Faculty Member: Elizabeth Peter

Physician-assisted suicide could affect nursing practice

18 March 2015

On February 6, 2015, the Supreme Court of Canada ruled that patients in desperate suffering have the right to physician-assisted suicide. This decision strikes down a ruling from 1993, where the Supreme Court upheld the criminality of physician-assisted suicide in the widely publicized case involving Sue Rodriguez, an ALS sufferer who sought permission to die with dignity. Rodriguez committed suicide with the assistance of a physician in early 1994 – while police conducted an investigation, no charges were laid.

Discussion around right-to-die legislation has been a hot topic since the Rodriguez case, and even for decades prior. Bodies such as the Canadian Medical Association have weighed in on the ethics of physician-assisted suicide, prohibiting members from performing the act in 2007. Disabled advocates have also rallied on both sides of the argument. A landmark ruling such as this one affects more than just physicians and patients, impacting families, and every member of a patient health care team.

We sat down with Associate Professor Elizabeth Peter, chair of the Health Sciences Research Ethics Board at U of T, to learn about the ethics of this new legislation, and some of the potential impacts on the nursing profession.

Much of the discussion on right-to-die legislation has centred on physicians and patients, but what role could nurses have with physician assisted suicide?

Nurses have long valued their role as patient advocates. As such, nurses are often the voice of patients not only in terms of their wishes for treatment, but also in terms of preserving their identities as people with a history of values, relationships and pursuits. This role places nurses in and among patients, their families and other healthcare providers and in some instances, positions nurses to advocate for system change.

In terms, of physician-assisted suicide, nurses could find themselves in these complex relationships negotiating for what they believe is best for patients. There will not always be agreement among all parties and nor will there always be the needed policies and resources present to enact patients’ choices. These challenges could call on nurses to strengthen their advocacy skills and to be clear about their professional and personal values.

What are some of the ethical challenges that physician-assisted suicide could present for nurses?

If additional legislation is developed making physician-assisted suicide legal in Ontario, the profession and individual nurses themselves will face a number of ethical challenges. First, many argue for religious and philosophical reasons that this practice amounts to killing and, therefore, is unequivocally wrong. Second, many have voiced concern that physician-assisted suicide will result in the devaluation of people with disabilities and serious illnesses, because it may imply that their lives are not worth living. Third, concern also has been expressed regarding the potential for misuse of this practice, allowing for the euthanasia of people who are incapable of consent. Given the contentious nature of this practice, provisions will need to be made for the conscientious objection of nurses, much in the same way that they have been made for abortion.

This legislation could potentially impact how we educate nurses as well, yes?

Absolutely. The legal and ethical dimensions of physician-assisted suicide will need to be examined by students so that they can be fully knowledgeable and determine where they stand on the issues surrounding this practice before they find themselves in the midst of a practice situation that demands that they are clear on their values and their practice expectations.

As nurses we will also have to anticipate that future nurses could have a greater role in this practice than is currently anticipated. Nurses’ scope of practice is continually expanding and, therefore, it would not come as a surprise that in ten years nurse practitioners would be authorized to perform this practice or that other nurses would be delegated to do so.  Ultimately, much discussion and reflection will be needed by nurses for us to consider how we will practice ethically given any future legislation.

– with files from Dying with Dignity Canada. Dave Ross is a writer with the Lawrence Bloomberg Faculty of Nursing.