David A. Asch, "The Role of Critical Care Nurses in Euthanasia and Assisted Suicide," New England Journal of Medicine (1996): 1374-79; Nessa Coyle, "The Euthanasia and Physician-Assisted Suicide Debate: Issues for Nursing", Oncology Nursing Forum 19, no. 7 (1992 Supplement): 41-46.

More than a year ago, a New England Journal of Medicine report sent tremors through the health-care community by claiming that up to 20 per cent of critical-care nurses had "performed" euthanasia or assisted suicide. In the extensive discussion of the physician's role, it is ironic that the question of nurses' involvement — or that of any non-physicians — has receded into the background.

At the time, the study received sharp criticism, much of it deserved. For example, the report did not clearly distinguish between assisted suicide and euthanasia, or between "hastening" death and commonly accepted forms of treatment withdrawal. The protests' intensity also reflected fears that the study would generate unwarranted mistrust of nurses. Unfortunately, the criticism appears to have stifled further discussion on the issue.

Has the nearly exclusive focus on the physician's role in assisted death been misplaced? If a minority of nurses has actually assisted in suicide or euthanasia, such a possibility demands further examination. Many nurses will continue to be primary providers of direct care for distressed, suffering patients and their families.

Even more than physicians, nurses will hear patient complaints about pain and discomfort, and about the deeply dispiriting effects of chronic or terminal illness. They will continue to see too many patients who suffer from inadequate pain management and poor palliative care. They will be keenly frustrated by their lack of authority to prescribe more appropriate pain medication.

Some will receive direct requests from patients for assistance in hastening death. Nursing education and its literature help clarify some ethical distinctions between hastening death and generally accepted pain-management practices, and describe interventions that address patient despair. But these alone cannot resolve nurses' distress.

Nurses are people of deep compassion, motivated by mercy and kindness. Nursing, like other health-care professions, is grounded in a desire to help those in distress. Nursing shares in the activist tradition of medicine and the other health-care fields; health-care personnel are typically conditioned to favor action — doing something — over inaction. This activism finds further support in the "can-do" attitude and expectations of American culture

The problem is finding effective ways for nurses to express their genuine care and compassion. If they feel unable to provide effective relief of pain and suffering, a small percentage of nurses may find assisting death an attractive option that speaks of mercy and compassion.

The fact that these virtues lie at the heart of the great religious traditions may inadvertently reinforce the attraction of euthanasia and assisted suicide—even if those same traditions also discourage such acts. Nurses who are Christian, for example, may well internalize their tradition's stress on compassion through the filter of the activism prevalent in our culture. Compassion and mercy can then become duties to make things happen.

Perhaps something from the tradition has been lost in modern Christians' understanding of compassion. Is there still a sense that meaning can emerge in suffering, or that there may be some good reason to live despite suffering? Are there traditional resources that might help the faithful develop a different perspective on suffering and its place in our lives?

There is a fundamental vulnerability, indeed helplessness, that plagues the human condition. The Christian tradition teaches that "waiting upon the Lord" is not only sometimes necessary but is strangely good for the soul. Can these dimensions of traditional faith provide support for nurses and others, including patients and families, who face circumstances beyond their control and feel compelled to "take matters into their own hands?"

Some nurses might be helped by the faith communities' efforts to ask and answer such questions. It might even be that the very effort to do so would be welcomed as a gesture of support and solidarity in matters that, after all, affect not only nurses but all of us.