Israeli critical care nurses’ attitudes toward physician-assisted dying

doi:10.1016/j.hrtlng.2006.06.008

Heart & Lung

Volume 35, Issue 6, November–December 2006, Pages 412-422

https://doi.org/10.1016/j.hrtlng.2006.06.008 Get rights and content

Background

Within critical care, end-of life decisions are common, including hastening of the dying process. One type of hastening the dying process is physician-assisted dying (PAD).

Objectives

The purpose of this study was to determine Israeli critical care nurses’ attitudes and practices toward PAD.

Methods

A convenience sample of 71 intensive care unit nurses were asked to fill out a modified critical care, Hebrew version of the Nurse’s Attitudes Regarding Physician-Assisted Dying Questionnaire. Subjects were also asked whether they were requested or whether they performed actions to hasten the dying process.

Results

The majority of nurses supported PAD. However, only 10% of the respondents agreed to participate when PAD was to be administered by the nurse. Some nurses were asked by patients (12.7%) and/or by families (7.0%) to hasten the dying process. No nurse reported administering any lethal treatment. No significant differences in responses to the vignettes were found based on gender, marital status, place of birth or parents’ place of birth, religion, age, type of education, having taken a post-basic course, years of general or intensive care unit nursing experience, or type of intensive care unit. However, significant differences were found in four vignettes based on level of self-perceived religiosity.

Conclusion

The findings demonstrated that the Israeli critical care nurses sampled tended to agree with the concept of PAD but were unlikely to agree to having a more active role in hastening the dying process. This particular finding was true especially among those nurses who considered themselves more religious.

Section snippets

Review of literature

Investigators around the world have researched the attitudes of health care professionals toward hastening the dying process (AE, PAS, and PAD). By far the largest body of literature is related to PAS.

Sample

The study was conducted at a major, nonsectarian, secular, teaching hospital in Israel. The convenience sample consisted of 71 nurses working in four critical care units. A record of the total number of questionnaires distributed was not kept. Therefore, the response rate could not be determined.

Instruments

The questionnaire used in this study was based on the Nurse’s Attitudes Regarding Physician-Assisted Dying Questionnaire,⁴² which consists of four situational vignettes followed by four possible

Demographic data

The sample consisted of 71 critical care nurses, 7 of whom were males. Approximately half of the sample were native Israelis (n = 35) with the rest immigrating to Israel from Asia (n = 8), Africa (n = 10), Europe (n = 28), the Americas (n = 3), or other countries (n = 1). More than half of the sample had a baccalaureate degree, with 71% having finished a post-basic specialization course in critical care. Most were staff nurses (n = 62). They worked a mean of 12.3 years (standard deviation =

Discussion

Although there is difficulty in comparing results between studies that define end-of-life treatments differently, it is interesting to note that the percentage of agreement of this sample of Israeli critical care nurses with PAD is higher than that of other critical care nurse and most other health care provider samples.8, 13, 14, 25, 33 These results are consistent with previous studies showing that Jewish health care providers tend to have more positive attitudes toward such issues.7, 36

Limitations

The study has several limitations. The sample for this study was a convenience sample, and the number of nurses sampled was small, which possibly affected the results of the study. It should also be noted that the actual refusal rate for participation in the study is unknown. Nurses’ attitudes were determined by the use of vignettes. Some investigators have questioned the use of this technique in that vignettes might not truly reflect the nurses’ attitudes. The questionnaire dealt with

Research

More cross-cultural research needs to be conducted, especially among critical care health care providers, related to the influence of culture and religion on patient care, including that related to PAD. Aspects related to how critical care practice might affect nurses’ attitudes differently than other patient care environments should also be investigated. Comparisons between nurses working in different clinical areas might shed some light on this issue.

Practice

As economic considerations continue to

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: Grant or other financial support: Sigma Theta Tau International.

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Ethical issueIsraeli critical care nurses’ attitudes toward physician-assisted dying

Background

Objectives

Methods

Results

Conclusion

Section snippets

Review of literature

Sample

Instruments

Demographic data

Discussion

Limitations

Research

Practice

Int J Nurs Sci

Lancet

Lancet

Lancet

Aust N Z J Public Health

Int J Nurs Stud

Appl Nurs Res

Psychosomatics

End-of-life practices in European intensive care units

JAMA

Legalization of physician assisted suicide: point/counterpoint

Nurs Forum

Physicians’ responses to patients’ requests for physician-assisted suicide

Arch Intern Med

Oncology nurses’ attitudes regarding voluntary, physician assisted dying for competent, terminally ill patients

Oncol Nurs Forum

The role of critical care nurses in euthanasia and assisted suicide

N Engl J Med

Views of United States physicians and members of the American Medical Association House of Delegates on physician-assisted suicide

J Gen Intern Med

Attitudes and practices of US oncologists regarding euthanasia and physician-assisted suicide

Ann Intern Med

Attitudes and practices among pediatric oncologists regarding end-of-life care: results of the 1998 American society of clinical oncology survey

J Clin Oncol

End of life care: a survey of US neurologists’ attitudes, behavior, and knowledge

Neurology

Medical students’ attitudes toward physician-assisted suicide

JAMA

Resident experience and opinions about physician-assisted death for cancer patients

Arch Surg

British community pharmacists’ views of physician-assisted suicide

J Med Ethics

Medical students’ opinions of euthanasia and physician-assisted suicide in Italy

Arch Intern Med

Position statement on active euthanasia

Ethical issue
Israeli critical care nurses’ attitudes toward physician-assisted dying