Seidlein Anna-Henrikje, Riedel Annette, Heidenreich Thomas, Klotz Karen
Institute of Ethics and History of Medicine, University Medicine Greifswald, Greifswald, Germany.
Faculty of Social Work, Education and Nursing Sciences, Esslingen University of Applied Sciences, Esslingen, Germany.
Front Psychiatry. 2025 May 14;16:1589487. doi: 10.3389/fpsyt.2025.1589487. eCollection 2025.
Euthanasia and medically assisted suicide (E/MAS) are (healthcare-)practices intended to cause a patient's death according to their wish and will. This article addresses the specific questions that arise in the context of E/MAS regarding older adults in need of long-term care (LTC) from a nursing ethics perspective. Older people in need of LTC are particularly vulnerable due to a combination of health-related, social, and economic factors. Multiple chronic diseases, age-related frailty and the subsequent need for LTC, for example, may contribute to an increased risk of social isolation, loneliness and hopelessness. The boundaries between "normal" age-related changes and changes that are deemed to be pathological also become blurred. The complex interplay of these factors results in the particular needs of older adults who rely on nursing care. Consequently, specific ethical issues arise that are unique in terms of their quality and quantity - also regarding E/MAS. We present a common scenario: a fall with a subsequent fracture, as a turning point in the LTC arrangement. The consequences of such an adverse event (limited mobility, risk of further falls) compromise the security of care at home, raising the (potential) need for transfer to a LTC facility. This (potential) move represents a major disruption, is experienced as a crisis, and marks a transition for the older adult in need of LTC. We highlight the complex interplay between aging, health-care dependency, personal values and the resulting wish/request for E/MAS. We discuss how the professional self-perception and ethical values of the nursing profession in the home care setting determine the treatment pathway for older peoples' request for E/MAS.
安乐死和医疗协助自杀是旨在根据患者的意愿导致其死亡的（医疗保健）行为。本文从护理伦理的角度探讨了在安乐死和医疗协助自杀背景下，针对需要长期护理的老年人所产生的具体问题。由于健康、社会和经济因素的综合作用，需要长期护理的老年人特别脆弱。例如，多种慢性疾病、与年龄相关的身体虚弱以及随之而来的长期护理需求，可能会增加社会隔离、孤独和绝望的风险。“正常”的年龄相关变化与被视为病理性变化之间的界限也变得模糊。这些因素的复杂相互作用导致了依赖护理的老年人的特殊需求。因此，出现了一些在质量和数量上都很独特的具体伦理问题——在安乐死和医疗协助自杀方面也是如此。我们提出一个常见的情景：一次跌倒并随后骨折，这是长期护理安排中的一个转折点。这样一个不良事件的后果（行动不便、再次跌倒的风险）危及在家护理的安全性，增加了（潜在的）转至长期护理机构的需求。这种（潜在的）转移是一次重大干扰，被视为一场危机，并且标志着需要长期护理的老年人的一个转变。我们强调衰老、医疗保健依赖、个人价值观以及由此产生的对安乐死和医疗协助自杀的愿望/请求之间的复杂相互作用。我们讨论家庭护理环境中护理专业的职业自我认知和伦理价值观如何决定老年人对安乐死和医疗协助自杀请求的治疗途径。
