The Corner

Health Care

Now Will Nurses Only Prevent Some Suicides?

A nurse updates a patient’s chart at a hospital in Sylvania, Ohio, May 14, 2018. Picture taken May 14, 2018. (Aaron Josefczeyk/Reuters)

The American Nursing Association has stalwartly supported suicide prevention throughout its history.

In 2015, an article in the Association’s Online Journal of Issues in Nursing recognized nurses’ vital role in suicide prevention. From “Suicide Assessment and Nursing” (my emphasis):

RNs are in a prime position to detect and prevent suicidal behaviors due to their numbers and strategic placement in communities. Dr. M. Justin Coffey (in Wood, 2010) notes that “Nurses serve the most vital role [in preventing suicide] because they spend more time with patients than any other health care worker…We need to feel comfortable talking about suicide in the same way we are in talking about chest pain” (para 2). RNs must be educated and trained to successfully assess, evaluate, treat, and/or refer suicidal patients. Missing a suicidal patient is lethal…

The literature suggests that as more nurses are trained in the prevention of suicide, more lives can be saved. Training RNs should become a primary goal across the globe to prevent suicides and improve patient care.

Notice, the paper did not differentiate between healthy, ill, or disabled suicidal patients. It discusses prevention in hospital settings, for example. In other words, nurses were declared integral to preventing suicide across the board, as indeed, they are.

The ANA historically opposed any nurse participation in assisted suicide as an unethical practice (my emphasis):

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, forgoing life-sustaining treatments. The American Nurses Association (ANA) believes that the nurse should not participate in assisted suicide. Such an act is in violation of the Code for Nurses with Interpretive Statements (Code for Nurses) and the ethical traditions of the profession.

That’s absolutely right and consistent with the goal of preventing all suicides.

But here’s the problem. The leadership of organized medicine and mainstream bioethicists are increasingly joining the progressive ideological coalition. Thus we should be disheartened — but not surprised — that the leadership of ANA also wants to jump in the progressive pool by abdicating the nurse’s role in preventing all suicides.

Instead of pursuing universal prevention, when it comes to terminally ill patients contemplating assisted suicide, a draft ethics opinion declares that a nurse’s duty is to be non-judgmental. (AID” stands for aid in dying, the political euphemism for suicide committed with a doctor’s complicity). From the draft statement (again, my emphasis):

Patients expect nurses to be able to discuss all end of life options. An understanding of the ethical issues surrounding AID is essential to support patients in making informed end-of-life decisions. Nurses should be aware of ethical arguments which support and challenge AID. It is especially important that nurses are clear about the ethical foundations of their own views on AID. Knowledge of one’s own stance helps clarify the boundary between non-judgment and respect for patients’ decisions, and imposition of personal values.

If a nurse calls in suicide-prevention services for a suicidal patient whose baby died, should that be considered an imposition of personal values? Of course not! It is fulfilling the nurse’s duty to care for all patients equally. The same should be true for patients requesting assisted suicide.

Alas, the ANA proposal would have nurses stand down when terminally ill patients contemplate assisted suicide (my emphasis):

Therefore, the ANA supports that:

1. The nurse should remain non-judgmental when discussing end of life options with patients, who are exploring AID…
2. The nurse must have self-awareness of his/her personal values regarding AID and how these values might affect the patient/nurse relationship…
5. The nurse must protect the confidentiality of the patient who chooses AID.
6. The nurse must remain non-judgmental about and protect the confidentiality of healthcare professionals who are present during the AID process as well as those who choose not to be present.

Talk about terminal nonjudgmentalism!

The ANA draft position paper is a call for nurses to betray Hippocratic values and abandon terminally ill (for now, the list will expand over time) suicidal patients to their darkest desires.  It is a direct contradiction of the call in the 2015 paper to refer suicidal patients for prevention services, a mandate that included all patients at risk for suicide, not just some.

I hope the membership of the ANA will oppose their leaders’ attempt to accommodate the culture of death. If nurses become non-judgmental” — e.g., indifferent — to some suicides, the consequent failure to request specialized preventative interventions could become the precipitating omission that sends some suicidal patients into the abyss.

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