Beliefs and Attitudes of American Nurses on Physician Assisted Suicide: An Integrative Literature Review

Background: With increasing awareness and legal issues on physician-assisted suicide (PAS) sweeping across the nation in today’s society, it is important to investigate the predominant opinions, beliefs and attitudes of American nurses toward PAS, as it will have significant implications for nursing practice. Objectives: The purpose of this integrative literature review (ILR) was to determine the predominant perspective of nurses, including their opinions, beliefs and attitudes, regarding PAS suicide. Method: An integrative literature review was conducted utilizing the following databases accessed through the DePaul University Library – CINAHL Complete, PubMed, PsycINFO, Academic Search Complete, ProQuest Dissertations and Thesis, and ProQuest Nursing and Allied Health Source. Results: A total of twenty six articles are included in this ILR, which include ten survey studies of American nurses in oncology, critical care, and hospice practice settings, thirteen expert opinion papers, and three specialty nursing organizations’ position statements. Descriptive statistics showed that of the ten peer-reviewed survey studies representing American nurses’ opinions, beliefs and attitudes on PAS, only four studies demonstrated majority support by American nurses for PAS. However, of these studies where majority of nurses supported PAS, these nurses were not willing to participate in the execution of PAS. The thematic commonalities nurses expressed for supporting PAS included relief of pain and suffering, death with dignity, and self-determination. The predominant perspective of nurses in the remaining six studies was unsupportive of PAS. The thematic commonalities nurses expressed for opposing PAS included proper pain management, religion, personal morals and ethics, and the risk for abuse or misuse of PAS. Three of the unsupportive studies revealed nurses might perceive PAS differently if they had more information or knowledge on the subject. There were five and six expert opinions that were pro and individual nurse decision for PAS, respectively. Only two expert opinions were against PAS and they can be considered outdated since these opinions were published in 2000 and 2007. Conclusion: This integrative literature review provides evidential support on the predominant beliefs and attitudes of American nurses, which is unsupportive of PAS. However, these surveys were conducted from 1993 to 2012, which may no longer represent the current trends on nursing opinions, beliefs and attitudes on PAS. The public’s desire for PAS continues to grow with six states enacting laws that have legalized PAS. New PAS opinion surveys among nurses in AIDS care, critical care, hospice care, palliative care, home care, long-term care and cancer care settings are warranted. If nurses remain unsupportive of PAS, ethical dilemmas in clinical nursing practice will become pervasive particularly in states that have already legalized PAS. Further investigation of inconsistencies between American nurses’ support for the legalization of PAS and their personal unwillingness to be present during the execution of PAS is needed. A concerted effort to educate American nurses on legal and ethical issues related to PAS can raise their awareness of their own personal moral views and can potentially alter their current stance on PAS