Admittedly, as RN “in the field” I never paid attention to health care policy. My thinking was those in administrative roles would engage in these types of issues. It wasn’t until pursuing the DNP degree did the realization register that everyone, including patients, families, and healthcare workers, have a voice; and with a substantial amount of voices, changes can occur.
For this week I am beginning at ground zero; and asking the question, “What exactly is a healthcare policy?” To clarify for those who are wondering the same, the World Health Organization (WHO) describes healthcare policy as actions, decisions, and plans initiated to enact specific health care goals within a society (WHO, 2015). Let’s take this concept and apply it the topic, Death with Dignity, and think about how healthcare policy (or the lack thereof) relates to this topic. Clearly, as related in Week One’s post, the state of Oregon was a trailblazer with the landmark ruling to legalize physician-assisted suicide in 1994. Since then, other states have succeeded, but many have failed in their attempts to establish aid in dying policies. Arizona (AZ) is one such state where the Aid in Dying bill, sponsored by former State Representative, Linda Lopez (Democrat), has consistently been rejected in the House of Representatives. For those of you who need a quick civics review of how a bill turns into a law, I included a picture because who doesn’t like visuals?
I also included a link to a news clip on how Death with Dignity remains dead in the water (no pun intended). (For effective view please right click and open as new link).
For those terminally ill patients (living in AZ) seeking to make their own choice in when and how they want to die, this is an extremely frustrating situation. The only choice for these patients may be a hospice program, where at least end-of-life symptom management is offered. For others, desperate times call for desperate measures, like violent suicide (e.g, guns); and looking for organizations that may assist in finding measures to hasten one’s death. For instance, the case of a 58 year old Phoenix woman, Jana Van Voorhis, who inquired the help from Final Exit members to help with her suicide. Final Exit is an organization that counsels and supports mentally competent people with intolerable diseases end their lives (Final Exit, 2011). The problem was Jana told members, one being a retired anesthesiologist, that she had terminal conditions that were never verified by her physicians. In fact, Ms. Van Voorhis had been recently diagnosed as having psychosis; and had persistent disturbing hallucinations. These members were tried in an AZ court for manslaughter. The physician was acquitted; and the three other members pleaded to lesser charges (AZ Central, 2012). This led to a bill, recently signed by former Governor Jan Brewer in 2014, to prosecute any individuals with manslaughter who assist in suicides. The term assist means providing physical means to end one’s life (Arizona Capitol Times, 2014).
Watch Dr. Sanjay Supta, my favorite CNN consultant, investigate the Jana Van Voorhis case. Think about what side of the fence you are on in this debate; and if heath care policy could have prevented tragedies like this case.
There are still those in the community keeping the Death with Dignity debate alive. Arizona State University (ASU) hosted an event, that I attended, in September 2014 titled “Should Arizonans Have the Right to Die with Dignity?” This event had a panel discussion with two highly informed professors on the topic: Dr. Courtney Campbell, from Oregon State University; and Dr. Helene Sparks, from the University of Washington. Both taught courses in ethics; and have numerous articles published on topics like physician-assisted suicide.
Here is the video discussion for those interested in this debate. Think about the question, “Do Arizonans have the right to die with dignity?”
Role of Ethics
The ASU discussion on Death with Dignity leads us to the topic of ethics. How does the role of ethics affect the decision-making policy regarding aid in dying for terminally ill patients? As it stands, the American Nurses Association (ANA) has this position statement regarding assisted-suicide that “prohibits nurses’ participation in assisted suicide and euthanasia because these acts are in direct violation of Code of Ethics for Nurses with Interpretive Statements, the ethical traditions and goals of the profession, and its covenant with society (ANA, 2013, p. 1). This code also applies to advanced practice registered nurses (APRNs). With the ANA against assisted-suicide, only strengthens the debate for those opposed to an Aid in Dying bill in AZ. As a hospice RN in AZ, I believe those diagnosed with a terminal illness; and who are mentally deemed competent should be able to end their own life. If for any reason to stop drastic, desperate measures by those seeking a safe, painless, monitored way to die.
Let’s talk further about this topic in Week Three when I will delve more into the actual policy-making process!
American Nurses Association (2013). Position statements: Euthanasia, assisted suicide, and aid in dying. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements/Euthanasia-Assisted-Suicide-and-Aid-in-Dying.pdf
Arizona Capitol Times (2012). Brewer signs bill targeting assisted suicide. Retrieved from http://azcapitoltimes.com/news/2014/04/30/brewer-signs-bill-targeting-assisted-suicide/
Arizona State University (2014). Should Arizonans have the right to die with dignity? Retrieved from https://www.lincolncenter.asu.edu/events/should-arizonans-have-right-die-dignity
AZ Central (2012). Jury acquits Phoenix doctor in assisted-suicide case. Retrieved from http://archive.azcentral.com/community/ahwatukee/articles/2011/04/21/20110421phoenix-doctor-assisted-suicide-verdict.html
Final Exit Network (2011). Our guiding principles. Retrieved from http://www.finalexitnetwork.org/
Mullins, Jean (2015, November 4). Sanjay Gupta, MD: Assisted suicide or manslaughter? Retrieved from https://www.youtube.com/watch?v=_of5pFqLB-k
News 4 Tucson (2014, November 3). Death with dignity legal in only 5 states, and Arizona is not one of them. Retrieved from http://www.kvoa.com/news/death-with-dignity-legal-in-only-5-states-arizona-is-not-one-of-them/#.VL7aKRev61M.wordpress
World Health Organization (2015). Health policy. Retrieved from http://www.who.int/topics/health_policy/en/