European nurses' attitudes towards assisted death: A scoping review

Assisted death, which encompasses euthanasia and assisted suicide, remains a contentious ethical and legal issue across Europe. As frontline healthcare professionals, nurses are uniquely positioned to interpret and respond to patients' suffering as well as their complex requests for assisted death. This scoping review explores European nurses' attitudes towards assisted death, examining the factors that shape their views. A systematic literature search was conducted in six databases, which was complemented by manual searches yielding 20 studies from various European countries. Thematic groups identified in the review include: (1) Legal and organisational conditions, (2) ethical tensions and moral reasoning, (3) nurses' roles and responsibilities and (4) individual and professional characteristics. The findings highlight significant variations in attitudes towards assisted death, which are influenced by legal, ethical, cultural and organisational conditions. In those European countries where assisted death has been legalised, nurses have expressed a strong desire to be more involved in decision-making processes, reflecting their proximity to patients and their critical role in interdisciplinary teams. Conversely, in countries without legal frameworks for assisted dying, nurses often reported uncertainty and ethical quandaries when navigating patients' requests for assisted death. Key factors that shaped these attitudes include demographic characteristics, religion, education, professional experience and work environment. Ethical tensions were identified between caring perspectives and principle-based concerns, and between respecting patient autonomy and adhering to the principle of non-maleficence. Additionally, differences in attitudes towards euthanasia and assisted suicide were linked to ethical distinctions between actively causing death and allowing death to occur. This scoping review underscores the need for enhanced training in communication and ethical competence, as well as the greater involvement of nurses in policy discussions and decision-making processes. The nursing profession can enhance its capacity to manage the ethical complexities of assisted death, ensuring that decisions are both ethically sound and patient-centred.