the continuing demand for amendments to current legislation.

Nurses and healthcare professionals must inform themselves about the ethical principles that support its relevance and validity (West et al., 2024).

There are concerns about patient autonomy and its impact on the medical profession.

It raises questions about the role of healthcare providers in end-of-life decisions and the balance between respecting a patient’s wishes and upholding the sanctity of life (Downie et al., 2022).

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Who is directly affected? (How, where, when, why)

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Who is directly affected? (How, where, when, why)

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1. The individual requesting the procedure and their immediate family or caregivers are directly affected

2. The medical professionals involved in the process (doctor, nurse)

How:

The person choosing assisted death is the primary focus, but their decision also impacts the relationships they have with those closest to them.

Doctors and nurses involved in providing assisted death may face ethical and emotional challenges

Where

It is currently legal in different forms and with varying levels of accessibility in Austria, Belgium, Canada, Columbia, Germany, Italy, Luxembourg, the Netherlands, New Zealand, Portugal, Spain, Switzerland, and parts of Australia (West et al., 2024).

As of 2025, 10 States of the United States and Washington, D.C. have legalized assisted dying, including California, Colorado, Hawaii, Maine, Montana, New Jersey, New Mexico, Oregon, Vermont, and Washington (West et al., 2024).

When

It has expanded significantly around the world over the past 20 years

The number of people with access increased to over 200 million (Mroz et al., 2021)

Why

The person making the request is the most direct beneficiary of assisted death, seeking to alleviate suffering and gain control over their end-of-life process.

Close family members and caregivers may experience a range of emotions (grief, relief, ethical dilemmas) as they navigate the decision-making process.

Doctors and nurses involved in providing assisted death may face ethical and emotional challenges (feelings of guilt, and discomfort).

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Examine the nurses' current roles and participation regarding the issue

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Examine the nurses' current roles and participation regarding the issue

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There is a significant need for ongoing opportunities for nurses to speak openly and process their experiences with assisted dying (West et al., 2024).

Nurses are ethically obligated to support patients, families, and the healthcare team during end-of-life conversations, provide objective information about options, and ensure patients receive appropriate palliative and hospice care (West et al., 2024).

They also play a crucial role in assessing the context of a request for aid-in-dying, considering factors like treatable depression or potential coercion (ANA, 2019).

Nurses must be comfortable supporting patients with end-of-life conversations, assessing the context of medical aid in dying requests (e.g., concern about treatable depression or coercion), advocating optimized palliative and hospice care services, and knowing about aid-in-dying laws and how those affect practice (ANA, 2019).

Protect the confidentiality of the patient who chooses medical aid in dying (ANA, 2019).

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Explain why the nurse's involvement is important

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Explain why the nurse's involvement is important

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Studies show that nurses involved in assisted dying see it as an important and appropriate addition to their scope of practice and that nurses play a central role in the navigation and provision of end-of-life care (West et al., 2024).

Understanding the ethical foundation of assisted dying could potentially enable nurses to better serve their patients and communities, as well as improve and advance the nursing profession (West et al., 2024).

Providers and nurses must better understand and appreciate the intersections of hope, futility, and potentially ineffective treatments to help patients and families understand their options during end-of-life care (West et al., 2024).

Increased awareness and education could potentially help patients and families make informed end-of-life decisions and avoid unnecessary pain and suffering (West et al., 2024).

If administered without proper safeguards, assisted dying could violate the principles of autonomy, justice, beneficence, and non-maleficence, but nurses who understand these risks can advocate for policies that will act as safeguards while promoting equity in assisted dying (West et al., 2024).

Nurses can also help to mitigate the ethical risks posed by assisted dying (West et al., 2024).

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What are the challenges or barriers to nurse involvement in the issue?

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What are the challenges or barriers to nurse involvement in the issue?

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Nurses face ethical problems in end-of-life care. It is important to know the nurses’ attitudes and perceptions toward death and dying with dignity in the healthy execution of this care (Can Özdemi̇r et al., 2024).

In the current healthcare system focused on saving lives, nurses have difficulty talking about death-related issues and are faced with a dilemma between saving lives and supporting “good death.” (Can Özdemi̇r et al., 2024).

Nurses may experience difficulty maintaining a therapeutic relationship with patients who are seeking assisted death, particularly if they have personal reservations about the practice (Can Özdemi̇r et al., 2024).

This can lead to a diminished sense of trust and empathy because of the impact on the nurse-patient relationship (Can Özdemi̇r et al., 2024).

The nurse may experience feelings of sadness, grief, or a sense of failure, especially if they have a close relationship with the patient because of the emotional impact on nurses (Can Özdemi̇r et al., 2024).

Nurses who are involved in assisted death may experience a shift in their professional identity as they move beyond their traditional role of preserving life because of the impact on professional identity (Can Özdemi̇r et al., 2024).

Furthermore, end-of-life care is emotionally taxing work that can have profound psychological and emotional impacts on nurses (West et al., 2024).

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PICO(T) question: In terminally ill patients with a prognosis of 6 months or less (P). How does the provision of physician-assisted death (I) compare with standard end-of-life care (C) impact patient autonomy and control over their dying process (O) over 6 months (T)?

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Equipped with an understanding of the ethical principles of autonomy, justice, beneficence, and non‐maleficence, nurses and other healthcare professionals can begin to engage in informed, nuanced conversations about assisted dying (West et al., 2024).

This treatment option has the potential to benefit patients by enabling them to fully exercise their autonomy, while also experiencing beneficence from their providers. However, it is crucial to implement robust safeguards to ensure the equitable provision of assisted dying (West et al., 2024).

Providers and nurses must better understand and appreciate the intersections of hope, futility, and potentially ineffective treatments to help patients and families understand their options during end‐of‐life care (West et al., 2024).

Healthcare leaders must establish opportunities for clinicians to reflect on and process their experiences with assisted dying (West et al., 2024).

If these provisions are in place, assisted dying can become a standard, evidence‐based addition to the continuum of care around the world (West et al., 2024).

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What nurses must understand about the ethics of assisted dying

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A Journal of Medicine and Philosophy, 2022, 47, 101-710

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A Journal of Medicine and Philosophy, 2022, 47, 101-710

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Judging a situation undignified or an affront to dignity does not imply any graduation of the dignified status of the person in question (on the contrary, it must be presupposed) (Dige et al., 2022)

The main aim of a principle of respect for dignity is not to issue an absolute prohibition of assisted death (AD). Its main purpose is to remind us of what is at stake in such decisions and the kind of attitude with which we should approach them (Dige et al., 2022)

The protection of “humanity in the person” is a central concern, but we should not understand this in exclusively rationalistic terms. What is at stake in AD scenarios is just as much a person’s capacity for loving relations, creativity, hopes, and imagination (Dige et al., 2022)

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Assisted Death, Dignity, and respect for Humanity

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Annals of Palliative Medicine, Vol 10, No 3 March 2021

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Annals of Palliative Medicine, Vol 10, No 3 March 2021

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Many countries are currently grappling with issues related to end-of-life care and new assisted-dying legislation has been proposed in a variety of jurisdictions throughout (Mroz et al., 2021).

As access to assisted dying increases, the need for additional research into the impacts on patients, physicians, healthcare systems, and communities is ever more relevant and pressing, as is the careful monitoring of adherence to substantive and procedural safeguards (Mroz et al., 2021).

Ongoing examination of the impact of new and expanded assisted dying legislation on members of vulnerable groups, such as those with psychiatric illness and minors, will be of particular importance (Mroz et al., 2021).

With demographic, cultural, and societal trends worldwide leading to increased debate about autonomy and self-determination at the end of life, assisted dying will continue to grow as a critical public health issue (Mroz et al., 2021).

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1. Downie, J., Gupta, M., Cavalli, S., & Blouin, S. (2022). Assistance in dying: A comparative look at legal definitions. Death Studies, 46(7), 1547–1556. https://doi.org/10.1080/07481187.2021.1926631

2. West, E. D., & Ricks, T. N. (2024). What nurses must understand about the ethics of assisted dying. Nursing open, 11(3), e2129. https://doi.org/10.1002/nop2.2129

3. Dige, M. (2022). Assisted Death, Dignity, and Respect for Humanity. The Journal of Medicine and Philosophy, 47(6), 701–710. https://doi.org/10.1093/jmp/jhac024

4. Mroz, S., Dierickx, S., Deliens, L., Cohen, J., & Chambaere, K. (2021). Assisted dying around the world: a status quaestionis. Annals of Palliative Medicine, 10(3), 3540–3553. https://doi.org/10.21037/apm-20-637

5. Can Özdemi̇r, R., Işik, M. T., Dogan, H., & Erden Ertürk, S. (2024). Intensive Care Nurses’ Anxiety About COVID-19, Approaches to and Attitudes Toward Dying with Dignity Principles During the Pandemic. Omega: Journal of Death & Dying, 89(3), 916–930. https://doi.org/10.1177/00302228221087505

6. ANA Position Statement: The Nurse’s Role When a Patient Requests Medical Aid in Dying. (2019). Online Journal of Issues in Nursing, 24(3), N.PAG. https://doi.org/10.3912/OJIN.Vol24No03PoSCol02

7. Nacak, U. A., & Erden, Y. (2022). End-of-Life Care and Nurse's Roles. The Eurasian journal of medicine, 54(Suppl1), 141–144. https://doi.org/10.5152/eurasianjmed.2022.22324

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Develop clear and comprehensive policies that outline the nursing role in assisted death, including their responsibilities, limitations, and ethical considerations (West et al., 2024).

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Nurses need comprehensive training on the laws, regulations, and ethical principles surrounding assisted death in their jurisdiction, including distinctions between medical aid in dying and euthanasia (West et al., 2024).

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Nurses should be experts in pain and symptom management to ensure that physical distress is not a factor in a request for assisted death, and they need to understand the importance of palliative care (Nacak et al., 2022).

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Nurses, particularly those in leadership, can advocate for improved end-of-life care, foster open communication about dying, and ensure that policies are in place to support patients' wishes and rights (West et al., 2024).

Leadership can also play a crucial role in educating and supporting nurses on the ethical and practical aspects of assisted dying, promoting a culture of respect and compassion at the end of life (West et al., 2024).

Leaders can provide support and guidance to nurses who are facing ethical dilemmas related to assisted dying, recognizing that it can be a challenging and emotionally difficult experience (West et al., 2024).

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Leadership can promote advocacy for patient rights and ensure that patient's wishes and preferences are respected, even when they differ from those of healthcare providers or families (West et al., 2024).

Foster a culture of compassion and respect for patients and families with dignity at the end of life.