THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Thursday, May 23, 1996 TAG: 9605230355
SECTION: FRONT PAGE: A1 EDITION: FINAL
SOURCE: FROM WIRE REPORTS
LENGTH: 85 lines
Acting on their own, or with at least the tacit consent of doctors or families, one of five nurses in intensive care units report that they have deliberately hastened patients' deaths, according to a national survey.
The nurses invariably said they acted out of compassion - a strong desire to end patients' misery - and they often accused doctors of letting the hopelessly sick suffer needlessly.
But the survey, conducted by Dr. David Ascha, a medical ethicist at the University of Pennsylvania, did not suggest an epidemic of homicidal nursing. About 90 percent of the time, the nurses said, they refused a patient's or family member's request for euthanasia. The small number of nurses who had euthanized a patient had done so only once or twice in their career.
Both Ascha and nurses' groups say the numbers, drawn from a mail survey, are far from solid. The study's real significance, said Asch, is the profound frustration it reveals among nurses caring for the terminally ill. Often, some nurses said, doctors pay so little attention to alleviating suffering that euthanasia seems humane.
``The tragedy I see here is that some of the nurses act as if they feel euthanasia was the best option for patients because other options'' - such as better pain control or moving to a hospice - ``seem unavailable to them,'' said Asch. His study appears today in the New England Journal of Medicine.
If doctors paid more attention to alleviating suffering, forgoing care that only prolongs a painful death or authorizing hospice-type care, nurses would feel much less pressure to consider euthanasia or assisted suicide, Asch's report said.
Asch mailed 1,600 eight-page surveys to subscribers of Nursing magazine and got back anonymous replies from 852 critical-care nurses. His study included some of the comments the nurses wrote.
``I'm left with the dilemma of carrying out orders that I believe - and sometimes know - are not in the patient's best interest or what the patient or family has expressed as their desires,'' one nurse wrote.
Wrote another: Doctors ``should step into our shoes for about one month to get a much better idea of how much patients and their families are allowed to suffer.''
One hundred forty-one of those surveyed said they had received requests from patients or family members to engage in euthanasia or assisted suicide; 129 of the nurses said they had carried out these practices at least once, and 35 said they had hastened a patient's death by only pretending to carry out a life-sustaining treatment that had been ordered. Fifty-eight of the nurses said they had taken a life at least once without the patient's urging. Six nurses said they had hastened the deaths of 20 or more people.
The survey found the most common way of killing patients is giving them overdoses of narcotics. One nurse confessed to giving morphine doses much higher than prescribed, then falsifying the amount of the drug left over.
A number of experts said the survey questions were so ambiguous that they were subject to misinterpretation.
Instead of revealing critical care units filled with self-appointed angels of death, they said, the nurses' responses revealed their anxieties and confusion about where palliative care ends and euthanasia begins. Euthanasia, deliberately killing a person to end suffering, is illegal and is in violation of professional nursing codes.
Dr. Michael De Vita, chairman of the ethics committee at the University of Pittsburgh Medical Center, said he feared that the paper ``will make medical consumers very nervous.'' But he added that while he believes the study exaggerated the number of nurses performing euthanasia, he also believes that Asch's study reveals ``some core kernel of truth that is very problematic.''
Others questioned whether any conclusions can be drawn from the study.
Colleen Scanlon, a nurse and lawyer who directs the American Nurses Association's Center for Ethics and Human Rights, wrote an editorial accompanying Asch's paper expressing her concerns about the survey.
She said that Asch's questions were so ambiguous that nurses who were acting entirely within prescribed guidelines were counted as performing euthanasia. For example, the most common situation the nurses revealed was giving pain-relieving narcotics to patients, knowing that the drugs might hasten death. That is not necessarily euthanasia, Scanlon said.
She added that ``it would be naive not to acknowledge the likelihood that some nurses consider participating in euthanasia and some probably have done so.'' But, she said, Asch's study does not reveal the prevalence of such actions. And, she said in an interview, she is deeply concerned ``not only by the damaging light that this casts on critical care nurses, but also what it does to families' trust.'' She added, ``This could be truly frightening for families, and I think unjustifiably.'' MEMO: The Associated Press, the Boston Globe and The New York Times
contributed to this report. ILLUSTRATION: Color drawing by CNB