Bakgrund: Dödshjälp är ett debatterat ämne som berör sjuksköterskans arbetsuppgifter. Flera länder och stater har legaliserat dödshjälp. Dödshjälp kan ses som ett sätt att respektera patientens önskemål, att lindra lidande och bevara värdighet. Det kan även ställas mot vårdpersonalens egen autonomi eller ICN:s etiska kod som menar att sjukvårdens uppgift är att lindra och bota sjukdom och inte skada patienten. Vårdpersonal beskriver svårigheter i att hantera situationer där dessa komponenter på olika sätt ställs emot varandra. Syfte: Syftet var att belysa sjuksköterskans erfarenheter upplevelser och faktorer som kan påverka upplevelser av att arbeta med personer som önskar eller kommer att genomgå dödshjälp. Metod: En litteraturöversikt i enlighet med Friberg genomfördes. Resultatet byggde på tio originalartiklar som togs fram genom systematisk sökning. Analysen genomfördes genom tematisering och färgkodning.   Resultat: Arbetet med dödshjälp upplevdes olika beroende på vilken typ av dödshjälp som genomfördes, patientens och anhörigas upplevelser, deltagandet i beslutsfattandet, etiska koder och lagar som gällde samt sjuksköterskornas egna värderingar och erfarenheter. Detta ledde till både positiva och negativa upplevelser för sjuksköterskan. Dessa upplevelser kunde också hanteras genom formellt eller informellt stöd, vilket i sin tur bidrog till sjuksköterskans upplevelser. Diskussion: Resultatet diskuteras utefter Travelbees teori om den mellanmänskliga relationen och hur vårdandet utan roller kan bidra till en bättre vård, men även påverka sjuksköterskans upplevelser av vården. Dessutom diskuteras om hur sjuksköterskans egna värderingar och erfarenheter påverkar upplevelserna i vården. / Background: Euthanasia is a debated subject that concerns nurses’ duties. Several countries and states have legalized euthanasia. Euthanasia can be seen as a way of respecting patients wishes, relieving suffering and preserving dignity. However, it can also be considered against healthcare personnels own autonomy or ICN ethical code, which means that the health care task is to alleviate and cure and not harm the patient. Healthcare professionals describe difficulties in dealing with situations where these components differ in a variety of ways. Aim: The aim of the study was to highlight nurses’ experiences and factors that may affect experiences of working with people who want or will undergo euthanasia.  Method: A literature review according to Friberg was conducted. The result is based on ten original articles that were obtained through systematic search. The analysis was conducted by thematization and color-coding. Results: Workning with assistens in death was experienced differently depending on the type of euthanasia that was carried out, the experiences of patients and relatives, participation in decision making, ethical codes and laws, as well as nurses’ own values and experiences. This led to both positive and negative experiences for the nurse. These experiences could also be managed through formal or informal support, which in turn contributed to nurses’ experiences. Discussion: The discussion is based on Travelbees theory of interpersonal relationships and how care without rolls can contribute to better care, but also affect nurses’ experiences of care. In addition, there is discussion about how nurses own values ​​and understandings affect experiences in health care.

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The paper explores historical positions on suicide and philosophical, theological, and moral positions on physician-assisted suicide and euthanasia. In 1900, most people died from infectious diseases, which have relatively short periods of morbid decline. With advances in the biomedical sciences, people are living longer, and most people die from chronic diseases, which are usually accompanied by prolonged periods of morbid decline. In addition to living longer, people today are generally more individualist and seek methods to control many aspects of life. While assisted death is rarely used, it represents a means to control end-of-life suffering. The paper demonstrates that there is substantial opposition to assisted death among philosophers, theologians and bioethicists. The paper also argues that improved education about end-of-life palliative alternatives would alleviate fears about end-of-life suffering. The thesis is that the use of palliative alternatives is morally and ethically superior to physician-assisted suicide or euthanasia.

Physician assisted suicide (PAS) has been a legalized presence in the United States since Oregon first passed the Death with Dignity Act in 1994. Now PAS is legalized in six states and it is realistic that nurses may encounter PAS during their career. This project explores pre-licensure nursing student attitudes toward PAS. A mixed method design incorporating descriptive correlation and thematic analysis of an open-ended question was used. Surveys were sent to 550 nursing students enrolled in the UCF nursing program asking participants to complete the 34-question survey. This survey included a 12 item “Domino scale” on student nursing opinions toward physician-assisted suicide, and a 23-item demographic scale. Complete, usable results were obtained from 231 participants. Demographic data revealed that the typical participant was between 18 and 25 years of age (80%), female (82%), single (87%), white (69%), in their first two semesters of the nursing program (60%), and unemployed (56%). The total scores for the Domino scale indicated a mean of 40. Regression analyses found that participant experience of someone having asked for help with PAS, and participant religiosity were significant predictors (F = 9.82, p = .0019; and F= 160.36, p < .0001) respectively of nursing student opinions on PAS as measured by the Domino scale. Qualitative analysis produced the following themes related to participant opinion on the nurse’s role in PAS: ways nurses can help with PAS, nurses should not be involved with PAS, clarification and delineation of the PAS process, the preservation of autonomy, the need for more education and inaccurate assumptions of PAS. This study showed that nursing students are moderately in support of PAS and willing to provide care to patients who are terminally ill regardless of a his or her personal decisions regarding PAS. Participants also comment that they desire additional education. Suggestions for further education, practice enhancements, research and policy development are discussed.

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Since passing its Death with Dignity Act into law in 1997, Oregon remains the only state in America to make physician-assisted suicide an explicit legal right. Currently, the legality of physician-assisted suicide falls under the jurisdiction of each individual state. Had the United States Supreme Court ruled differently in a recent case, however, the issue would have transferred to federal jurisdiction. The Death with Dignity National Center (DDNC) takes responsibility for developing the original Death with Dignity Act and has since moved on to proposing similar legislation in other states. It also champions states' rights, fearing that placing physician-assisted suicide under federal jurisdiction would severely hinder its goals. The DDNC has led the legal movement for making physician-assisted suicide an end of life choice available in each state, as well as for keeping that decision at the state level. Utilizing a content analysis, this study coded for frames used by the DDNC in its press releases and frames used in newspaper coverage of death with dignity across the same period of time. It was found that press releases about and newspaper coverage of the death with dignity social movement shared significant correlations in terms of the frames each used, as well as the level of substance given to these frames. Few significant correlations were found, however, for frame valence. It seems as though discussion of this social movement utilizes the same substantive or ambiguous frames, but cannot decide whether these frames are positive, neutral, or negative. / Master of Arts

Bakgrund: Dödshjälp är endast lagligt i ett fåtal länder och stater i världen, men det förekommer att patienter förmedlar en önskan om dödshjälp till vårdpersonal, även i andra länder. Läkare beskriver bördan med att hantera förfrågningar om dödshjälp och försöker undvika dessa genom att behandla patienters fysiska samt psykiska behov. Anhöriga till individer som dött genom dödshjälp, menade att den döende individens livskvalitet förbättrades i slutet av deras liv relaterat till beslutet gällande dödshjälp. Syfte: Att beskriva sjuksköterskors attityder till, samt erfarenheter kring dödshjälp. Metod: En litteraturöversikt, i enlighet med Friberg genomfördes. Systematisk sökning har utförts i databaserna CINAHL Complete och PubMed. Resultatet av översikten baseras på 13 originalartiklar.  Resultat: Sjuksköterskors attityder varierar oavsett om de arbetar i länder där dödshjälp är lagligt eller inte. Tendenser tyder på att sjuksköterskor är mer positivt inställda till eutanasi än läkarassisterat självmord. De underliggande aspekter som påverkar sjuksköterskors attityder grundas på deras personliga värderingar utifrån professionell kunskap, erfarenheter och religiösa övertygelser. Sjuksköterskor kan rättfärdiga sina handlingar genom så kallad dubbel-effekt, där goda handlingar utförs trots att det kan leda till negativa konsekvenser. Palliativ vård fungerar som preventiv strategi, vilket tidvis minskar antalet förfrågningar om dödshjälp. Diskussion: Resultaten är diskuterade utifrån Beauchamp och Childress etiska principer, samt vårdande utifrån deras tolkning av vårdande etik. Det uppstår konflikter mellan sjuksköterskors personliga värderingar, yrkesprofessionella kunskap, lagar och de etiska principerna i vårdandet av döende individer med obotliga sjukdomar.

This thesis defends an individual's moral right to be aided in dying by a physician (that is, voluntary active euthanasia, or VAE), but departs significantly from the view in its favor generally accepted in the bioethics literature. The prevailing view appeals to both respect for an individual's autonomy and promotion of an individual's well-being as necessary conditions for a right to VAE, so as to justify the right only for those suffering grave illnesses and/or disabilities. The author argues that such a view is logically untenable; one or another aspect must be given up. Since invoking the premise that certain individuals would be better off dead necessarily relies on controversial assumptions about both the value of life and the nature and value of death, about which reasonable people disagree, it is the justification from an individual's best interest which must be excluded in a liberal society. The author endorses a self-determination justification for the right to VAE, but rejects understanding this in terms of respecting personal autonomy, instead making the case for a right to VAE grounded in self-ownership. The author's main conclusion is that the right to VAE is a general right applying to all competent adults, not only those suffering grave illnesses or disabilities, or those whose choice for VAE is an exercise of autonomy. Moreover, by analyzing the basis of physician authority over prescription medicine and how this can be justified to a society of self-owners, she maintains that individuals have not only the right to choose VAE without state interference, but also the right to be provided VAE by doctors. Nevertheless, both rights are compatible with reasonable limitations to protect both the interests of VAE seekers and the rights of others.

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The thesis deal with the topic of induced abortion and euthanasia as the basic issue of the theme of process of dying and death. The theoretical part presents how an acceptation of death have been changing during the human history, deals with the concept of after-life in five world religions, presents how death is perceived in different life period, gives the analysis of abortion and euthanasia as an issue of ethics. The second part od the thesis is to serve as the background material to design lessons of ethics for the secondary schools according to the RWCT program (Reading and Writing Critical Thinking). The aim is to depict the topicality and importance of these issues that a disciple is not only to meet during the lesson, but also to be able to handle, to judge and to draw conclusions for his behaviour.