Nurses’ perceptions of ‘letting die’ and ‘killing’ at the end of life: an empirical study in the Argentine context

We carried out a cross-sectional quantitative, anonymous survey to examine how nurses perceive end-of-life decisions and attribute causality to physicians’ actions in a socio-cultural context in which palliative care is unregulated and active euthanasia is illegal. The survey concerns a hypothetical elderly patient with a terminal illness and considers three scenarios: withholding mechanical ventilation (MV), withdrawing MV, and medically assisted death. One hundred seventy-three nurses from a private university hospital in Buenos Aires participated. Over 70% perceived that illness was the cause of death when MV was withheld or withdrawn at the patient’s request. In the case of physicianassisted suicide, 61% perceived that the physician was the cause of death. Among nurses who perceived illness as the cause of death when MV was withheld, 73% (χ² test, p < .001) reported the same perception when MV was withdrawn. By contrast, only 33% (χ² test, p ≤ .001) of those who perceived illness as the cause of death when MV was withdrawn reported the same perception in the scenario of physician-assisted suicide. The nurses’ responses indicate variability in the attribution of causality when life-sustaining treatment is withdrawn, rather than evidencing a uniform interpretative pattern. Within these limits, the findings raise ethically relevant questions regarding how “letting a patient die” is understood in clinical practice. Normative ethical considerations are discussed separately, building on – but not directly inferred from – the empirical results.