Jane MacGeorge is NZNO’s nursing and professional services manager and a nurse with a deep understanding of palliative care and end of life issues.
There has been a lot of discussion lately about “assisted suicide” or “euthanasia”, a lot of it stemming from the case of patient with brain cancer, Lecretia Seales, who petitioned the court to allow her GP to assist her to die. Lecretia lost her bid to die with the dignity she desired but her situation has opened the way for discussions that might previously have been taboo.
Talking about end of life decisions and care is important, as every NZNO member knows. The work we do to ease pain and lighten the path to dying is a fundamental part of our role as nurses and caregivers.
An AUT study of 650 GPs found 359 had made decisions such as withdrawing treatment or alleviating pain, taking into account the probability they may hasten death. One of the findings of the study was that even though it was doctors prescribing, in most cases it was nurses who were administering the drugs.
That finding opens a can of worms… End of life care and decisions are extremely complex, challenging and fraught with ethical dilemmas. Nurses need to understand all viewpoints to advocate in the best interest of the patient and to make sure the patients’ rights are respected and supported. Understandably, health care professionals may sometimes need to be mindful of legal and ethical implications.
The reality is that patients die within every health setting; in the community under the care of the primary health team, in EDs, in wards, in rest homes and in other palliative care settings. Nurses need to work within their scopes of practice and be aware of the ethical issues involved in supporting patients and whānau who are experiencing dying and death.
The role of the nurse is critical in the delivery and planning of a dying person’s care. We are advocates for safe, compassionate and ethical end of life care. We have a professional responsibility to provide appropriate care to our patients.
We need to have a good understanding of legislation and regulation and ensure we comply with the code of rights and the policy and guidelines within our practice specialty and organisation.
We are often faced with challenging decisions when caring for people at the end of life. It is important we question any medications that are not prescribed in an appropriate manner. In these situations our hope is that the whole healthcare team can discuss different treatment options and decisions with the prescriber to support quality end of life care.
Above all, it is important we understand our patient’s wishes. A healthy healthcare system places the patient at the centre of every decision. When we use this as the basis for our decision-making, at the end of life, at the beginning and everywhere in between, we can be sure that we will provide the right care at the right time in the right place.