Nurses' involvement in end-of-life decisions.

In Dutch healthcare, patients and physicians are responsible for medical end-of-life decisions. These include nontreatment decisions, withholding or withdrawing parenteral hydration and nutrition where the patient can no longer drink or eat, relieving pain and other symptoms with drugs that might shorten life, euthanasia, and physician-assisted suicide. The objective of this study is to investigate the views of nurses on their role with regard to discussing these kinds of decisions, as well as their actual role in the decision-making process. Nurses (n = 489) involved in palliative terminal care answered questions about their preferred and actual role in end-of-life decision-making processes. Nurses want to be involved in making end-of-life decisions, but this depends partly on the kind of decision that has to be taken. When caring for terminal patients, 62% of the nurses usually talk about such decisions with patients or their families. Three-quarters of the nurses had been involved in an end-of-life decision-making process in the previous 2 years, mostly by talking with the physician and the patient's family. It is concluded that physicians should discuss these decisions with nurses more often. The finding that characteristics of the nurses influence their role in end-of-life decision-making processes emphasizes the importance of developing mechanisms to ensure that end-of-life decisions are made in a consistent manner and do not depend on the demographic characteristics of nurses.