An exploratory pilot study of nurse-midwives' attitudes toward active euthanasia and abortion

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Abstract

Over the past three decades, active euthanasia and abortion have received increasing international attention. Since both these practices are relevant to the role of the nurse-midwife, it is important to know what influences their attitudes towards them. Therefore, the purpose of this study was: 1, to survey the attitudes of nurse-midwives' to active euthanasia and its legalization; 2, to determine the relationship between nurse-midwives' attitudes toward active euthanasia and its legalization, and attitudes toward abortion, self-reported religiosity and religious affiliation. The study setting was an international midwifery conference and the sample consisted of 139 nurse-midwives attending the conference. The majority of nurse-midwives displayed a positive attitude toward active euthanasia and its legalization. In addition, there was a positive relationship between their attitude to abortion and active euthanasia. Self-reported religiosity and religious affiliation were significantly related to attitudes toward active euthanasia and its legalization. An interesting positive relationship between country of practice and attitudes to euthanasia was also found. Nurse-midwives practicing in countries with more liberal euthanasia and assisted suicide legislation were more supportive of active euthanasia. With the increasing acceptance of active euthanasia's legalization, the results of this study pose some ethical questions that nurse-midwives internationally will have to consider.

Introduction

In a world where rationed care, as well as quality of life issues are gaining increasing attention, the practice of active euthanasia and abortion play critical roles for health care providers and policy makers (Markle, 1992). Each year there are an estimated 26 million legal abortions and an additional 20 million illegal abortions performed world wide (“Rate of Unplanned Pregnancies High”, Population Today, 1999). Active euthanasia and physician assisted suicide are also gaining increasing acceptance internationally. In the Netherlands, over 18% of all deaths in 1995 were the result of intentioned acts by physicians to shorten or end life (Jochemsen and Keown, 1999). In Australia, the first legislation that legalized active euthanasia was enacted (Kitchener and Jorm, 1999). In Germany, although active euthanasia is illegal, assisted suicide has been legally permissible since 1751 (Battin, 1992). With the increased acceptance of these practices, it is important for the nursing profession to determine the factors that will influence attitudes towards their practice and what role nurses should and are willing to play in the performance of these practices.

The nursing profession's perspective on abortion and active euthanasia profoundly affects nursing practice. This change in perspective and practice may be seen in the change in policy of the American College of Nurse-Midwives (ACNM) towards abortion. In 1970, the ACNM stated that abortion was a procedure that should only be performed by a physician (Summers, 1992). In 1991, in their “Statement on Abortion” this statement was rescinded (Summers, 1992). This opened the doors to the possibility of nurse-midwives including the performance of abortion in their practice. In a nation wide survey conducted by the American College of Nurse-Midwives to study their membership's attitudes to abortion practices, 79% stated that they supported unlimited access to abortion and 52% supported abortion practice by nurse midwives (McKee and Adams, 1994). In a nationwide study conducted on American oncology nurses' attitudes to physician assisted suicide, although 49% of the sample were supportive of physician assisted suicide only 15% were willing to administer the fatal drug (Young et al., 1993). However, like abortion, it is possible that in the future both active euthanasia and physician assisted suicide will be included in the advanced practice role of nurses involved in these areas. It has already been hypothesized that in places where active euthanasia will be legalized nurse practitioners may be obliged to write prescriptions for lethal drug (Hall, 1996). In addition, nurses who are involved with the care of terminally ill patients may be faced with the possibility of performing or being accessories to the performance of active euthanasia (Musgrave, 1998).

What are the factors that may influence nurses' attitudes to active euthanasia? Ho and Penney (1991) conducted a survey among Australian adults to determine what personality correlates might influence attitudes toward the termination of life. They found a significant positive relationship between attitudes toward active euthanasia and abortion (Ho and Penney, 1991). Religious beliefs have also been shown to influence attitudes to active euthanasia. Nurses with strong religious beliefs are less likely to agree with the practice of active euthanasia or its legalizaiton (Richardson, 1994, Shuman et al., 1992). In addition, individuals who believe that God has the power to control and govern life are less likely to support abortion and physician assisted suicide (Ross and Kaplan, 1993–1994).

Although, active euthanasia and physician assisted suicide may not appear to play a part in the current role of nurse midwives, it is conceivable that in the future they may be involved with decisions related to life taking measures to end the life of severely deformed infants (Pellegrino, 1989). Before this happens midwives should examine their professional and personal values to determine what stance they should take. With the exception of a nursing study conducted in 1971 which demonstrated that nursery, post partum and delivery room nurses were among the nurses who least desired change in the legal, social or medical practices of abortion and active euthanasia (Brown et al., 1971), little research has been conducted among midwives regarding attitudes toward their active euthanasia and what may influence these attitudes.

This study was conducted to more clearly determine what characteristics influence the current attitudes of nurse-midwives to active euthanasia and the relationship between their attitudes to active euthanasia and abortion. It was hypothesized that there would be:

  • 1.

    a positive relationship between midwives' attitudes to active euthanasia and its legalization, and their attitudes to abortion; and

  • 2.

    a positive relationship between nurse-midwives' attitudes to active euthanasia and its legalization, and their self-reported religiosity and religious affiliation.

Section snippets

Sample and setting

This study's sample was a convenience sample derived from midwives attending an international midwifery conference held in 1996. At that time permission to conduct the research was not required by the conference board. Two hundred questionnaires were distributed by four midwives attending the conference. Those subjects who volunteered to participate in the research study either returned their completed questionnaires to the midwives who had distributed the questionnaires during the conference,

Demographic data

Midwives were mainly female (n=138/139), employed full time (74.2%) and in direct patient care (65.6%). They practiced in 27 different countries, with the greatest number practicing in the UK (20.1%), the USA (18.7%) and Australia (12.7%). The largest group (40.5%) worked as midwives in an inpatient setting. The average age of the midwives was 42.6 (range 24–80), with an average of 14.3 years experience in midwifery (range 0–28 years). Over 49% had a baccaulerate degree or higher. No

Discussion

Midwives attitudes' to active euthanasia in this study were generally positive. They were more positive than those of American registered nurses (Kowalski, 1997) but were similar to those of Australian nurses (Kitchener and Jorm, 1999, Kuhse and Singer, 1993). The difference in attitudes may have been due to the countries in which they practiced. Also nurse-midwives' in this study displayed a more positive attitude than those of oncology nurses (Richardson, 1994, Young et al., 1993). These

Conclusion

With the legalization of active euthanasia gaining increasing acceptance internationally, nurse-midwives will be faced with the possibility having to be involved with the performance of euthanasia on severely malformed and brain damaged infants. They will need to ask themselves where they are willing to draw the line. Are they willing to only assist in such a practice? Would they be willing to administer the means that would end the infant's life? Under what circumstances would they be willing

Acknowledgements

The authors want to express their appreciation for the help that Shoshi Kalishek, Ditta Golan and Nava Brauverman gave in the data collection phase of the study. The authors would also like to thank Dr Freda DeKeyser for her assistance with the editing and statistical analysis and Eli Smadja for his help in data analysis.

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