title: Decisions near the end of life: professional views on life-sustaining treatments.
abstract: OBJECTIVE
  How do health care professionals assess the care of hospital patients near the end of life? Are physicians and nurses aware of and in agreement with national recommendations regarding patients' rights to forgo life-sustaining medical treatments and to receive adequate pain control?
  
  
  METHODS
  We surveyed 687 physicians and 759 nurses in 5 hospitals.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  In summary, 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. However, changes in the care of dying patients may not have kept pace with national recommendations, in part because many physicians and nurses disagreed with and may have been unaware of some key guidelines, such as the permissibility of withdrawing treatments.
authors.affiliation: Decisions Near the End of Life Program, Education Development Center Inc, Newton, MA 02160.
authors.forename: M Z
authors.initials: MZ
authors.lastname: Solomon
authors.forename: L
authors.initials: L
authors.lastname: O'Donnell
authors.forename: B
authors.initials: B
authors.lastname: Jennings
authors.forename: V
authors.initials: V
authors.lastname: Guilfoy
authors.forename: S M
authors.initials: SM
authors.lastname: Wolf
authors.forename: K
authors.initials: K
authors.lastname: Nolan
authors.forename: R
authors.initials: R
authors.lastname: Jackson
authors.forename: D
authors.initials: D
authors.lastname: Koch-Weser
authors.forename: S
authors.initials: S
authors.lastname: Donnelley
mesh_terms: D001291:Attitude of Health Personnel; D032921:Consensus; D003657:Decision Making; D030881:Disclosure; D004992:Ethics, Medical; D004993:Ethics, Nursing; D005066:Euthanasia, Passive; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008020:Life Support Care / Q000592:standards*; D009726:Nurses; D010358:Patient Participation; D010820:Physicians; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D014481:United States; D028761:Withholding Treatment