June 1, 1996 in City

Murder Not In Nurse Job Description

Katherine Dowling Special To Los Angeles Times
 

One in five nurses who care for the terminally ill, according to a recent article in the New England Journal of Medicine, has decided that he or she knows best when life should end.

Interesting concept we have here. I’m sure glad that one in five wasn’t on duty when I admitted Mr. X, a centenarian, to the hospital recently. Mr. X lay in bed, unresponsive to anything but the nastiest pinches, tongue hanging out the corner of his slack mouth. Anyone seeing him would have been positive that he was in the process of dying a not very dignified death.

But we gave Mr. X some antibiotics for his pneumonia and by next morning a little miracle had occurred. Our patient had pulled himself back from the brink, regained his former impressive dignity and was carrying on a jovial conversation with the nurses, once again proving that we humans “know not the hour nor the day” when natural death will visit.

The Declaration of Independence champions our right to life, liberty and the pursuit of happiness, but society increasingly is seeking to put a percentage sign on the “life” part of that contract. As in, President Clinton may have a 100 percent right to life, but little Jenny, born with Down syndrome, only has a 50 percent relative life value, and old, crippled, diapered Mrs. Dowd has a 2 percent claim to life, at best.

We also fail to see the process of dying as having any intrinsic value in the life cycle. We think the life process should go from running the L.A. Marathon to stone cold dead, without any intermediate steps. And should those nasty in-between steps intrude - as when arthritis cripples limbs and chest pain reduces a sprint to a dodder - well, we’ve got a cure. It’s called physician-assisted suicide and has been declared a constitutional right by courts on both sides of the continent.

But come to think of it, why should doctors be the only ones allowed to terminate? Nurses, much more present at the bedside, might feel their patients’ pain with more acuity. And why should a patient who is demented forfeit his constitutional right to kick the bucket? Maybe nurses or even medical aides should make the call, if in their judgment the patient’s life doesn’t look like a bed of roses.

It’s called the slippery slope, folks.

I’ve seen a few people die in my career. The process of dying can be an important time for the dying and for their loved ones, a time when emotional healing and a special type of bonding that continues across death can take place. This developmental process isn’t always apparent to the casual observer, even one who is medically trained. To abort it is like cutting off a movie 20 minutes before the end.

We medical types have the duty to reduce pain and provide comfort. We do not have the right - not physicians, not nurses, not the CEO of an HMO to decide when someone’s time is up. Vulnerable patients have to be able to trust those who look after their well-being. Nurses who terminate life, though their motivations may be in perfect congruity with their personal philosophies, are violating a bedrock contract that their profession has made with the sick in their care.

If all his future nurses are as caring and positive as those he has encountered to date, Mr. X may live another 15 or 16 years. And who’s to say he won’t enjoy every one of those years?

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