Aim: Explore nurses’ values and perceptions regarding the practice of medical aid in dying. Background: Medical aid in dying is becoming increasing legal in the United States. The laws and American Nurses Association documents limit nursing involvement in this practice. Nurses’ values regarding this controversial topic are poorly understood. Methodology: Cross-sectional electronic survey design sent to nurse members of the American Nurses Association. Inductive thematic content analysis was applied to open-ended comments. Ethical Considerations: Approved by the institutional review board (#191046). (...) Participants: 1213 nurses provided 3639 open-ended comments. More than 80% of participants self-identified as white 58% held a graduate degree; and half were of Christian faith. Results: Values ranged on a continuum expressed through four themes: “Honoring Patient Autonomy without Judgment,” “Honoring with Limitations,” “Not until...,” and “Adamantly against.” Some felt it was a duty to honor the patients’ wishes, set aside own beliefs, and respect patients’ choices often with a spiritual connotation. Nurses held concerns about the process, policy, potential psychological harm, legal risk, and the need to learn more about MAID. Nurse who were adamantly against MAID associated the practice with murder/suicide and against religious beliefs. Disparate values were expressed about changing the MAID legislation to allow patient support with taking MAID medications and allowing MAID via advance directive. Conclusions: Nurses desire more education on MAID. There is not one universally held position on the nurse’s role during MAID. Healthcare policy/standards need to accommodate the wide variation in nurses’ values. Implications: Nurses desire education regarding their role in MAID. Nurses are encouraged to participate in policy discussions as the practice becomes increasingly legal. Managers need to expect that nurses, patients, and families will need psychological support to participate in MAID. Careful construction of policy/standards is needed to minimize conflict, moral distress, and psychological harm amongst nurses. Further research is needed. (shrink)

It is frequently contended that one of the gravest dangers of the future of civilization is that the organization of society will be carried so far as to imperil, if not indeed to destroy, social and individual liberty. If this is actually true, we seem compelled to choose between these two ends—either, that is to say, to subordinate or sacrifice freedom, or to minimize organization.

Not in the lay mind only, but also to a wide extent throughout the realm of Science itself, there exists the belief that no matter how thoroughly research is pursued, it can never yield anything more than descriptions of whatever it may be concerned with. Undeniably, such descriptions are becoming so complicated in detail, and at the same moment so far-ranging in their applications, that they inevitably assume the aspect of more or less final explanations; and previous investigators often regarded (...) them as being actually explanatory, finding indeed in this supposed result one of the most powerful impulses to carry their inquiries to their utmost limit. This however, it is frequently contended, is at best a short-sighted error and at worst a misleading superstition; the truth, no matter how unwelcome it may seem, being that explanation is unattainable because it is a wholly non-scientific category and ideal. If then we wish to discover any sufficient reason, any ultimate ground, any final solution, we must turn from Science to Philosophy; and even so, many sceptics do not hesitate to add, we are foredoomed to disappointment. (shrink)

The problem of the nature and scope of Causation has again been raised into prominence by recent research on atomic structures and processes, the result being that many physicists maintain that the causational principle must now be restricted to macroscopic changes regarded as the averaged outcome of microscopic events, each of which alone may not be causally determined, or at least not completely so. Of this markedly new departure Professor Eddington is perhaps the best-known advocate. “Physics,” he asserts, “is no (...) longer pledged to a scheme of deterministic law; the search for a scheme of strictly causal law not practical politics.” But the issue concerns not Physics only, for Dr. Eddington at once proceeds to interpret his viewpoint by contending that “science withdraws its opposition to free will”; and thus the realms of consciousness and conduct are once more brought into intimate connection with the realm of physical phenomena. It must of course be recognized that the question still remains highly debatable; for, as Sir Oliver Lodge has recently urged, “break down causality, and we are left with chance. That is wholly unsatisfactory. Chance is no solution”; and he likewise expands his survey beyond Physics by adding, “not in that way would I aim at freedom.” It is scarcely necessary to refer to current controversy in the biological sphere, between those who regard living processes as falling, if only to some degree, outside the domain of causal action, and those who insist that such action is universal, the indubitable proof of their position being prevented only by the difficulties of investigation. (shrink)

Few current problems have become so confused as that of Value. Its increasing importance in all departments of modern thought has made it the focal point of so many diverse aspects that the result seems a mass of formidable contradictions. But these can never be overcome by attempting to simplify the situation, which must on the contrary be recognized from the outset as presenting an extreme complexity that will inevitably advance pan passu with the advancing complexities of human experience. If, (...) then, simplification is impossible, the only alternative is to attempt to grasp the salient features and present these in their true relation, in the same way that an invading army seizes the principal bases of hostile territory. (shrink)