title: Nurses' involvement in the care of patients requesting euthanasia: a review of the literature.
abstract: OBJECTIVE
  The aim of this paper is to thoroughly examine the involvement and experiences of nurses in the care of mentally competent, adult patients requesting euthanasia (i.e. administration of lethal drugs by someone other than the person concerned with the explicit intention of ending a patient's life, at the latter's explicit request) by means of a literature review.
  
  
  METHODS
  A keyword search was used to identify relevant journal articles and books published between 1990 and 2007. Manual searches of review article bibliographies were also conducted as well as searches of archives and collections of key journals.
  
  
  METHODS
  The electronic databases Medline, Cinahl, PsycINFO, The Cochrane Library, Social Sciences Citation Index, and Invert were searched using a combination of keywords and carefully constructed inclusion criteria.
  
  
  METHODS
  Forty-two publications of empirical research were identified and included in the present study after critical appraisal. The included publications represented 35 separated studies (20 quantitative, 11 qualitative and 4 mixed-method publications) and 28 different research samples.
  
  
  RESULTS
  Analysis of these studies revealed that nurses across diverse geographic and clinical settings play a major role in caring for and showing a personal interest in patients requesting euthanasia. The nurses' feelings about euthanasia and their involvement are extremely complex. Descriptions of personal conflict, moral uncertainty, frustration, fear, secrecy,and guilt appear to reflect a complex array of personal and professional values as well as social, religious, and legal rules.
  
  
  CONCLUSIONS
  Nurses can make a significant contribution to the quality of care by assisting and counseling patients and their families, physicians, and their nursing colleagues in a professional manner, even in countries where euthanasia is not legal. However, research on nurses' involvement in euthanasia has methodological and terminological problems,leading to our recommendation for more carefully designed qualitative studies that explore in-depth the experiences of nurses in caring for patients requesting euthanasia.
authors.affiliation: Centre for Health Services and Nursing Research, Faculty of Medicine, Catholic University of Leuven, Kapucijnenvoer 35/4, 3000 Leuven, Belgium. neledebal@hotmail.com
authors.forename: Nele
authors.initials: N
authors.lastname: De Bal
authors.forename: Chris
authors.initials: C
authors.lastname: Gastmans
authors.forename: Bernadette
authors.initials: B
authors.lastname: Dierckx de Casterlè
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003220:Conflict, Psychological; D005065:Euthanasia / Q000941:ethics / Q000331:legislation & jurisprudence / Q000523:psychology; D005239:Fear; D005639:Frustration; D006167:Guilt; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016743:Mental Competency; D009014:Morals; D024802:Nurse's Role / Q000523:psychology; D015399:Nursing Research / Q000458:organization & administration*; D010344:Patient Advocacy / Q000941:ethics / Q000331:legislation & jurisprudence / Q000523:psychology; D010687:Philosophy, Nursing; D036301:Qualitative Research; D012107:Research Design; D035501:Uncertainty