Dilemmas encountered by hospice workers when patients wish to hasten death

In 1997, Oregon enacted the Oregon Death With Dignity Act, which legalized physician-assisted suicide. This article reports on a qualitative study of the ethical and clinical dilemmas experienced by hospice nurses and social workers when they encounter patients who wish to hasten death through physician-assisted suicide. The biggest dilemma arises from the conflict between two important hospice values: honoring patient autonomy versus promoting a death experience in which personal and spiritual transformation are possible. Hospice professionals report conflict between their advocacy for patients and for the family members who sometimes oppose physician-assisted suicide. Conversely, when patients choose to hasten death by voluntarily refusing all food and fluids, many of these dilemmas dissipate. As more patients request control of the circumstances of their deaths, a better understanding of the complex issues regarding hastening death is needed for patients, families, and the health professionals who provide care during this difficult transition.