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Ethically speaking: Ease suffering without crossing the line

Recent court case
On Feb. 11, 2014, a judge dropped the felony assisted suicide charges against Barbara Mancini, a Pennsylvania nurse accused of handing her 93-year-old terminally ill father a nearly full bottle of legally prescribed morphine. The nurse reportedly told a police officer that her father wanted to die and she handed him the morphine, fulfilling his wish. A hospice nurse called 911 after Mancini’s father took the morphine. He was admitted to the hospital and died four days later. At issue is whether Mancini gave her father the morphine to relieve his pain or to help him commit suicide. The judge who dropped the assisted suicide charges believed there was insufficient evidence to support prosecution of Mancini. The case is making many family members and nurses think twice, fearing that even appropriately administering pain medication can land one in jail if the patient dies.

What the ANA and the Code of Ethics say:
On April 24, 2013, the American Nurses Association issued a combined position statement on euthanasia, assisted suicide and aid in dying. ANA prohibits nurses’ participation in assisted suicide and euthanasia because these acts are in direct violation of Code of Ethics for Nurses with Interpretive Statements, which elucidates the ethical traditions and goals of the profession and its covenant with society. Nurses have an obligation to provide humane, comprehensive and compassionate care that respects the rights of patients but upholds the standards of the profession in the presence of chronic, debilitating illness and at the end of life. Visit to read the complete statement.
Provision 1, Interpretive Statement 1.3 of the code speaks to the nurse’s commitment by stating, “The worth of the person is not affected by death, disability, functional status or proximity to death. This respect extends to all who require the services of the nurse for the promotion of health, the prevention of illness, the restoration of health, the alleviation of suffering and the provision of supportive care to those who are dying.”
In a succeeding paragraph, the statement goes on to say, “… nursing care is directed toward meeting the comprehensive needs of patients and their families across the continuum of care. This is particularly vital in the care of patients and families at the end of life to prevent and relieve the cascade of symptoms and suffering that are commonly associated with dying … Nurses may not act with the sole intent of ending a patient’s life even though such action may be motivated by compassion, respect for patient autonomy and quality of life considerations.”

Scenario 1

Your mother has end-stage diabetes, cardiovascular disease, stroke, renal disease and arthritis — all necessitating home hospice care.

You are surprised to see the quantity and type of meds supplied by hospice, including a large bottle of liquid morphine. Your dad looks exhausted from caring for your mother 24/7. She is alert but complaining of great pain. After your dad leaves the room, she asks you to please give her something that will finally put her to sleep and allow her to never wake up. No matter how much you might want to do as your mother asks to compassionately end her misery, you cannot administer or help her to ingest a lethal amount of morphine or other medication with the intent to end her life. You can speak with the hospice nurse about other pain management options or ask hospice to send a palliative care physician or nurse practitioner with whom you can consult about an improved continuous pain regimen, which might include palliative sedation.

Scenario 2

You have been working in a surgical ICU for three years and have spent many nights awake, worrying about patients on the unit.

This time, “Maria” is weighing heavily on your heart. A 29-year-old mother of 3-year-old twins, Maria had a liver and small bowel transplant nine months ago and is suffering with posttransplant lymphoproliferative disease. She clearly is end-stage, but her transplant surgeons are not giving up as demonstrated by their aggressive clinical treatment. She tells everyone she sees, including healthcare providers, that she is tired of fighting and wants to go home. Maria’s nurse today was a new grad, who at the end of the shift asked why we couldn’t just open her morphine drip and let it run until Maria felt no more distress. You patiently explain the difference between carefully titrating increasing doses of opioids in response to increased pain or tolerance and administering lethal doses with the intent to achieve relief by the death of the patient. You recommend that she consult with the palliative care MD/NP about comfort strategies.

To see what else is trending in pain management, visit


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By | 2014-03-20T00:00:00-04:00 March 20th, 2014|Categories: National|0 Comments

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