677 Ala Moana Blvd Suite 301 Honolulu, HI 96813 http://www.hawaiinurses.org/

The Hawaii Nurses' Association does not support physician-assisted suicide (PAS) nor should nurses participate in assisted suicide. Such an act is in violation of the Code for Nurses and the ethical traditions of the profession. Nurses, individually and collectively, have an obligation to provide comprehensive and compassionate end-of-life care which includes the promotion of comfort and the relief of pain, and at times, foregoing life-sustaining treatments.₁

Nurses, as individuals and as professionals dedicated to meeting the health care needs of the public, are deeply concerned about the quality of care at the end-of-life. There is currently a national movement to improve end-of-life care. Recent, high-profile research reliably reports that our health care system and the American culture as a whole do not handle dying well.₂ The Hawaii Nurses' Association respects and understands the public's fears and concerns about end-of-life issues, but we do not believe physician assisted suicide is the answer to their rightful demands for improved care. We believe the focus on assisted suicide and its seemingly simple promises distracts from the real issues inherent to dying with dignity.

First and foremost it is essential that health care institutions, providers and the general public not confuse physician assisted suicide with ethically justified end-of-life decisions and actions. It is natural for people to fear death and dying. Most often they fear that their lives will unnecessarily be prolonged with technology. They do not want to die alone, to be in pain, nor to be a burden to others. They want to be in control. The right to refuse medical treatments, to request the withholding or withdrawal of life-sustaining treatment such as mechanical ventilation, CPR, chemotherapy, antibiotics and artificially provided nutrition and hydration, within certain contexts, are ethically and legally acceptable. Patients already have the right to exercise their decisional authority relative to health care decisions, including foregoing these life-sustaining treatments. As nurses we have historically advocated for and facilitated patients' rights to see that such treatments are not pursued against a patients' wishes.

Patients fear pain when dying. Yet today we have the ability to manage pain to minimize this fear. When sound principles of pain management are utilized, patients pain can be controlled and quality of life improved.

Patients fear isolation and loneliness when dying. Many patients who request assisted suicide may be depressed, without supportive caregivers, and go undiagnosed, exacerbating the problems further. As a profession it is our responsibility to provide for the physical and psychosocial needs of patients requesting PAS and to seek. to understand the meaning of the request. Our responsibility is to not abandon, but instead to help our patients define and understanding their suffering. We are obligated to seek channels of care that better manage chronic, severe bio-psycho-social and spiritual distress that limit quality of life and increase suffering.

Nurses are obligated to listen compassionately to patients' requests for PAS, but must recognize the boundaries of acceptable ethical practice. Nurses can be honest with and acknowledge that they cannot participate in assisted suicide, yet still manifest a commitment to non-abandonment and to create meaningful care plans for our patients.

Last but not least, patients fear being a burden upon others. We question the logic that PAS is an ethical, humane response to such fears. The endorsement of PAS distracts and may blind our society to the perspectives of the elderly, the poor, the disabled and other vulnerable groups who may not have the finances, care providers, families and other necessary resources that promote quality end-of-life care. The Hawaii Nurses' Association is deeply concerned that for even this reason alone, PAS is a very troubling public policy that ignores the diverse needs of all members of our society.

The Hawaii Nurses' Association stands on The American Nurses' Association's Code for Nurses and its position statement on assisted suicide that nurse participation in such acts is a clear violation of our professional ethics. Central to our position is our respect for persons, our role to promote, preserve, and protect human life, and our experiences in clinical practice dominated by an ethic of care where attentiveness and genuine presence of one human being to another prevails. These principles, well grounded in ethical reasoning, simply cannot support PAS as public policy. We acknowledge the profound complexity of this issue and deeply respect individual perspectives. However, as a profession, to legalize assisted suicide without first addressing the need to improve pain management, to increase and improve timely access to hospice services, to increase use of and respect for advance directives, to develop higher professional standards of care for the dying, and to create stronger community resources and financing ,would merely legalize one more psychological distraction from the real work of helping our patients live meaningful lives during their final days.

1. American Nurses' Association Position statement on Assisted Suicide. Washington D.C., 1996.
2. Last acts, care and caring at the end of life. Leverage Points: A report based on the second last acts national leadership conference. October 29-30. 1997. Washington D.C.
   
   

HPACC members are:

• Hawaii Medical Association
• Hawaii Nurses Association
• Healthcare Association of Hawaii
• Hawaii Cancer Pain Initiative
• Not Dead Yet (Disability Rights Organization)
• Disability Rights Hawaii
• Hawaii Centers for Independent Living
• Hawaii Family Forum
• Hawaii Catholic Conference
• Hawaii Right to Life

6301 Pali Highway
Kaneohe, HI 96744-5224
Phone: (808) 203-6704
Fax: (808) 261-7022
hpacc@hpacc.org