Relevance of the Project 

Nurses face specific challenges when caring for older adults in long-term care settings who express a desire to die or request assisted suicide. Their role in responding to such situations with professional empathy and appropriate communication is crucial. Due to their long-term, trust-based relationships with those in their care, nurses are often the first point of contact when the desire to die or thoughts of assisted suicide arise. These situations, in all their complexity, often lead to both professional and ethical uncertainty. Especially in long-term care, nurses are confronted with the demanding task of responding to such requests in a professional manner while simultaneously contributing to suicide prevention.

Currently, there is a lack of scientifically grounded guidelines and protection concepts in Germany to support nurses in making ethically informed and professionally sound decisions in these situations. This research project aims to close this gap by developing practice and ethics guidelines that provide situational guidance and moral orientation for nurses in residential and home-based long-term care.

Project Aim

The aim of the project is to develop practice and ethics guidelines in close collaboration with nurses working in residential and home-based long-term care. These guidelines are intended to support nurses in dealing with expressions of a desire to die or requests for assisted suicide, as well as in the context of suicide prevention. The guidelines will offer both professional security and moral orientation, enabling nurses to respond empathetically and competently in each situation, and to reflect ethically on their actions within a structured framework. A special focus is placed on promoting open and respectful conversations around the desire to die and assisted suicide. In addition to strengthening suicide prevention, the project aims to foster a sensitive, appreciative approach to such expressions, to understand the reasons behind them, and to center the situational needs of those affected.

Research Process

Based on a systematic literature review and findings from focus groups (group discussions) with nurses in both residential and home-based long-term care, the project will develop, refine and implement practice and ethics guidelines. To ensure that the guidelines for managing requests for assisted suicide and implementing suicide prevention are tailored to the realities of nursing practice, the first phase will involve focus groups with nurses working in residential and home-based long-term care to explore their experiences (exploration phase).

In the next phase, nursing professionals in the six participating organizations will be invited to evaluate and comment on the key elements of the draft guidelines via a written Delphi survey (consensus phase). Based on the results, the guidelines will be revised and finalized in collaboration with the project’s steering group and scientific advisory board by June 2026. Prior to implementation, the guidelines will be validated with nurses, residents’ advisory boards and family representatives. In the final phase, training sessions will be held with nurses in the participating organizations to support the sustainable application of the guidelines. These training measures will be evaluated as part of the project (implementation and evaluation phase).

The project has received ethical clearance from the Ethics Committee of the German Society of Nursing Science. An overview of the research project and the different phases of the research process is provided in our projekt poster (Please note: The poster is currently available in German only. 

Funding

This research is funded by the German Federal Ministry of Health (Bundesministerium für Gesundheit) (Funding Code: 2524FSB220, Funding Notification dated 10.06.2024). The funding period runs from 1 September 2024 to 31 August 2027. The project is administered by the German Aerospace Center (DLR).

A detailed project description is available on the website of the Federal Ministry of Health. 

Bundesgesundheitsministerium- Gesundheitsförderung und Prävention Attention