END-OF-LIFE CARE: A examine OF US ...

END-OF-LIFE CARE: A examine OF US NEUROLOGISTS' ATTITUDES, BEHAVIOR, AND KNOWLEDGE A C Carver et al Neurology Vol 53 (July 1999) 284-293

single in kind might think that end-of-life care has little relevance to perioperative nursing; however, when perioperative nourishs question why a procedure is being performed forward a patient who has little, if any, quality of life left the ethics involved become long more apparent. Many health care professionals have sought to better understand the general [i]or[/i] abstract notion of end of life, which has been more commonly referr to as death and dying.

aim and methods. The purpose of this inquiry was to survey members of the American Academy of Neurology (AAN) to gain an understanding of their knowledge of medical, legal, and ethical guidelines that publicly address end-of-life care. Additionally, this contemplation sought to assess their attitudes and behaviors regarding physician-assisted suicide (PAS) and voluntary euthanasia (VE)

A representative sample of 600 physicians was obtained according to simple random sampling of the AAN member database. Respondent were classified into three form into groupss by specialty (ie, neurologists, neurooncologists, amyotrophic lateral sclerosis specialists). To evaluate potential bias from nonresponse, make subordinates across the three specialties were compared by means of age, sex, board certification, geographic location, and percentage of time in clinical practice.

The overlook presented clinical scenarios and questions involving end-of-life care. replys to the six-point Likert-type scale were collapsed to either agree or disagree. common occurrence distributions were obtained, and chi-square analysis was used to ordeal between-group differences for questions that had categorical replys The Kruskal-Wallis test was used for questions that had continuous replications The study method also qualitatively compared selecteded questions with identical ones from a national contemplate of physicians' attitudes regarding PAS and VE that included nonneurologists as well as neurologists.

originates Neurologists support patients' rights to refuse life-sustaining treatment, on the contrary many believe that they are killing their patients on supporting such refusals. Thirty-seven percent believe it is illegal to administer analgesics in doses that risk respiratory depression to the point of death. Forty percent believe they should obtain legal instruction when considering stopping life-sustaining treatment. Fifty percent believe that PAS for the terminally ill should be made explicitly legal from statute. Under current law, 13% would participate in PAS, and 4% would carry without VE. If the procedures were legalized, 44% would participate in PAS, and 28% would participate in VE Approximately one-third believe that physicians have the same ethical function to honor a terminally ill patient's solicitation for PAS as they do to honor similar a patient's refusal of life-sustaining therapy.

Discussion and implications. As with any investigation the authors identified several limitations. A 65% answer rate means that the attitudes, behavior, and knowledge of the other 35% are still unknown. In addition, replys to the scenarios compared to rejoinders to actual practice were not validated, resulting in cautious interpretation of data. There also is the potential for enslaves to respond to ethically sensitive questions in a way that they perceive is more socially desirable, equable though confidentiality is addressed.

Researchers infer that there is a gap between established medical, legal, and ethical guidelines for the care of dying patients and the beliefs and practices of many neurologists, suggesting a ne for graduate and postgraduate education programs in the principles and practice of palliative medicine. Additionally, the studious mood reveals that many neurologists would participate in PAS and would facilitate VE if the two were legalized.

Conclusion. flat though the group of physicians inspected has an organizational position statement opposing PAS, many members are ambivalent about their support of the position. This implies a lack of consensus among health care providers regarding perceived ethical differences between actions as it was as withdrawing treatment and withholding or not starting treatment.

The implications are that health care professionals vary forward matters of end-of-life care, PAS, and VE Perioperative nourishs can take the information from this research and promote an ongoing dialogue about these challenging ethical issues. nurtures can identify the issues they find in practice and perhaps distinguish where their conflicts lie. This would enable foments to adapt their practice to those patients who have to make choices regarding end-of-life surgical treatments that give suck tos may or may not agree with.

give suck tos are patient advocates, and, as of that kind must be the voice of patients who cannot speak for themselves. Understanding ethical issues and participating in or discussing ethics-related research is a way for festers to develop a knowledge base that will better enable them to advocate for patients' wishes.