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Decisions Near the End of Life: Professional Views on Life-Sustaining Treatments

American Journal of Public Health, Vol. 83, pp. 14-23, 1993

Posted: 20 Jan 2011  

Mildred Z. Solomon

Education Development Center, Inc. - The Center for Applied Ethics

Lydia O'Donnell

Education Development Center, Inc. - Center for Research on High Risk Behaviors

Bruce Jennings

The Hastings Center; Center for Humans and Nature

Vivian Guilfoy

Education Development Center, Inc.

Susan M. Wolf

University of Minnesota Law School

Kathleen Nolan

Private Practice - Pediatrician; The Hastings Center

Rebecca Jackson Stoeckle

Education Development Center, Inc.

Dieter Koch-Weser

Harvard Medical School; Education Development Center, Inc.

Strachan Donnelley

The Hastings Center

Date Written: January 1, 1993

Abstract

A growing number of authorities have articulated ethics guidelines for decisions about the use of life-sustaining medical technologies, in keeping with the basic legal principles articulated by the courts. These guidelines recognize the right of competent patients to forgo treatment, even if refusal may lead to death; they support deference to patients' wishes to withhold or withdraw life support of all kinds, from cardiopulmonary resuscitation and mechanical ventilation to antibiotics; they encourage the use of advance directives to guide treatment once the patient has lost the ability to make decisions; and they call for the provision of adequate pain relief and palliative care. A central tenet is the right of patients to refuse medical treatment they find unduly burdensome.

However, there has been very little research to determine whether clinicians know about these recommendations, agree with them, and find them useful. Nor do we know how health care professionals themselves see the issues. To explore these questions, we surveyed 687 physicians and 759 nurses at five hospitals. The hospitals were located in Massachusetts; Georgia; Washington, DC; and California. They included a city hospital, a Catholic community hospital, and three urban teaching facilities. They ranged in size from 180 to 660 beds. This article reports and analyzes the empirical results.

The data reveal an important gap between the views of practicing clinicians and the prevailing guidelines. They also reveal important differences in the views of attending physicians, house officers, and nurses. Almost half (47%) of all respondents and fully 70% of the house officers reported that they had acted against their conscience in providing care to the terminally ill. Four times as many respondents were concerned about the provision of overly burdensome treatment than about undertreatment. Many physicians and nurses were disturbed by the degree to which technological solutions influence care during the final days of a terminal illness and by the undertreatment of pain.

These survey results suggest that changes in the care of dying patients may not have kept pace with national recommendations, in part because many physicians and nurses appear to disagree with or be unaware of some key recommendations, such as the permissibility of withdrawing treatments.

Keywords: Life-Sustaining Treatment, End-of-Life, Termination of Treatment, Pain Relief, Palliative Care, Death, Dying, Medical Practice, Physicians, Nurses, Attitudes, Empirical Research, Empirical Studies, Bioethics, Health Law

Suggested Citation

Solomon, Mildred Z. and O'Donnell, Lydia and Jennings, Bruce and Guilfoy, Vivian and Wolf, Susan M. and Nolan, Kathleen and Jackson Stoeckle, Rebecca and Koch-Weser, Dieter and Donnelley, Strachan, Decisions Near the End of Life: Professional Views on Life-Sustaining Treatments (January 1, 1993). American Journal of Public Health, Vol. 83, pp. 14-23, 1993 . Available at SSRN: https://ssrn.com/abstract=1743766

Mildred Z. Solomon

Education Development Center, Inc. - The Center for Applied Ethics

55 Chapel Street
Newton, MA 02458-1060
United States

Lydia O'Donnell

Education Development Center, Inc. - Center for Research on High Risk Behaviors ( email )

55 Chapel St.
Newton, MA 02458-1060
United States

Bruce Jennings

The Hastings Center ( email )

Garrison, NY 10524
United States

Center for Humans and Nature

New York, NY
United States

Vivian Guilfoy

Education Development Center, Inc. ( email )

Newton, MA
United States

Susan M. Wolf (Contact Author)

University of Minnesota Law School ( email )

229 19th Avenue South
Minneapolis, MN 55455
United States
612-625-3406 (Phone)
612-624-9143 (Fax)

HOME PAGE: http://www.law.umn.edu/facultyprofiles/wolfs.html

Kathleen Nolan

Private Practice - Pediatrician

Mount Tremper, NY

The Hastings Center

Garrison, NY 10524
United States

Rebecca Jackson Stoeckle

Education Development Center, Inc.

Newton, MA 02458-1060
United States

Dieter Koch-Weser

Harvard Medical School

250 Longwood Avenue
Boston, MA 02115
United States

Education Development Center, Inc.

Newton, MA 02458-1060
United States

Strachan Donnelley

The Hastings Center

Garrison, NY 10524
United States

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