The role of nurses in physician-assisted dying

Euthanasia is legal in Belgium if performed by physicians under strict requirements of due care, one of which is that they discuss the request with the nurses involved. Little is known about the role of nurses in euthanasia and in the use of life-ending drugs without a patient's request.

The study looked at the experiences of nurses in Belgium with euthanasia and other end-of-life decisions. The study, with 1265 respondents, had a response rate of 75.8%. Of this number 128 nurses reported that the last patient in their care who had a life-shortening end-of-life decision received euthanasia and 120 nurses reported on a patient who received life-ending drugs without the patient posing an explicit request.

In using life-ending drugs without explicit request, 48% of nurses helped prepare drugs, 56% were present during administering and 45% administered the drugs, mostly without the physician co-administering (82%) but under physician orders (98%). In euthanasia where the law states that it has to be performed by a physician, 12% of nurses administered the drugs, also mostly without the physician co-administering (86%) but always under physician orders.

"Particularly when due care criteria are not fulfilled, such as the patient poses no explicit request, nurses, next to the physician, risk legal prosecutions," write Els Inghelbrecht, Vrije Universiteit Brussel and coauthors. "Nurses stand in a vulnerable position as they can get stuck between performing a physician's orders and performing illegal acts."

The authors recommend further research as well as professional regulation and guidelines to clarify nurses' involvement in euthanasia and other end-of-life practices.