Ethics and law However, supporters contend that these
changes represent a deeper recognition of autonomy and the subjective nature of suffering.7
Canada therefore raises a critical question: does expansion signify ethical progress, or does it reveal systemic failures in healthcare and social support?
Europe: divergent models and ethical boundaries Europe presents a diverse legal landscape. Countries such as Switzerland, the Netherlands, Belgium, Luxembourg, Spain, and Austria permit some form of assisted dying. Switzerland, which legalised assisted suicide in 1942, allows individuals – including foreigners – to access services, provided there is no selfish motive.8 In contrast, the Netherlands and Belgium permit euthanasia as well as assisted suicide, including for non-terminal conditions and, in limited cases, minors. These laws prioritise relief from “unbearable suffering,” broadening eligibility beyond life expectancy. Spain and Austria represent more recent developments, with differing approaches to administration – Spain permitting clinician administration, while Austria requires self-administration. These variations reflect differing cultural and ethical priorities, particularly regarding autonomy, medical responsibility, and the definition of suffering.
Ethical principles and tensions in nursing practice Nursing practice is grounded in four key ethical principles: autonomy, beneficence, non-maleficence, and justice.9
challenges all four simultaneously. l Autonomy supports a patient’s right to choose death.
l Beneficence supports relieving suffering. l Non-maleficence raises concerns about causing harm.
l Justice requires protection of vulnerable groups.
These principles often conflict in the context of assisted dying, creating moral uncertainty for nurses. The Nursing and Midwifery Council Code requires nurses to prioritise patient wellbeing while preserving safety and professional integrity.10
Assisted dying complicates this
mandate, particularly when preserving life may conflict with respecting patient wishes.
Moral distress and professional identity A significant implication for nurses is moral distress, which arises when individuals feel unable to act in accordance with their ethical beliefs.11
16
www.clinicalservicesjournal.com I June 2026
In assisted dying contexts, nurses may experience: l Conflict between personal values and professional duties
l Emotional strain from participation or non- participation
l Tension within multidisciplinary teams
Over time, unresolved moral distress can contribute to burnout, reduced job satisfaction, and workforce attrition.12
Assisted dying
Communication, advocacy, and power dynamics Nurses play a critical role in patient communication and advocacy. Patients may express a desire to die during periods of acute distress, pain, or psychological suffering. This places nurses in a complex position: l They must respond with empathy l Assess underlying causes such as depression or inadequate symptom control
l Ensure decisions are informed and voluntary
Power dynamics are central to this role. Vulnerable individuals – including the elderly, disabled, or socially isolated – may experience subtle pressure, even in the absence of overt coercion.13
Nurses therefore act as safeguards,
ensuring that autonomy is genuine rather than constrained by circumstance.
Assisted dying and palliative care: conflict or complement? A key debate is whether assisted dying undermines or complements palliative care. Critics argue that legalisation may reduce investment in palliative services, framing assisted dying as a response to systemic shortcomings. Supporters contend that both can coexist, with assisted dying providing an additional option when suffering cannot be
Emotional and psychological impact End-of-life care is inherently emotionally demanding. Assisted dying may intensify this burden. Nurses may experience: l Grief and emotional fatigue l Ethical reflection and uncertainty l Psychological stress related to participation
Healthcare organisations must provide appropriate support, including supervision, debriefing, and access to mental health resources.
Conclusion Assisted dying represents one of the most profound ethical challenges in modern healthcare. While legal frameworks continue to evolve globally, the core tensions between
Legal accountability and clinical practice If legalised, assisted dying would require nurses to operate within strict regulatory frameworks. Responsibilities may include: l Supporting assessment processes l Coordinating care l Providing end-of-life support to patients and families
Failure to adhere to legal and professional guidelines could result in disciplinary or legal consequences. Ongoing education and clear institutional policies would therefore be essential.
alleviated.14
For nurses, this debate is particularly
significant, as they are central to delivering palliative care. Ensuring access to high-quality symptom management and psychosocial support remains a fundamental responsibility regardless of legal context.
Courtney/
peopleimages.com -
stock.adobe.com
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72
