End-of-life issues in intensive care units: a national random survey of nurses' knowledge and beliefs.
OBJECTIVE
To investigate the knowledge, beliefs, and ethical concerns of nurses caring for patients dying in intensive care units.


METHODS
A survey was mailed to 3000 members of the American Association of Critical-Care Nurses. The survey contained various scenarios depicting end-of-life actions for patients: pain management, withholding or withdrawing life support, assisted suicide, and voluntary and nonvoluntary euthanasia.


RESULTS
Most of the respondents (N = 906) correctly identified the distinctions among the end-of-life actions depicted in the scenarios. Almost all (99%-100%) agreed with the actions of pain management and withholding or withdrawing life support. A total of 83% disagreed with assisted suicide, 95% disagreed with voluntary euthanasia, and 89% to 98% disagreed with nonvoluntary euthanasia. Most (78%) thought that dying patients frequently (31%) or sometimes (47%) received inadequate pain medicine, and almost all agreed with the double-effect principle. Communication between nurses and physicians was generally effective, but unit-level conferences that focused on grief counseling and debriefing staff rarely (38%) or never (49%) occurred. Among the respondents, 37% had been asked to assist in hastening a patient's death. Although 59% reported that they seldom acted against their consciences in caring for dying patients, 34% indicated that they sometimes had acted against their conscience, and 6% had done so to a great extent.


CONCLUSIONS
Intensive care unit nurses strongly support good pain management for dying patients and withholding or withdrawing life-sustaining therapies to allow unavoidable death. The vast majority oppose assisted suicide and euthanasia. Wider professional and public dialogue on end-of-life care in intensive care units is warranted.
Puntillo
K A
KA
University of California, San Francisco, USA.
Benner
P
P
Drought
T
T
Drew
B
B
Stotts
N
N
Stannard
D
D
Rushton
C
C
Scanlon
C
C
White
C
C
D000328:Adult; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D002983:Clinical Competence; D003657:Decision Making; D004993:Ethics, Nursing; D005065:Euthanasia; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology* / Q000706:statistics & numerical data; D010166:Palliative Care; D017236:Suicide, Assisted; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods / Q000592:standards*; D014481:United States