Intensive Care Nurses Sometimes Hasten Terminally Ill Patients’ Deaths
BOSTON (AP) _ One in five intensive-care nurses responding to a survey admitted hastening the deaths of terminally ill people, sometimes without the knowledge of doctors, families or the patients themselves.
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.
``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 Dr. David A. Asch of the University of Pennsylvania.
Asch mailed 1,600 eight-page surveys to subscribers of Nursing magazine and got back anonymous replies from 852 critical-care nurses. He described the results in Thursday’s New England Journal of Medicine and 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.″
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.
Most nurses who intentionally killed patients said they had done it only once or twice. However, six nurses said they had hastened the deaths of 20 or more people.
Most of the time, nurses acted on the request of patients, their families or the doctors. However, 58 of the nurses said they had taken a life at least once without the patient’s urging.
Among other findings of the survey:
_16 percent of the nurses said they had performed euthanasia or assisted in suicide, and an additional 4 percent said they had hastened patients’ deaths by only pretending to give life-sustaining treatment ordered by doctors.
_40 percent said they sometimes wanted to help patients die but did not. The most common reasons for holding back were fear of getting caught, concern that it might be illegal and worry that they did not know the patients’ wishes.
_Five nurses reported helping patients die outside the hospital. Among these was one who gave liquid morphine to her father, who was dying of cancer.
Euthanasia _ giving a drug or doing anything else to hasten a patient’s death _ is illegal and violates nursing standards. However, pulling the plug on terminally ill patients by turning off their automatic breathing machines is not generally considered to be euthanasia and was not included in the survey statistics.
In an accompanying editorial in the journal, Colleen Scanlon of the American Nurses Association Center for Ethics and Human Rights called the study disturbing and ``potentially damaging to the nursing profession.″
She criticized the survey for failing to draw a clear distinction between euthanasia and assisted suicide, which involves giving patients the means to take their own lives.
Nonetheless, she wrote, ``It would be naive not to acknowledge the likelihood that some nurses consider participating in euthanasia and some have probably done so.″
Dr. Joseph Fins, director of medical ethics at New York Hospital, said one solution may be giving nurses more say in the care of desperately ill patients.
``I see this as a symptom of a much more complicated cultural problem about how we die,″ he said. ``These nurses may be responding to feeling entrapped by technology and circumstances.″