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ADVANCE Perspective: Nurses

Assisted Suicide: What If It Were Me?

Published June 23, 2010 12:26 PM by Chuck Holt

I recently edited a compelling article on physician-assisted suicide (PAS) written by Lisa Siminski, BSN, RN, CHPN, staff nurse, St. Luke's Hospice House, Bethlehem, PA.  

In her report on PAS, Siminski points out straight away that the American Nurses Association Code of Ethics for Nurses "clearly specifies that nurses should not deliberately terminate the life of any person." 

I can and do totally respect that.

I'm relived even, as I fully expect to be a patient in need of skilled nursing care in the future - perhaps sooner than later if the economy doesn't turn around - and want all nurses everywhere (and especially in southwest Florida where I live) to understand how much I appreciate and support ANA's position.

But I digress.

The day after the article posted on our website, I saw a report on a local TV news program about controversy surrounding a new billboard going up along Interstate 75, just north of us down here in Ft. Myers. 

The billboard reads: "My Life. My Death. My Choice."

It's being paid for by an outfit called the Final Exit Network or FEN for short. 

According to the report, in the past 5 years FEN has obliged 130 individuals in the U.S. who availed themselves of their services, which largely amounts to advice on available options, advanced directives and other information, such as which states have legalized PAS, as detailed in Siminski's report. Unlike PAS, FEN members have "no active participation" in the death of client, said a spokesperson.

The Catholic Church, for one, doesn't like the billboard or the very idea of the Final Exit Network for that matter, according to the news report I saw. Therefore neither would my elderly Irish-Catholic mother. And like it or not, those things matter in shaping my opinion on this issue. So sue me.

Perhaps above all else though, as an American, I cherish my freedom - and yours, too. And so I tend to think a person has a right to choose what they want to do with their body. Does that extend to people who intentionally harm themselves for any reason? Maybe.

But is choosing suicide to end immense physical suffering and intractable pain from injury or terminal illness necessarily harming one's self?

I really don't know, to be perfectly honest, and I would appreciate your insight and hearing about your experiences with this issue both as a nurse and an individual.

Seems I just end up asking myself, "What if it were me?"


You have written a very thoughtful article. I would like to suggest a response to your questions. The problem with the billboard signs, or any public policy allowing assisted suicide, is that it changes the way society thinks and behaves. What was once an unheard of idea, becomes a little less problamatic in people's minds, then a little less, then even neutral, and then acceptable, and finally demandable. At that point, "choice" is no longer an option for the patient. Instead, the patient has to defend his or her right to live. So who's choice are we really defending - the patients - or the "others" who will be burdened by the patient?

air jordan, October 20, 2010 2:27 AM
asasg AE

Listen up, People.  NO ONE has the right to inflict pain and suffering on anyone.  That is exactly what you are doing when you prolong the life of someone who is in constant pain and has no chance of improvement.  YOU are NOT a don't represent GOD...who is suppose to be merciful, by the way...and what you are actually doing is torturing that person.  And you call yourself Christians?  It is pure selfishness on the part of anyone who refuses to let a person die with dignity and grace when that person can no longer stand being alive.  Thank GOD for FEN.  I definitely intend to join it when I get closer to the need for it and am grateful of their existence.  

Al Calvert August 23, 2010 12:34 PM
Franklin TN

 I appreciate the article. I am in intractable pain and have been for over seven years. My life was "saved" by an emergency operation and cancer treatment, but I was left partially paralyzed and in constant pain. All movement for me is painful, including typing this response. I was grateful for the years I was given by modern medicine, but now I am afraid of the years I have left. It all became too much about five months ago and now I mostly sit in the house and worry. I can barely take minimal care of myself and am putting terrible stress on my wife. What if I get worse which I inevitably will? Having a means to an assisted death would take away so much of the stress that I am going through, stress that is adding more pain to my current condition and damaging my health even more. I am sick from this worry, physically sick. As others pointed out, animals do not have to suffer this way. Oregon law is such that assisted dying must be requested several times by the patient. I see no slippery slope. The billboard may be much, but our society needs a big push to address such issues. I feel trapped inside this deteriorating body and must wait in pain and fear until another system failure will bring me to the end of life. I am miserable and will be for who knows how long. Each day is terribly long and difficult to get through. This is not an academic argument. It exists minute by minute each and every day. I hope you can understand. Thank you for this forum and the chance to respond.

Gary August 4, 2010 3:55 PM

Sheba, I really like your response and totally agree!

Brenda, surgery - RNFA July 23, 2010 7:19 AM
Fredericksburg TX

Thank you for your article. I know this is a very controversial issue.

I would not intentionally harm anyone. But now we need to define harm. I believe placing a Peg tube in or doing CPR on a debilitated, dying patient is doing them harm. I would not want it done to me. I consider it a horrible situation what some families have put their loved ones through, instead of just letting the person go and rest in peace. When Dr Kavorkian first made the news, I was outraged that someone would do this. But as I get older, and I live in an elderly community and hold the hand of a person who just wants to be out of pain and suffering, I have to rethink things. I believe the problem is when we see a young person who is wanting "assisted suicide", or someone who seems "alive and well" to us. It is hard to draw the line, so it is easier to just say "No assisted suicide" at all.

As far as the church, I am a God believing person, and my parents would say No assisted suicide, no cremation, no abortion, no, no no. But I don't see suffering as living.

Brenda Dodds, surgery - RNFA, self-employed July 23, 2010 7:17 AM
Fredericksburg TX

I as a nurse would never do anything to harm a patient intentionally. I  have seen families that just couldn't give up and put feeding tubes in a loved one and there they lived almost like a vegetable for years. I could never do that to my  mother, father, child or someone else that I love. Alzheimers is another disease that is a living death when it is advanced. It's not that I believe in assisted suicide for my patients or others but I do hope that option will be available for me if I need/ want it.

Peggy, LTC - RN, retired July 14, 2010 7:50 PM

How we deal with death reflects how we dealt with life and influences how others deal with both. How did we deal with childbirth, the loss of loved ones, being fired, wayward teens, raising children, illness, and other trials? Were we leaders or followers, pioneers or reactionaries? What did we say to our children when they fell down, wanted to quit and felt there was no purpose for living because things were hard or painful? Is there any greater pain than being abused or ridiculed, tortured or tormented and what do we and others learn when we overcome or succumb? How does this relate to the repulsive, callous and malicious practice of keeping people alive for years with feeding tubes and other methods? There is a difference between not letting someone die and helping them die to magnify and testify to how they lived. And, how does how we live and die affect how we live after we die?

wayne russell, Geriatrics - Nurse July 10, 2010 2:16 AM
Kansas City MO

The issue that is the focus of this article is crucially important.  I am an ethicist and patient advocate by profession and I have worked with the theory as much as with the reality of this issue.  One reality is that when a patient is in extremise, and he/she has decided to stop living, there is little that anyone can do to completely prevent this from happening.  Methods are available to even the most closely watched patients: starvation, overdosing, underdosing, etc.  So, why don't we behave in a humane manner to our fellow human beings and give them an option that is merciful and respectful?  I have seen what happens when someone commits suicide by drinking a bottle of bleach and I guarantee you that morphine is much kinder.  So long as it always remains the patient's choice and the patient's action alone, who has a right to interfere?  In addition, as my students remind me every semester, it is only in the 'legal realm' that access to lethal doses of pain meds is restricted.  A patient (or any other person with money) could acquire that lethal level of drugs in one day on any college campus in the country.  But, as i write this, I do remind myself that I still agree with Sheba that we may be in danger of embarking on a slippery slope here that could diminish our regard for the value of human existence. But, then again, we may be moving in a direction that acknowledges both the reality of our mortal nature and the obligation incumbent upon us to honor a person's life and choices.  Mere existence in any kind of debilitated condition could not possibly be what Hippocrates envisioned when he argued to 'do no harm' and to never end a life.  What technology enables us do to force individuals to live verges upon the barbaric these days.  I am not sure that we want to walk that road either.

Janet , Philosophy - Professor July 3, 2010 2:07 PM

Since I am an RN and someone suffering from intractable pain and still have to continue to work i will say how I feel.  While I would never assist anyone else unless it was legal I myself have already been in touch with Dignitas in Switzerland where they are more open minded and have started my own prearrangements.  I prefer Physician assisted suicide be legalized in the very backward US but obviously we still treat animals kinder than humans.  I do not intend to live one minute longer than I feel I have to.  It is my life and it is my death.

Janet, M/S - RN July 1, 2010 12:18 PM
Cleveland TN

this is a tough one, Chuck. And Sheba does make a good point. However, there's a lot to be lost in absolutes: i.e. you absolutely may not support assisted suicide in this country. When a situation is so dire, so painful, so heart-wrenching that people seek a "final" solution,  they are traveling a solitary road others cannot imagine until they, too, are on the final lap. I think this is a choice best made by individuals, in consultation with their families, their religious advisors, their own consciences. Who are we to say others must endure? Seems to me the human race so often loses compassion when it clings steadfastly to status quo. And changing the status quo sometimes requires billboards.

Valerie Newitt June 24, 2010 5:46 PM

The spokesman for FEN is not telling the truth. FEN volunteers actively participate in suicide. Two legal cases emerged, one in Arizona the other in Georgia. I suggest you do more fact checking.

william June 24, 2010 9:15 AM
katonah NY

Thank you for your wonderfully articulated perspective, Sheba. I can absolutely see how condoning one patient's assisted suicide could lead to another patient fighting for his life. You've caused me to think about assisted suicide in a way I hadn't previously and I really appreciate that.    

Chuck Holt, editor June 23, 2010 2:36 PM
Ft. Myers FL


You have written a very thoughtful article. I would like to suggest a response to your questions. The problem with the billboard signs, or any public policy allowing assisted suicide, is that it changes the way society thinks and behaves. What was once an unheard of idea, becomes a little less problamatic in people's minds, then a little less, then even neutral, and then acceptable, and finally demandable. At that point, "choice" is no longer an option for the patient. Instead, the patient has to defend his or her right to live. So who's choice are we really defending - the patients - or the "others" who will be burdened by the patient?

Therefore, society as a whole should not condone assisted suicide; nor should the Government allow billboards advertising such ideas.

Sheba June 23, 2010 2:14 PM

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