THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Monday, June 10, 1996 TAG: 9606070009
SECTION: FRONT PAGE: A6 EDITION: FINAL
TYPE: Another View
SOURCE: By MARY CORLEY and LISA PETTREY
LENGTH: 88 lines
When millions of Americans picked up their newspapers or listened to the evening news recently, reports that nurses were ``hastening deaths'' for many terminally ill patients sent a shocking chill through our society, and no less the nursing community.
The study on the role of critical-care nurses in euthanasia and assisted suicide first appeared in the prestigious New England Journal of Medicine. The popular media raced ahead with the headlines because this journal carries a measure of credibility, meaning its potential for both good and harm are considerable.
That one out of five nurses has been involved in euthanasia and/or assisted suicide is debatable because of the definitions used to guide the nurses in responding to survey questions. Nationally, the American Nurses Association and the American Association of Critical-Care Nurses issued a joint statement that noted the study's research ``is so seriously flawed that it cannot provide an accurate depiction of nursing practice.'' Our colleagues at Virginia Commonwealth University's School of Nursing were distressed as well as dubious about the study findings.
Many nurses have raised legitimate concerns about the study, including the methods and reliability of the survey. The use of terminology is even more disturbing. Distinctions between those actions that are morally and legally sound, such as providing morphine to relieve pain in a dying patient, and those of concern, such as providing lethal injections, are unclear. Unfortunately, many nurses may be confused about the terminology that accompanies these practices. They may use the label ``euthanasia'' or ``assisted suicide'' when what they are actually doing is providing pain relief to a patient dying from an end-stage-disease process such as cancer or heart disease.
In reality, a significant problem we face is that patients continue to die amidst highly invasive and aggressive technology and without adequate pain relief. Nurses have an indispensable role in facilitating or orchestrating a pain-free, dignified death for their patients. Nurses provide respectful and compassionate care at the end of life. At VCU's Medical College of Virginia Hospitals and other reputable institutions, nurses have been leaders in educating and changing practices among all disciplines to ensure that patients do not suffer endlessly as they are dying.
This is vastly different from administering lethal injections to hasten death. This approach, which values this final stage of life, involves not only adequate pain medication but measures such as providing for quiet, uninterrupted time with family and music, hand-holding and countless other supports. Nurses staunchly support patients' rights to make decisions about their care.
To aid the public, the AACN developed a community project to educate citizens about their choices before they face such questions about dying. Through an advanced directive and a durable power of attorney, patients have the tools to make to their wishes known. Nurses help patients articulate their wishes and work with their families to provide care that controls pain and suffering.
As health care continues to change rapidly with the growing use of technology, nurses and other professionals are finding it increasingly difficult to identify when efforts to save a patient's life should stop and providing only comfort care should begin. Many nurses - and even patients' families - become convinced that further use of technology to treat and sustain patients in an intensive-care unit is futile long before other health professionals do.
In nursing research, the practice is termed ``prolonging the patient's death,'' and this is a significant source of moral distress. We have been challenged to develop strategies to address this difficulty, including the creation of ethics committees. Nurses can refer their concerns to these committees for review and assistance by colleagues from various disciplines to aid in identifying better approaches to managing these patients and, ultimately, their care. The public can't be led to believe that nurses are left alone to enact these life-or-death decisions, much as this disturbing study signaled to the nation.
Hospice care has proved to be an alternative endorsed by both patients and families. However, many patients who are admitted to intensive-care units are seriously ill and not candidates for hospice care.
Members of our society need to believe that their trust in nurses, particularly those in the critical-care units, will not be broken. At the same time, nurses have a responsibility to help society provide a better environment for living while we are dying - for living with hope during chronic illness and ensuring that patients can die in a peaceful and comfortable manner the way most of us would choose so that euthanasia and assisted suicide are not the only options. MEMO: Mary Corley, an associate professor of nursing at Virginia
Commonwealth University, teaches nursing ethics and researches ethical
decision-making. Lisa Pettrey is co-chair of VCU's MCV Hospitals Ethics
Committee and nurse manager of MCV Cardiac Surgery Intensive Care Unit. by CNB