As an RN who has worked in hospice for 17 years, I was inspired by the July Viewpoint by Reanne Booker, "Assisted Death: A Call to Action to Improve End-of-Life Care." Booker wrote that Emma, a patient who petitioned for assisted death, did not do so because of physical pain but because of unmet psychosocial needs. She was distressed by feelings of being a burden to caregivers, feelings of losing dignity, and being unable to enjoy the activities that had previously enriched her quality of life.

I believe that hospice services would have been the resource of choice for Emma. Booker mentioned that Emma received a meeting with a hospital psychosocial and spiritual clinician who determined her not to be clinically depressed. An ongoing relationship with a psychosocial or spiritual team, as provided by hospice services, can aid in exploring the deep feelings of loss experienced by a terminally ill patient and their loved ones, unlike a one-time meeting could provide. Hospice nurses can also offer psychosocial support as an inherent component of their practice.1 Hospice services are well rounded and include pet therapy, music therapy, art therapy, aroma therapy, and massage therapy, which can enhance quality of life. Hospice can also facilitate creative ways to foster a patient's interests, like Emma's love of gardening and art.

I believe hospice leaders should be heavily involved in the legislation of assisted death. Strong hospice leadership is critical to addressing the multifaceted needs of terminally ill patients and the continuously changing world of end-of-life care.2

Margaret Ball, BSN, RN

Dallas

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