The spiritual care provided by nurses is not obvious. The literature on spiritual care within the context of palliative care nursing is sparse and contradictory. None of the research is from the Canadian perspective. Thus, this project examined the meanings made by palliative care nurses as they provided spiritual care to people who were dying at home. This qualitative study utilized the methodology of the naturalistic inquiry. From a population of 47 Canadian palliative care nurses who provided home nursing in Kingston, Ontario, Canada, six nurses participated in semi-structured conversations about their experience of providing spiritual care within the context of palliative care. Three major themes emerged : the nurses' focus of spiritual care on the time surrounding the dying and the death; the nurses' beliefs about spirituality, religion, and their own work; and the nurses' evaluation of their caregiving as evidenced by the 'Good Death'. The nature of the nurses' spiritual care was of guiding, doing the unusual, relating to distress as well as relating to the one cared-for with love and friendship. The nature of the spiritual care is discussed from the perspective of caring as moral grounding and cultural imperative. Consideration is given to empowering nurses through liberating the ethic of care. What the nurses know about spiritual caregiving is looked at through the framework of the art of nursing, the nurses' beliefs about spirituality, and the hidden work of nursing. As well, the nurses' evaluation of their spiritual caregiving resulting in 'good death' and 'death with dignity' is explored. Noting incongruence between the nurses' personal beliefs and religiosity and what they want for their patients, the author offers the possibility that caregiving itself has become the religious expression of the nurses. Implications for nursing encompass the education of nurses, the practice of nursing, as well as the inclusion of nursing knowledge at the policy and budgetary levels. Nursing education must change, from talking about wholistic care, to teaching how to care for the whole person by including care of the spirit in the curriculum. Nurses who have knowledge and experience in caring for spiritual distress need to share their knowledge and start the process of mentoring other nurses into the practice of truly wholistic care. As well, nurses must become advocates and educators at the institutional and governing levels in order that human needs, including spiritual needs, are included in the decision making about health care policy and budgets / Master of Nursing (Hons)

This dissertation takes as its central topic visual narratives in Death with Dignity Storytelling and posits the author’s ideas of a beautiful death and the heard gaze. Its methodology includes a textual analysis of such images, which in turn leads to a typology, and the use of a digital tool to “sum images” to test the veracity of the typology. What creates the impulse to look at images of pain, suffering the withering body, the compulsion to bear witness to misery? That question is in part answered by Sontag (2003) Regarding the Pain of Others—“we are spectators of calamities” (p. 18)—and is evident in the indefinite pronoun that hangs at the end of the slim volume’s title. Because it is in those others, that we see ourselves. A Beautiful Death: Visual Representation in Death With Dignity Storytelling considers two case studies as examination and proofs of its claims.

abstract: Advocacy groups work across many aspects of “death with dignity” practice and treatment, and provide insight across multiple aspects of “death with dignity”. This study argues that key advocacy groups in the American death with dignity movement influenced the broader conceptualization of death with dignity in a way that makes patients more able to achieve it. This influence has been a dynamic process across different periods of practice starting the discussion of “death with dignity” in 1985 through today, although this thesis extends only to 2011. The question in this study is how do the three main historical advocacy groups in the US: the Hemlock Society, Compassion in Dying, and Compassion and Choices, conceptualize death with dignity with regards to patient and doctor relationship, legal and policy factors, and medical technologies and protocols? This study found that the Hemlock Society (1980-2005) characterized death with dignity as a terminally ill patient being able to “self-deliver” from suffering via autoeuthanasia regardless of medical community approval or legality. Compassion in Dying (1993-2007) characterized death with dignity as involved advocacy work with terminal patients and their communities to pursue palliative care and hospice up to the point of assisted death. This organization was also involved in the passing of Oregon Death with Dignity Act. Compassion and Choices (2007-present) characterized death with dignity similarly to Compassion in Dying but also advocated for adequate management of pain and suffering symptoms in palliative care to prevent people from desiring death over the illness. Conceptualizing death with dignity is important for understanding why patients want death with dignity and better accommodating their end of life needs when they are suffering with terminal illness. / Dissertation/Thesis / Masters Thesis Biology 2019

Oregon’s Death with Dignity Act: An Evidenced-Based Approach to Improving End-of-Life Healthcare in Tennessee Erin E. Mauck, MA Community and Behavioral Health, College of Public Health East Tennessee State University Johnson City, TN The legalization of physician-assisted death has been shown to improve the quality of end-of-life healthcare in the states that have passed Death with Dignity or End-of-Life Care Acts. The state of Oregon passed its Death with Dignity Act in 1994, and it is a model that has been replicated in Washington, Vermont, California, Colorado, and Washington D.C. In a national ranking of states in the areas of long-term services and supports for end-of-life care, five of the top nine were states with either a Death with Dignity or End-of-Life Care Act. This is not merely a coincidence. This data is a clear reflection that having legislation which clarifies the rights of a dying individual, impacts end-of-life healthcare in a positive way. Tennessee is currently ranked 47th nationally based on the following criteria: affordability and access, choice of settings and provider, quality of life and quality of care, support for family caregivers, and effective transitions. There are three major determinants that impact Tennessee’s poorly rated end-of-life health care. The first determinant is the limited use of advanced directives, living wills and patient-physician discussions about death, dying, and end-of-life healthcare choices. The second determinant is lack of coverage for the uninsured and less affluent. End-of-life healthcare is not strictly for individuals over the age of 65, terminal illness can impact the life of someone, regardless of age, income, or health insurance status. The third major determinant that is negatively impacting Tennessee’s end-of-life health care, is the lack of a Death with Dignity or End-of-Life Care Act. Data has been collected over the past 36 months, including data from secondary sources and field research data collected in Oregon, including 14 in-depth interviews with volunteers, employees, and the directors of two advocacy organizations at the center of Oregon’s Death with Dignity Act. The analysis of this data shows that states which have enacted Death with Dignity Acts, have better end-of-life care than states that have not. This includes the use of hospice and palliative care at the end of life, and the percentage of people who die at home. When a law that legalizes physician-assisted death is being considered, everyone, including citizens of the state, state policy makers, and healthcare professionals take notice. This encourages the public education of end-of-life healthcare options, as well as promotes further education in end-of-life care for all health professionals. In Tennessee, efficient and regulated end-of-life care is becoming more essential as the population increases, and life expectancy is extended.

Résumé Euthanasia is and always will be a hot topic of very heated debate among both non specialists and experts. The purpose of my thesis is to provide the reader with information about euthanasia and a list of rules dealing with the issue of euthanasia in selected countries. The introduction outlines the problems of euthanasia. The second chapter is devoted to clarifying the content of the notion of euthanasia, which comes from the Greek word for the phrase, "eu" meaning good and "thanatos" meaning death, a "good death", sometimes we can also meet the looser translation of euthanasia as a beautiful death. The content of the notion of euthanasia in the course of history changed. Today we see euthanasia as an act which one person intentionally ends the life of another person's own request with the intent to end her suffering. In the chapter are identified and defined forms of euthanasia, especially active and passive. The third chapter deals with the European Union's attitude to euthanasia. No law of the European Union explicitly addressed the euthanasia. Health policy in principle falls within the competence of national governments. And every Member State has its own position on the issue of euthanasia. In this chapter, I mention the idea and recommendations of the Council of Europe, though it isn't the...

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As aid-in-dying legislation expands across the United States, this study examines the dynamics influencing participation in Oregon’s Death with Dignity Act. In addition to data from secondary sources, this thesis analyzes field research data collected in Oregon, including 14 in-depth interviews with volunteers and employees of two advocacy organizations at the center of legalized physician-assisted death. Themes emerged including the conditions that motivate participation, the importance of both personal and professional autonomy, the significance of a good death, and the growth of open dialogues about end of life choices. This thesis concludes with a discussion of the impact Death with Dignity laws could have across the United States, with a specific focus on the state of Tennessee.

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.

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

Thesis advisor: Marc Landy / The “Death with Dignity Act,” if passed in November 2012 in Massachusetts by means of a ballot initiative, would have allowed doctors to prescribe lethal drugs to patients with fewer than six months to live. Introduced by two pro-assisted suicide organizations from the Pacific Northwest, the initiative was expected to take advantage of a political “perfect storm” brewing in the Bay State. A blue state in a presidential election year, with President Obama at the top of the Democratic ticket, Massachusetts was expected to produce an electoral outcome favorable to assisted suicide. Oregon and Washington State had legalized physician-assisted suicide in 1998 and 2008, respectively. Polling in 2011 showed a 2-1 majority among Massachusetts voters in favor of assisted suicide. Nonetheless, the Archbishop of Boston and the Bishops of Worcester, Fall River and Springfield, organized as the Massachusetts Catholic Conference, took up the challenge to oppose the initiative. Relying on the expertise of paid political consultants, they mounted a two-tiered campaign. An internal component, directed at Catholics, included the dissemination of over 2 million pieces of in-print and electronic materials urging a “no” vote on the measure. An external component, directed at the wider public, relied on a coalition of organizations representing the three major religions, health and hospice organizations, disabilities rights activists, and pharmacists. Using “flaws” in the bill identified through strategic polling, they appealed to voters even sympathetic to assisted suicide to reject the bill. When the votes were counted 2.7 million Massachusetts citizens voted on the physician-assisted suicide initiative and it was defeated by 67,891 votes, 51.1% to 48.9%. One key to the defeat was the split in the vote in the city of Boston, where Question 2 was defeated 50.9% to 49.1% . Twelve of Boston’s 22 wards voted against the measure. Leading the way among the twelve were Dorchester, Roxbury, and Hyde Park, traditionally black, liberal Democratic strongholds. This study shows that even the most effective, well-funded, Church-initiated campaign in Massachusetts in 2012 might well have foundered on the 2-1 majority in favor of assisted suicide at the polls, not for the strategic identification of “flaws in the bill,” the broad-based coalition campaign based on them, and the “split in the vote in the black community in Boston.” . / Thesis (PhD) — Boston College, 2021. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Political Science.