Jannette Jessica, DeWolf Bosek Marcia Sue, Rambur Betty
Department of Nursing, The University of Vermont, Burlington, USA.
JONAS Healthc Law Ethics Regul. 2013 Apr-Jun;15(2):80-8; quiz 89-90. doi: 10.1097/NHL.0b013e3182919e81.
Patient-directed dying (PDD) (also known as physician-assisted suicide) has been a heavily debated issue in the United States since the passing of the Death With Dignity Act in Oregon in 1997. Previous research surrounding PDD has been limited to assessing the attitudes of physicians, nurses, and patients. The purpose of this study was to describe the intended actions of advanced practice registered nurses (APRNs) toward initiating PDD discussions and prescribing a lethal dose of medication under PDD legislation. A survey design was used to guide this pilot study. An investigator-developed questionnaire was disseminated electronically to APRNs on a free professional Listserve in a rural northeastern state. The final sample was composed of 16 APRNs whose area of certification were identified as 63% family, 31% adult, 6% psychiatric/mental health, and 13% other. Hospice and palliative care employment experience was reported by 75% of the sample.
The APRN subjects were more willing to engage in PDD discussions than to prescribe under PDD legislation. The APRNs reported an increased willingness to initiate discussions and prescribe when patient pain and suffering were explicitly stated. Seventy-five percent of APRNs viewed their personal and professional opinions regarding PDD to be synonymous even though 50% were unsure as to whether PDD was consistent with the American Nurses Association (2001) Code of Ethics for Nurses.
Advanced practice registered nurses reported increased intent to discuss than actively participate through means of prescriptive authority under PDD legislation. The depiction of pain and suffering may have an impact on APRN intention to act in cases of PDD.
Increased awareness and education surrounding professional codes for APRNs, particularly regarding PDD, are needed.
自1997年俄勒冈州通过《尊严死法案》以来，患者自主死亡（PDD）（也称为医生协助自杀）在美国一直是一个备受争议的问题。此前围绕PDD的研究仅限于评估医生、护士和患者的态度。本研究的目的是描述高级执业注册护士（APRN）在PDD立法下发起PDD讨论和开具致死剂量药物的预期行为。采用调查设计来指导这项试点研究。一份由研究者编制的问卷通过电子方式分发给美国东北部一个农村州免费专业邮件列表服务中的APRN。最终样本由16名APRN组成，其认证领域分别为63%家庭护理、31%成人护理、6%精神科/心理健康护理和13%其他护理。75%的样本报告有临终关怀和姑息治疗工作经验。
APRN受试者更愿意参与PDD讨论，而不是根据PDD立法开具药物。APRN报告称，当明确说明患者的疼痛和痛苦时，他们发起讨论和开具药物的意愿增强。75%的APRN认为他们对PDD的个人和专业意见是同义的，尽管50%的人不确定PDD是否符合美国护士协会（2001年）《护士伦理守则》。
高级执业注册护士报告称，他们更倾向于讨论，而不是根据PDD立法通过处方权积极参与。对疼痛和痛苦的描述可能会影响APRN在PDD案例中的行动意愿。
需要提高对APRN专业守则的认识和教育，特别是关于PDD的内容。
