Assisted suicide, recent judicial decisions, and implications for critical care nurses

1997 ◽  
Vol 17 (5) ◽  
pp. 71-79 ◽  
Author(s):  
GS Wlody
Keyword(s):  
Critical Care ◽  
Assisted Suicide ◽  
Healthcare Providers ◽  
Supreme Court Decision ◽  
The United States ◽  
Critical Care Nurses ◽  
Value Systems ◽  
Physician Assisted Suicide ◽  
Death With Dignity Act ◽  
The Individual

The passage of the Oregon Death With Dignity Act on November 8, 1994, heralded a wake-up call for healthcare professionals. Oregon, the first state to systematically "ration care" was thought to be a fertile ground for testing new and, some say, radical concepts in healthcare and government. Although the act was not implemented because it was tied up in legal action until February 1997, the fact that more than 50% of the voters in Oregon voted for it mandates that healthcare providers listen to their patients. Patients want more control of their pain, the way they die, and the resources spent on their care in the final days of their lives. Thoughts of future suffering engender great fear on the part of healthcare consumers. Concern exists that physician-assisted suicide in the ICU will affect not only physicians but also nurses, pharmacists, respiratory therapists, and other clinicians as terminally ill patients make requests for assisted suicide while in the acute and critical care setting of the hospital. Critical care nurses must examine their value systems, review the Code for Nurses, and make their own decisions about participation in deliberately ending lives of patients. With the impending Supreme Court decision due in July 1997, the court may leave these issues to the individual states, opening the door for assisted suicide to occur throughout the United States. Therefore, the possibility will remain that critical care nurses may be put in positions in which physicians are providing assistance to patients who wish to commit suicide and are requesting nurses' assistance to do so.

American Association Of Critical-Care Nurses’ National Survey of Facilities and Units Providing Critical Care

2006 ◽  
Vol 15 (1) ◽  
pp. 13-28 ◽  
Author(s):  
Karin T. Kirchhoff ◽  
Nancy Dahl
Keyword(s):  
Critical Care ◽  
Quality Indicators ◽  
American Association ◽  
Response Rate ◽  
Healthcare Providers ◽  
Initial Response ◽  
The United States ◽  
Critical Care Nurses ◽  
Second Phase ◽  
Critical Care Units

• Background Little information is available nationally about critical care units and nurses. What is known about nurses in hospitals is generally not broken down among all the specialties. • Objectives To describe issues of workforce, compensation, and care specific to critical care units and nurses who work in them. • Methods The American Association of Critical-Care Nurses conducted a survey of randomly selected facilities with critical care units in the United States. Facilities were solicited via e-mail to respond to a survey on the World Wide Web and provide information on operations, evaluations, nursing staff reimbursement and incentives, staffing, and quality indicators. Responding facilities also provided contact information for units in the facilities. Those units were surveyed about operations, acuity systems, staffing, policies on visitation and end-of-life care, administrative structure, documentation, certification, professional advancement, vacancy/floating, staff satisfaction, orientation, association membership, wages, advanced practice nursing, and quality indicators. • Results The initial response rate (120 of 658 eligible facilities) was 18.2%, and 300 of 576 solicited units nominated by the facilities responded, yielding a 52.1% response rate for the second phase. • Conclusions These survey data define the scope and intensity of services offered and provide more specific figures about staffing issues and unit practices than has been accessible before. Healthcare providers may use this information for benchmarking purposes, especially for instances in which the tables provide data for each particular type of critical care unit.

Oregon v. Ashcroft: The Battle over the Soul of Medicine

2003 ◽  
Vol 12 (3) ◽  
pp. 310-321 ◽  
Author(s):  
BEN A. RICH
Keyword(s):  
Assisted Suicide ◽  
The United States ◽  
Physician Assisted Suicide ◽  
Death With Dignity ◽  
War Of Attrition ◽  
Dying Patients ◽  
Medical Disputes ◽  
Aid In Dying ◽  
Death With Dignity Act ◽  
Dignity Act

When one considers the protracted and continuing struggle of the citizens of Oregon to include physician-assisted suicide (also known as “physician aid in dying”) among the panoply of measures available to dying patients and the physicians who care for them, the depth and breadth of the issue becomes inescapable. The potential intractability of the dispute is illustrated by the very fact, noted in the preceding parenthetical phrase, that consensus eludes us on even the most basic of semantic points—how we are to most aptly characterize the conduct in question? The case featured in this issue's The Caduceus in Court must be examined as the latest battle in a long war of attrition waged by opponents of physician-assisted suicide against the Oregon Death with Dignity Act (“the Oregon Act”). After briefly reviewing that history, I will then consider the details of Oregon v. Ashcroft and the implications of the litigation not only for the care of dying patients but also for the regulation of medical practice in the United States and, more broadly still, the search for resolution of serious medical disputes in a democratic society.

Rights Discourse and Assisted Suicide

2001 ◽  
Vol 27 (1) ◽  
pp. 45-99
Author(s):  
Penney Lewis
Keyword(s):  
United States ◽  
Assisted Suicide ◽  
Public Awareness ◽  
The United States ◽  
Medical Professionals ◽  
Physician Assisted Suicide ◽  
Criminal Trials ◽  
Supreme Courts ◽  
Rights Discourse ◽  
Law Professors

The debate surrounding the legalization of assisted suicide has been galvanized in recent years by reports of specific cases of assisted suicide, primarily involving physicians such as Kevorkian and Quill, and by impassioned pleas for legalization and assistance in suicide from individuals suffering in the throes of terminal or agonizing diseases, such as Sue Rodriguez. Media attention on criminal trials of individuals accused of assisting in a suicide has heightened public awareness of the issue. The constitutionality of criminal prohibitions on assisted suicide has been tested in various jurisdictions, and has recently been considered by the Supreme Courts of both the United States and Canada. Following two narrowly unsuccessful attempts to enact dignified death provisions by referenda in Washington and California, Oregon voters passed the first of such proposed laws in November 1994, providing for physician-assisted suicide under certain specified conditions. Attempts to introduce legislation to legalize assisted suicide in other jurisdictions have been galvanized by the success in Oregon. A model statute has been drafted by a group of law professors, philosophers and medical professionals.

The Practice of Euthanasia and Physician-Assisted Suicide in the United States

JAMA ◽  
1998 ◽  
Vol 280 (6) ◽  
pp. 507 ◽  
Author(s):  
Ezekiel J. Emanuel ◽  
Elisabeth R. Daniels ◽  
Diane L. Fairclough ◽  
Brian R. Clarridge
Keyword(s):  
United States ◽  
Assisted Suicide ◽  
The United States ◽  
Physician Assisted Suicide

AMA Reconsiders Opposition to Physician-Assisted Suicide

2016 ◽  
Vol 41 (10) ◽  
pp. 1-3
Author(s):  
Ralph A. Capone ◽  
Keyword(s):  
Annual Meeting ◽  
Assisted Suicide ◽  
Code Of Ethics ◽  
Medical Profession ◽  
Human Life ◽  
The United States ◽  
Physician Assisted Suicide ◽  
Judicial Affairs ◽  
Aid In Dying ◽  
Recent Edition

In 1847, the American Medical Association established the first professional code of ethics for physicians in the United States. Expanded over the years to meet the needs of the medical profession, its most recent edition, adopted in 2016, includes a statement of AMA principles of medical ethics and eleven sets of opinions on various topics. After 169 years of opposition to physician involvement in directly causing patients’ deaths, the AMA is considering a change in its position—a position that has always averred the sacredness of every human life, asserting that the physician’s role is to cure when possible, care always, and ultimately err on the side of protecting and preserving human life. Following its annual meeting this past June, the AMA House of Delegates recommended that the Council on Ethical and Judicial Affairs study aid-in-dying as an end-of- life option and report back at the annual meeting in 2017.

A national survey of critical care nurses' practices related to administration of neuromuscular blocking agents

2001 ◽  
Vol 10 (3) ◽  
pp. 139-145 ◽  
Author(s):  
JG Foster ◽  
SK Kish ◽  
CH Keenan
Keyword(s):  
Critical Care ◽  
Peripheral Nerve ◽  
The United States ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Critical Care Nurses ◽  
Blocking Agents ◽  
Care Facilities ◽  
Acute Care Facilities

BACKGROUND: Recommendations on use of neuromuscular blocking agents include using peripheral nerve stimulators to monitor depth of blockade and concomitantly administering sedatives and/or analgesics. OBJECTIVE: To evaluate critical care nurses' practices in administering neuromuscular blocking agents. METHODS: A 16-item survey was mailed to 483 acute care facilities in the United States. Of these, 246 surveys (51%) were returned and analyzed to determine use of neuromuscular blocking agents, peripheral nerve stimulators, sedatives, and analgesics. Logistic regression analysis was used to find independent predictors of use of peripheral nerve stimulators. RESULTS: Seventy-five percent of respondents reported long-term use of neuromuscular blocking agents in critically ill patients. Of those, 63% monitored the level of blockade with peripheral nerve stimulators. Reasons for not using peripheral nerve stimulators included unavailability of equipment (48%), lack of training (36%), and insufficient evidence that peripheral nerve stimulators improve care (23%). Predictors of use of stimulators were facilities with more than 150 beds (P < .001) and administration of neuromuscular blocking agents by continuous infusion (P < .001). Ninety-five percent of respondents reported using concurrent analgesics/sedatives always or most of the time. Facilities with fewer than 10 beds in the intensive care unit used concurrent analgesics/sedatives significantly less often than did facilities with 10 beds or more (90% vs 98%, respectively; P = .03). CONCLUSIONS: Small and large facilities differ in concomitant use of analgesics/sedatives and peripheral nerve stimulators. Education and research are needed to ensure that patients receive adequate monitoring and sedation during administration of neuromuscular blocking agents.

Novel Spanish Translators for Acute Care Nurses and Physicians: Usefulness and Effect on Practitioners’ Stress

2005 ◽  
Vol 14 (6) ◽  
pp. 545-550 ◽  
Author(s):  
Andrew C. Bernard ◽  
Audra Summers ◽  
Jennifer Thomas ◽  
Myrna Ray ◽  
Anna Rockich ◽  
...  
Keyword(s):  
Critical Care ◽  
Stress Reduction ◽  
Quality Care ◽  
Healthcare Providers ◽  
Critical Care Nurses ◽  
Survey Period ◽  
Acute Care Nurses ◽  
Quality Healthcare ◽  
Stress Levels ◽  
Nurses And Physicians

• Background Language barriers are significant impediments to providing quality healthcare, and increased stress levels among nurses and physicians are associated with these barriers. However, little evidence supports the usefulness of a translation tool specific to healthcare. • Objectives To evaluate the effectiveness of a novel English-Spanish translator designed specifically for nurses and physicians. The hypothesis was that the translator would be useful and that use of the translator would decrease stress levels among nurses and physicians caring for Spanish-speaking patients. • Methods Novel English-Spanish translators were developed entirely on the basis of input from critical care nurses and physicians. After 7 months of use, users completed surveys. Usefulness of the translator and stress levels among users were reported. • Results A total of 60% of nurses (n = 32) and 71% (n = 25) of physicians responded to the survey. A total of 96% of physicians and 97% of nurses considered the language barrier an impediment to delivering quality care. Nurses reported significantly more stress reduction than did physicians (P = .01). Most nurses and physicians had used the translator during the survey period. Overall, 91% of nurses and 72% of physicians found that the translator met their needs at the bedside some, most, or all of the time. All nurses thought that they most likely would use the translator in the future. • Conclusions The translator was useful for most critical care nurses and physicians surveyed. Healthcare providers, especially nurses, experienced decreased stress levels when they used the translator.

Safeguarding the Patient and the Profession: The Value of Critical Care Nurse Certification

2003 ◽  
Vol 12 (2) ◽  
pp. 154-164 ◽  
Author(s):  
◽  
Keyword(s):  
Critical Care ◽  
American Association ◽  
The United States ◽  
White Paper ◽  
Critical Care Nurses ◽  
Specialized Knowledge ◽  
Care Nurse ◽  
Call To Action ◽  
Knowledge And Skills ◽  
The Public

Today’s critically ill patients require heightened vigilance and extraordinarily intricate care. As skilled and responsible health professionals, the 403 000 critical care nurses in the United States must acquire the specialized knowledge and skills needed to provide this care and demonstrate their competence to the public, their employers, and their profession. Recognizing that nurses can validate specialty competence through certification, this white paper from the American Association of Critical-Care Nurses and the AACN Certification Corporation puts forth a call to action for all who can influence and will benefit from certified nurses’ contribution to patient care.

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