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Medical Marijuana and Medical Aid in Dying: Practice Implications

Mike Burgess, MBA, BSN, RN

Johns Hopkins School of Nursing

NR.210.607.8101 Context of Healthcare for Advanced Nursing Practice

27 October 2019
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Medical Marijuana and Medical Aid in Dying: Practice Implications

Practice guidelines for Advanced Practice Registered Nurses (APRN) are dictated by a

variety of state, federal, and institutional bodies. Controversial legislation like medical marijuana

programs (MMP) and medical aid in dying (MAiD) can impact practice. They may also present

additional ethical and moral considerations. Clinicians must be aware of how new laws such as

these influence practice and how to mitigate associated risk.

The tenuous legality and novelty of medical marijuana presents challenges to APRNs that

must be considered. Medical marijuana has gained increasing support, with 33 states legalizing

MMPs to date (National Conference of State Legislatures, 2019). Federally, it remains a

Schedule 1 controlled substance, prohibiting prescription and curtailing research (Controlled

Substances Act of 1970). Information regarding potential drug interactions, side effects, and

efficacy of medical marijuana is limited. Clinicians face potential prosecution for contravening

federal law by recommending use, leading to an ethical dilemma. An APRN’s decision to

recommend medical marijuana must weigh all of these factors.

APRNs must advocate for further high-quality research of medical marijuana,

particularly in comparison to FDA-approved synthetic cannabinoids such as dronabinol and

nabilone. The safety and efficacy of these drugs is known, and there is current research

supporting use for specific conditions, such as chemotherapy-induced nausea and vomiting

(Badowski, 2017). In order to make the optimal recommendation for patients, clinicians need

similar evidence for medical marijuana.

In order to minimize risk regarding the legal status of medical marijuana, APRNs must

keep current with legislation, both at the federal and state levels. Each MMP is unique to the
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state in which it was enacted, and APRNs should be familiar with the MMP for their state. It

outlines specifics of the program, such as qualifying conditions and who is authorized to certify

(National Council of State Boards of Nursing, 2018). The ethical decision to participate,

however, remains with the APRN.

Medical Aid in Dying (MAiD) is another controversial area with increased public

support, with passage of laws in nine states over the last 20 years (Span, 2019). Hospice and

palliative care APRNs are the most impacted by this, as patients with terminal illness may view

MAiD as a viable treatment option. However, active participation by APRNs in MAiD is

currently restricted, potentially severing an active therapeutic relationship. There are also ethical

considerations for APRNs when working with patients who have requested MAiD.

MAiD statutes only allow physicians to serve as certifying clinicians, qualified second

opinions, and providers of lethal medication doses. However, there are jurisdictions outside the

United States that have expanded practice guidelines to include Nurse Practitioners and

Physician Assistants (Stokes, 2017). As more legislation is passed and research becomes more

readily available, APRNs may play a broader role in MAiD in the US.

There are also ethical implications for this legislation. Historically, the American Nurses

Association opposed MAiD, and the official position statement indicated that MAiD was a

violation of nursing ethics (2013). With the shift in public opinion, the ANA released an updated

position statement in 2019 that takes a more neutral stance. It now includes language that

supports the need to be educated and unbiased when caring for patients who request MAiD.

(American Nurses Association, 2019). This new position helps provide professional guidance

for APRNs, and allows clinicians more freedom to practice according to conscience.