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Aid in Dying: The Role of the Critical Care Nurse

W the term chronic critical illness is reserved for patients who require more than 21 days of mechanical ventilation or who have been discharged from the intensive care unit (ICU) after requiring at least one lifesaving technology,1-3 the walls of the ICU are no longer the boundaries for where critically ill people are treated and cared for.4,5 Those with chronic, debilitating, incurable illness now commonly are found outside the ICU, with intermittent admissions to ICU for critical illness. Some posit that it is our duty as critical care nurses to seek to understand what patients and families experience once they leave our care and to advocate on their behalf when necessary. The patient–nurse relationship built through the crisis of critical illness allows us to gain a unique knowledge of the patient’s goals, preferences, and values over time. Critical care practitioners may best understand how and why these patients are suffering, the intensity and origins of their pain,4,5 and the valuedriven goals of care. In addition, because of the nature of critical illness, patients or their families may ask the ICU nurse about ending their own life, or what is called aid in dying (AID). Therefore, when competent patients intentionally choose the timing and circumstance of their death, critical care nurses must understand the intricacies of the nurse’s role in removal of nonbeneficial treatment versus the nurse’s role in requests for AID. The purpose of this column is to prepare critical care nurses when put in this situation, respond appropriately.