Understanding and responding to patients' requests for assistance in dying.
OBJECTIVE
To explore how nurses experience and respond to patients' requests for assistance in dying (AID).


METHODS
A phenomenological study of 10 self-selected nurses.


RESULTS
Four major themes: Being Open to Hear and Hearing; Interpreting and Responding to the Meaning; Responding to Persistent Requests for AID, and Reflections. When faced with persistent requests for AID, participants provided a continuum of interventions: refusal, providing palliative care that might secondarily hasten dying, respecting and not interfering with patients' or families' plans to hasten dying, and providing varying types and degrees of direct AID. Their responses were context-driven rather than rule-mandated, and they drew a distinction between secondarily hastening and directly causing death.


CONCLUSIONS
Few nurses in this study unequivocally agreed or refused to directly help a patient die. Most struggled alone and in silence to find a morally and legally acceptable way to help patients who persisted in requesting AID. Regardless of how they responded, many described feelings of conflict, guilt, and moral distress.
Schwarz
Judith Kennedy
JK
New York University, New York, USA. Judschwarz@rcn.com
D001291:Attitude of Health Personnel; D001293:Attitude to Death; D003220:Conflict, Psychological; D034723:Double Effect Principle; D005260:Female; D006167:Guilt; D006379:Helping Behavior; D006801:Humans; D008297:Male; D016743:Mental Competency; D009014:Morals; D020380:Needs Assessment; D024802:Nurse's Role; D009723:Nurse-Patient Relations / Q000941:ethics; D009730:Nursing Assessment; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000523:psychology*; D009859:Oncology Nursing / Q000941:ethics / Q000379:methods*; D028662:Principle-Based Ethics; D017236:Suicide, Assisted / Q000941:ethics / Q000523:psychology*; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000941:ethics / Q000379:methods / Q000523:psychology*; D019452:Terminally Ill / Q000523:psychology; D014481:United States