US Hospice "Leave the Room" Policies: Ethical Challenge to Nursing Commitments (TH111A).

Outcomes: 1. Utilizing a case-based approach, participants will self-report the concerns that lead hospice programs to ask nurses to leave the room when a patient ingests the prescribed life-ending medications 2. Utilizing the ANA Code of Ethics, participants will self-report the ethical dilemma that occurs when the nurse is required to leave the room when the patient ingests the medications Some hospices in US jurisdictions where Medical Aid in Dying (MAID) is legal have implemented policies that require nurses to "leave the room" when a patient ingests aid-in-dying medication. Two questions with ethical implications arise from these policies: (1) Is it ethically supportable for a hospice to require staff leave the room while a patient ingests aid-in-dying medication? (2) Does this requirement compromise the nurse's professional commitment to patient and family? We review the origins of this common policy, nursing codes of ethics and professional organization policy statements related to nursing commitments to patients. In the United States, physicians and nurses cannot administer aid-in-dying medication directly; the patient must self-administer. But the scope of hospice engagement and employee policies vary widely. In all ten jurisdictions with statutes permitting aid-in-dying, the statute provides that aid in dying "is not to be construed as suicide, assisted suicide, euthanasia under the law." Institutions remain concerned about the federal Assisted Suicide Funding Restriction Act (1997), legislation enacted in direct response to Oregon's first statute legalizing physician assistance in dying. The act provides that no federal funding "may be used... for the purpose of causing, or ... assisting in causing, the death of an individual... by assisted suicide." Institutional policy requiring nurses to "leave the room" while a patient ingests risks violating professional standards, reinforces stigma around MAID, potentially abandoning patients and loved ones at a critical time accessing a desired and legal death. We present a case that depicts these potential risks and conclude that such a policy is not ethically supportable. Hospice programs must be transparent about their aid-in-dying policies and procedures, including restrictions on staff participation at the time of ingestion, so that patients and families can make an informed choice of hospice providers. [ABSTRACT FROM AUTHOR]