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Decisions near the end of life: professional views on life-sustaining treatments.

M Z Solomon, L O'Donnell, B Jennings, V Guilfoy, S M Wolf, K Nolan, R Jackson, D Koch-Weser and S Donnelley

Decisions Near the End of Life Program, Education Development Center Inc, Newton, MA 02160.

OBJECTIVES. 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.

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