Assisted suicide, recent judicial decisions, and implications for critical care nurses.

The passage of the Oregon Death With Dignity Act on November 8, 1994, heralded a wake-up call for healthcare professionals. Oregon, the first state to systematically "ration care" was thought to be a fertile ground for testing new and, some say, radical concepts in healthcare and government. Although the act was not implemented because it was tied up in legal action until February 1997, the fact that more than 50% of the voters in Oregon voted for it mandates that healthcare providers listen to their patients. Patients want more control of their pain, the way they die, and the resources spent on their care in the final days of their lives. Thoughts of future suffering engender great fear on the part of healthcare consumers. Concern exists that physician-assisted suicide in the ICU will affect not only physicians but also nurses, pharmacists, respiratory therapists, and other clinicians as terminally ill patients make requests for assisted suicide while in the acute and critical care setting of the hospital. Critical care nurses must examine their value systems, review the Code for Nurses, and make their own decisions about participation in deliberately ending lives of patients. With the impending Supreme Court decision due in July 1997, the court may leave these issues to the individual states, opening the door for assisted suicide to occur throughout the United States. Therefore, the possibility will remain that critical care nurses may be put in positions in which physicians are providing assistance to patients who wish to commit suicide and are requesting nurses' assistance to do so.

Malignant hyperthermia.

Although MH is a rare disease, occurring 1 in 7000 to 14,000 anesthetics in children and one in 50,000 to 200,000 anesthetics in adults, the critical care nurses must possess knowledge of its causes and treatment. MH can be potentially fatal. With aggressive intervention, both morbidity and mortality will be reduced.

Ethical issues in critical care: a nursing model.

The role of critical care nurses in relation to ethical issues has become increasingly complex. An original nursing model for addressing ethical issues at the bedside is described in this study. A case study incorporating ethical conflicts demonstrates use of this model.