Page 4 • <strong>DNA</strong> <strong>Reporter</strong> <strong>December</strong> <strong>2021</strong>, January, February 2022 Guest Editor continued from page 1 treatment options and willingness to pursue or not pursue. How a patient understands their choices influences the care they receive in end of life care, and options should be well laid out to our patients for informed decision making. Treatment decisions in end of life care include resuscitation in the form of CPR or intubation, palliative sedation for intractable pain, refusal of artificial nutrition and hydration via tube, refusal of life saving surgery, refusal of blood products, refusal of antibiotics, refusal of chemotherapy or radiation therapy, and refusal for initiation of or stopping of hemodialysis. These decisions to stop or not initiate treatments generally result in a death that would have naturally occurred without the intervention of medicine. I have observed that patients nearing the end of their life may make decisions to continue treatments inconsistent with their personal preferences based upon lack of information regarding the impact on their healthcare outcomes. This unwanted care has led to increased psychological distress and increased utilization of health care resources that may offer little therapeutic benefit or impact on quality of life and may leave their loved ones without the ability to have closure. In 1997, Oregon was the first state to legalize aid in dying. Since that time, Washington, D.C, California, Colorado, Hawaii, Maine, New Jersey, Vermont, Washington, and most recently in <strong>2021</strong>, New Mexico has followed suite. Although Montana does not have a dedicated law, in 2009, its supreme court supported that nothing in Montana’s State Law prohibited a physician from honoring the wishes of a competent terminally ill adult to be able to hasten their death. Only New Jersey and Hawaii currently allow nurse practitioners to prescribe end of life medications (“Death with Dignity Acts,” n.d.). Death with Dignity is the underlying concept of Delaware’s House Bill 140 (HB140), with Representative Paul S. Baumbach as the primary bill sponsor. This <strong>2021</strong>, the Delaware Death with Dignity Act, HB 140, was assigned to the House Health & Human Development Committee on the final day of the session, just before the Delaware General Assembly adjourned (“Death with Dignity Delaware,” n.d.). House Bill 140 would allow another option in end of life care, and would permit a terminally ill patient with six months or less life expectancy who is an adult resident of Delaware (age 18 and above) to request and self-administer medication to end the individual’s life in a humane and dignified manner if both the individual’s attending physician/advanced practice registered nurse (APRN) and a consulting physician/advanced practice registered nurse (APRN) agree on the individual’s diagnosis and prognosis and believe the individual has decision making capacity, is making an informed decision, and is acting voluntarily (“Delaware General Assembly,” n.d., House Bill 140). House Bill 140 has safeguards built in to protect the public and providers when considering this as an option. It would be up to the healthcare institution and individual practitioner to consider and decide how they would respond to HB140 based on legal, ethical, moral, and personal values. The American Nurses Association (ANA, 2019) as cited in the ANA Position Statement, stated the hallmarks of end-of-life care include respect for patient selfdetermination, nonjudgmental support for patients’ end-of-life preferences and values, and prevention and alleviation of suffering. Death with Dignity should be viewed as medical aid to those dying with a terminal illness (OJIN, 2019). It is not considered suicide, assisted suicide, homicide, or euthanasia, and would offer another option in end of life care planning to existing hospice care and comfort care provided under palliative care. The ANA 2019 position statement recommends that nurses have knowledge on the current environment for medical aid in dying and remain objective if patients wish to discuss medical aid in dying, thus preserving self-autonomy and dignity in making end of life health care decisions (OJIN, 2019). States that have Death with Dignity Laws provide another option suited to meet end of life preferences in those suffering with a terminal illness. The role of the nurse is to listen, to be an advocate for their patient’s needs, and to ensure continuation of care based on the patient’s personal preferences. Only our patients can state their wishes for their end of life care planning and tell us if medical aid in dying would be in their best interest. This edition of the <strong>DNA</strong> <strong>Reporter</strong> is focused on how palliative care may improve quality of life and preserve dignity in end of life care. The first step is to recognize the need to have end of life care discussions to share our thoughts on how we want to spend our final days and to revisit one’s medical wishes as health changes. Heather Milea, MSN, FNP-BC, AGACNP-BC, PCCN, CHFN, highlights how the Covid epidemic impacted patient’s quality of life in end of life care. Ginna Keil, MSN, FNP-BC demonstrates how community palliative care is high quality and cost effective when shifting the focus from active disease treatment to comfort care. LaTonya Mann, DNP, FNP-BC, OCN discusses that early intervention of palliative care with the assistance of nursing leads to a better quality of life for those living with cancer. Kiernan Quay, DNP, APRN, FNP-C relays that non beneficial treatment in end of life care may not equate with quality of life. Karin Cooney-Newton, MSN, RN, APRN, ACCNS-AG, CCRN presents an effective objective tool for end of life care that can promote comfort and alleviate suffering for patients and their families in end of life care. References ANA Position Statement: The nurse’s role when a patient requests medical aid in dying. (2019). OJIN: The Online Journal of Issues in Nursing, 24 (3). https://www.doi. org/10.3912/OJIN.Vol24No03PoSCol02 Death with Dignity. (n.d). https://deathwithdignity.org Retrieved 7/20/<strong>2021</strong>. Death with Dignity, Delaware. (n.d.). https://deathwithdignity. org/states/delaware/ Death with Dignity Acts. (n.d.) https://deathwithdignity.org/learn/ death-with-dignity-acts Retrieved 8/11/<strong>2021</strong>. Delaware General Assembly, House bill 140. https://legis. delaware.gov/BillDetail?LegislationId=79026 Retrieved 10/7/<strong>2021</strong> Institute of Medicine. (1997). Approaching death: Improving care at the end of life. Washington,D.C: National Academy Press. The Delaware Code Online (n.d). Title 16 Health and Safety, Regulatory Provisions Concerning Public Health Chapter 25. Health-Care Decisions, section 2502. http://delcode. delaware.gov/title16/c025/ accessed 7/1/<strong>2021</strong>.
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