Is Palliative Care the Answer to the Medical Aid in Dying Discussion?

As reported to Chris Pirschel, Staff Writer by Betty Ferrell, PhD, MA, FAAN, FPCN

Healthcare providers and researchers have strong consensus that palliative interventions should begin at the time of diagnosis for patients with cancer. The Clinical Journal of Oncology Nursing and Oncology Nursing Forum have published excellent articles in nearly every issue on topics of palliative care, quality of life, and symptom management issues. 

However, whether you’re a proponent or opponent of assisted death in the United States, it’s important to look at why mandates and legislation for medical aid in dying are becoming more commonplace throughout the country. The reality is that many people don’t believe they can rely on our healthcare system to provide them with the care they want at the end of life. This should be an important message to us in health care and oncology. 

Patients with terminal diagnoses fear having pain and symptoms out of control, they fear losing their dignity, and they fear burdening their families in their final days. 

As key healthcare providers, oncology nurses should work diligently to improve care for all patients, including those with terminal diagnoses. To address abundant end-of-life fears and a lack of trust with the healthcare system, nurses can advocate for early palliative care interventions to help all of their patients understand that pain can be managed, that symptoms won’t be out of control, and—if their situation is terminal—they won’t lose their dignity in the dying process. 

Oncology nurses recognize that medical aid in dying is becoming legalized in more states, and they should certainly be aware of it. If nurses practice in a state with assisted death laws, then they should look to their institution to understand what that means for their practice. But the bigger issue that nurses should recognize is the work we need to do to change public perceptions of the care they’ll receive at the end of life. 

Both ONS and the American Society of Clinical Oncology have strong documents and position statements addressing the topic of medical aid in dying along with the importance of palliative interventions early in care. All oncology nurses should feel confident to advocate for their patients to receive the highest-quality care through palliative interventions, helping to alleviate the misconceptions about symptom management and the end-of-life processes. 

All oncology nurses should be centrally involved in palliative care, but advanced practice RNs (APRNs) have a real opportunity to lead those efforts. The City of Hope, with grant funding from the National Cancer Institute, has a new APRN training course to prepare oncology APRNs to be generalists in palliative care. Working together, oncology nurses and APRNs can help promote strong palliative care initiatives in their institutions and help ameliorate the misunderstanding for patients at the end of life. 

Visit ONS’s palliative care page for ideas and resources for oncology nurses.