Dignified Death not Common, Doctors and Nurses Say

Of acute-care doctors and nurses responding to a national survey, 62% said that clinically hopeless patients have a “dignified death” in the hospital only “sometimes.” Another 33% said that this scenario occurs “frequently,” and just 5% said “always.”

The poll was conducted in July 1997 among chief doctors and nurses in hospital acute-care units nationwide by Dignified Death Update, a monthly newsletter for health-care professionals.

Other survey results included the following:

• In cases that are deemed “clinically hopeless,” 51% of doctors and nurses said that the patient is “frequently” or “sometimes” (10% and 41%, respectively) “eased into death by staff through unspoken agreement (ie, passive nonaction) without the explicit request of relatives.” However, 48% of respondents definitely stated that this “never” occurs.

• “Futile last-ditch treatment” was administered “frequently” or “sometimes” in clinically hopeless cases, said 97% of respondents. Only 2% said that this was “never” done.

• If patients have made their end-of-life instructions known prior to death (such as by a living will, advance directive, or appointment of a health-care surrogate), these instructions are followed “frequently,” replied 41% of respondents. However 32% indicated that such instructions are followed only “sometimes.”

• Do staff on an acute-care unit end life support more quickly for hopeless cases “if the unit is already filled to capacity and new patients are waiting to be admitted?” In response to this question, 89% said that the practice “never” occurs. However, 5% said that scenario happens “sometimes,” and another 5% said that they were “not sure” whether it ever occurs.

• The vast majority (93%) of professionals said that patients’ relatives “drag their feet” about decisions to end life support in hopeless cases. The 93% figure comprised 29% who felt relatives “frequently” procrastinated and 64% who said that this occurs “sometimes.” This survey finding was confirmed by another question that approached the same topic from the opposite direction: Asked whether patients’ relatives are “too eager to end life support,” 79% of the doctors and nurses responded “no.”

Survey Reflects “Prevailing Opinion”
The survey did not obtain a strict random sample and, thus, indicates the general direction of professional thought rather than an exact quantitation of it, said newsletter publisher, Leslie C. Norms, md, PhD. However, he added that because there were 362 responses from both large and small hospitals, because these facilities were spread across the country, and because both physician and nurse “chiefs-of-units” responded, he was confident that the survey had accurately captured current prevailing opinion in hospitals.