To Explore the Nurses’ Roles in Discouraging Palliative Patients from Euthanasia

Jose Cardentey Hernandez

Nursing Research and Evidence-Based-DL-MSN1

Nora Hernandez-Pupo

Sep 26, 2021


To Explore the Nurses’ Roles in Discouraging Palliative Patients from Euthanasia

Introduction to the Problem

The issue of dying with dignity and the right to die has been debated for decades. The

debate revolves around whether a person should be allowed to choose to die when they can

continue living at a diminished capacity or aid of life support. The debate is centered on the ethical

position of the medical intervention. One of the questions is whether the right to die is universal

and only applicable in palliative care. On an ethical basis, health professionals should adhere to

patient autonomy which questions euthanasia as a care intervention. Nurses in assisted death face

conflicting requirements from autonomy, maleficence, and non-maleficence. However, the concept

of freedom of expression exists where the dying patient has a right to make decisions regarding

their health.

Nurses play a vital role in caring for patients during their end of life compared to other

health care professionals (Dierckx de Castle, 2006). Technological advancement in healthcare has

facilitated quality of life and prolonged life. However, technological advancement has also led to

controversial debates on euthanasia (Berghs et al., 2005). According to Asai et al. (2019), the

attitudes towards the legality and the ethics of euthanasia has drastically changed in the last few

decades. This has led to the legalization of euthanasia in some countries, but the circumstances of

assisted suicide vary from one city to another.

The issue of cancer is a global issue, and it has increased the need for palliative care

services. Nurses provide care geared towards patient satisfaction. In palliative care, the nurses

work towards meeting cancer patients’ needs during the end of life care (Henson et al., 2016).

During the end of life, the patients and the family face challenges and must make choices that

benefit the patient. Wright et al. (2016) explain that choices during the end of life may have a


quality of life dimension where the nurse guides the patient and the carer to adapt to painful

realities and confront difficult situations.

Problem Statement

The practice of euthanasia involves medical procedures that end life to relieve the patients

suffering or pain. The concept of euthanasia is explained by the American Medical Association’s

Code of Medical Ethics (1997) as a process where a health professional facilitates a patient’s death

by providing the necessary means and information to enable the patient to perform the life-ending

act” (p. 56).

According to Gill (2019), there are different forms of euthanasia; passive, active, voluntary

and non-voluntary. On voluntary euthanasia, the patients request health professionals to die, while

non-voluntary involves death assistance in patients who cannot make requests like infants and

comatose patients. On active and passive euthanasia, passive procedures withhold life-sustaining

treatments while active is injected with lethal drugs. According to Gill (2019), the goal of

euthanasia is to relieve patients from unbearable pain and allow them to die with dignity. Although

cancer is a significant cause of palliative care, a rising number of patients like children and

neonates require palliative care. Some of the conditions resulting in palliative care include frailty,

dementia, learning disabilities, and seniors with multiple comorbidities.

Significance of the problem to Nursing

Although nurses spend more time with palliative patients and receive euthanasia requests,

their views on the procedure remain unclear. This creates a research gap and a need to conduct an

in-depth exploration of nurses’ attitudes and involvement in euthanasia decision making. The

responsibility of nurses in palliative care is to provide compassionate and comprehensive end of


life care. According to Weaver et al. (2018), the cost of caring for the palliative patient has a

financial impact and physical, emotional and psychological.

The caring process may negatively affect caregivers resulting in physical illness,

psychiatric illness, physiologic responses, impaired health habits, psychological distress or death.

Several factors influence the attitudes of nurses towards palliative care. For example, religion

views euthanasia as a practice that is against the value of human life. Such nurses may view the

practice as an unethical sanctioned choice hence discouraging euthanasia. Due to the varying

factors influencing the decision making of euthanasia in palliative care, there is a need to explore

the attitude of palliative nurses towards euthanasia.

Purpose of the Research

The purpose of the study is to describe and explore the attitude of palliative nurses towards


Research Questions

The primary research topic is; what is the attitude of nurses regarding voluntary euthanasia, and

should they encourage or discourage the process? The following specific research questions will

address this.

 What is palliative nurses’ attitude towards voluntary euthanasia?

 What are the ways in which palliative nurses wish to get involved involuntary euthanasia?

 What is the relationship between the demographic characteristics of palliative nurses and

their attitude towards voluntary euthanasia?

Master’s Essentials that aligned with your topic

The concept of euthanasia is in line to the World Health Organization definition of palliative care.

According to WHO, palliative care is,


“… an approach that improves the quality of life of patients and their families facing the problem

associated with life-threatening illness, through the prevention and relief of suffering by means of

early identification and impeccable assessment and treatment of pain and other problems,

physical, psychosocial and spiritual” (National Consensus Project for Quality Palliative Care,

2009, p. 8). Palliative care “affirms life and regards dying as a normal process” and “intends

neither to hasten nor postpone death” (Ferrell et al., 2018, p. 8).

Although euthanasia involves the prevention of suffering and relieving patients’ pain, it is

against the goal of nursing care, which is to promote quality of life. However, it is in line with

palliative care on providing care and support to help patients die with dignity (Cardiff University,

2014). Different professional organizations in nursing address the issue of euthanasia and the

clinical participation of health professionals. According to Cardiff University (2014), assisted

suicide is contrary to professional role integrity as it violates the social construct of health

professionals to the people. Besides, the procedure is contrary to the role of nurses and other health

professionals in promoting healing, creating a social risk.

A master’s in palliative care is to promote patient outcomes through quality palliative care

facilitated by quality improvement and research. The role of the course is patient care improvement

through the delivery of effective and accessible education. The goal is to help nurses to develop,

extend and share their understanding, knowledge and application of evidence to palliative care.

Other essentials include research evidence, challenges, frameworks, and core understanding that

develop and optimize palliative care and palliative medicine practice. It also assists students in

identifying significant issues in their practice and conducting evidence-based research (Cardiff

University, 2014). The goal is to attain vital information to the practice and knowledge of palliative

care and palliative medicine.




American Medical Association. (1997). American Medical Association. Code of Medical Ethics.

Asai, A., Ohnishi, M., Nagata, S. K., Tanida, N., & Yamazaki, Y. (2019). Doctors’ and nurses’

attitudes towards and experiences of voluntary euthanasia: survey of members of the

Japanese Association of Palliative Medicine. Journal of medical ethics, 27(5), 324-330.

Berghs, M., De Casterle, B. D., & Gastmans, C. (2005). The complexity of nurses’ attitudes toward

euthanasia: a review of the literature. Journal of Medical Ethics, 31(8), 441-446.

Cardiff University. (2014). Palliative Medicine for Health Care Professionals


medicine-for-health-care-professionals-msc-part-time. Cardiff University. Retrieved 26

September 2021, from


Dierckx de Casterle, B. (2006). Nurses’ views on their involvement in euthanasia: a qualitative

study in Flanders (Belgium). Journal Of Medical Ethics, 32(4), 187-192.

Ferrell, B. R., Twaddle, M. L., Melnick, A., & Meier, D. E. (2018). National consensus project

clinical practice guidelines for quality palliative care guidelines. Journal of palliative

medicine, 21(12), 1684-1689.

Gill, B. (2019). Euthanasia and Nurses Role in It. IRIS.


Henson, L. A., Gomes, B., Koffman, J., Daveson, B. A., Higginson, I. J., & Gao, W. (2016).

Factors associated with aggressive end of life cancer care. Supportive Care in

Cancer, 24(3), 1079-1089.

Weaver, M. S., Wichman, B., Bace, S., Schroeder, D., Vail, C., Wichman, C., & Macfadyen, A.

(2018). Measuring the impact of the home health nursing shortage on family caregivers of

children receiving palliative care. Journal of Hospice and Palliative Nursing, 20(3), 260.

Wright, A. A., Keating, N. L., Ayanian, J. Z., Chrischilles, E. A., Kahn, K. L., Ritchie, C. S., … &

Landrum, M. B. (2016). Family perspectives on aggressive cancer care near the end of

life. Jama, 315(3), 284-292.

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