Retired ANA Position Statement
Originated by: Task Force on the Nurse's Role in End-of-Life Decisions, Center for Ethics and Human Rights
Adopted by: ANA Board of Directors
Endorsed by: American Association of Critical Care Nurses; Oncology Nursing Society
Related Past Action:
Code for Nurses with Interpretive Statements, 1985.
The American Nurses Association (ANA) believes that the nurse should not participate in active euthanasia because such an act is in direct violation of the Code for Nurses with Interpretive Statements (Code for Nurses), the ethical traditions and goals of the profession, and its covenant with society. Nurses have an obligation to provide timely, humane, comprehensive and compassionate end-of-life care.
- Active Euthanasia:
- The term euthanasia is defined and characterized in many ways, thus clarification of language is important. Euthanasia is often called "mercy killing" and has been taken to mean the act of putting to death someone suffering from a painful and prolonged illness or injury. Active euthanasia means that someone other than the patient commits an action with the intent to end the patient's life, for example injecting a patient with a lethal dose. Sometimes euthanasia is subdivided into a situation in which a patient consents to euthanasia (voluntary) or a situation in which a patient refuses euthanasia (involuntary) or a situation when a patient is unable to consent to euthanasia (nonvoluntary). Active euthanasia is distinguished from assisted suicide. In active euthanasia someone not only makes the means of death available, but serves as the direct agent of death.
For the purpose of this statement, the term active euthanasia refers to those actions that are inconsistent with the ANA Code for Nurses and are ethically unacceptable, whether the euthanasia is voluntary, involuntary or nonvoluntary.
- Withholding, Withdrawing and Refusal of Treatment:
- Honoring the refusal of treatments that a patient does not desire, that are disproportionately burdensome to the patient, or that will not benefit the patient can be ethically and legally permissible. Within this context, withholding or withdrawing life-sustaining therapies or risking the hastening of death through treatments aimed at alleviating suffering and/or controlling symptoms are ethically acceptable and do not constitute active euthanasia. There is no ethical or legal distinction between withholding or withdrawing treatments, though the latter may create more emotional distress for the nurse and others involved.
The ANA Code for Nurses provides guidance for ethical conduct and explicates the values and precepts of the profession. It is within the context of the Code for Nurses that nurses make ethical judgements and discharge their responsibilities. The principal axiom that directs the profession is respect for persons, and this respect is extended to patients, families, nurse colleagues and team members.
Historically, the role of the nurse has been to promote, preserve and protect human life. The Code for Nurses asserts that respect for persons "extends to all who require the services of the nurse for the promotion of health, the prevention of illness, the restoration of health, the alleviation of suffering and the provision of supportive care of the dying. The nurse does not act deliberately to terminate the life of any person." This ethic of moral opposition to actively taking a human life prohibits the nurse from participating in active euthanasia.
The profession's opposition to nurse participation in active euthanasia does not negate the obligation of the nurse to provide proper and ethically justified end-of-life care which includes the promotion of comfort and the alleviation of suffering, adequate pain control, and at times, foregoing life-sustaining treatments.
Nurses must be vigilant advocates for the provision of humane and dignified care. Nurses can demonstrate their respect, support and lasting commitment to patients and families without participating in active euthanasia.
- American Nurses Association (1985). Code for Nurses with Interpretive Statements. Kansas City, MO: The Author.