Academic journal article The Hastings Center Report

Commentary

Academic journal article The Hastings Center Report

Commentary

Article excerpt

Nurses often have more continuous and intimate contact with patients than any other health care professional. Because of daily experiences with patients and families, they are uniquely situated to understand suffering and its impact on both patient and family: Not suprisingly, nurses use their position to respond to patients' suffering and wishes. Indeed, David Asch's recent article in the New England Journal of Medicine reported that some nurses have caused or hastened patient death by giving higher than warranted doses of narcotics.

Such a finding, while troubling, is plausible. Nurses administer powerful medications as part of their daily routine and have a remarkable degree of anonymity. As the professionals responsible for mixing, hanging, and administering medication, they control what the patient receives. Nursing practice standards include carefully labeling IV bags when medications are added. However, labels can be falsified and, in a case like this one, there is little likelihood of discovery. No one would know--short of a chemical investigation--that a drug had been omitted. The combination of close patient contact, access to powerful medication, and anonymity create conditions that make euthanasia by nurses a real possibility.

Professional nursing today entails much more than following doctors' orders or silently caring for patients. As a result of the managed care driven changes in health care delivery, nurses have been given a larger role in treatment and decisionmaking. In many instances, nurses have become the hub of the health care team. This is especially true in regard to one of the most important issues raised by this case study: respecting patient wishes. Honoring patient autonomy is an increasingly important element in health care decisionmaking, and nurses have a unique role to play in helping to integrate the will of patients into their treatment plan. …

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