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JONAS Healthc Law Ethics Regul. 2013 Apr-Jun;15(2):80-8; quiz 89-90. doi: 10.1097/NHL.0b013e3182919e81.

Advanced practice registered nurse intended actions toward patient-directed dying.

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Department of Nursing, The University of Vermont, Burlington, USA.


Patient-directed dying (PDD) (also known as physician-assisted suicide) has been a heavily debated issue in the United States since the passing of the Death With Dignity Act in Oregon in 1997. Previous research surrounding PDD has been limited to assessing the attitudes of physicians, nurses, and patients. The purpose of this study was to describe the intended actions of advanced practice registered nurses (APRNs) toward initiating PDD discussions and prescribing a lethal dose of medication under PDD legislation. A survey design was used to guide this pilot study. An investigator-developed questionnaire was disseminated electronically to APRNs on a free professional Listserve in a rural northeastern state. The final sample was composed of 16 APRNs whose area of certification were identified as 63% family, 31% adult, 6% psychiatric/mental health, and 13% other. Hospice and palliative care employment experience was reported by 75% of the sample.


The APRN subjects were more willing to engage in PDD discussions than to prescribe under PDD legislation. The APRNs reported an increased willingness to initiate discussions and prescribe when patient pain and suffering were explicitly stated. Seventy-five percent of APRNs viewed their personal and professional opinions regarding PDD to be synonymous even though 50% were unsure as to whether PDD was consistent with the American Nurses Association (2001) Code of Ethics for Nurses.


Advanced practice registered nurses reported increased intent to discuss than actively participate through means of prescriptive authority under PDD legislation. The depiction of pain and suffering may have an impact on APRN intention to act in cases of PDD.


Increased awareness and education surrounding professional codes for APRNs, particularly regarding PDD, are needed.

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