Paper
Thursday, July 22, 2004
Hospice Workers’ Attitudes Towards Voluntary Refusal of Food and Fluids
Theresa A. Harvath, PhD, RN, CNS, Oregon Health & Science University, School of Nursing, Portland, OR, USA
Objective: One of the alternatives to physician-assisted suicide (PAS) is for patients to voluntarily refuse all food and fluids (VRFF). This paper describes the attitudes of hospice nurses and social workers towards VRFF and compares these to their attitudes towards PAS. Design: Cross-sectional mailed survey of all hospice nurses and social workers in Oregon. Population, Sample, Setting, Years: Of the 545 eligible respondents, 397 (73%) returned the survey. The sample ranged in age from 23 to 88 years (M=49.25, s.d.=9.18), were primarily female (90.7%) and worked in hospice for an average of 6.8 (s.d.=5.25) years. Concepts or Variables: The questionnaire measured demographic variables, attitudes towards and comfort with discussion of PAS and VRFF. Method: Categorical variables were compared using Chi-Square; continuous variables were compared using Student’s t-test. Relationships among variables and scales were explored using bivariate correlations. Findings: Only 2.6% stated that they thought VRFF was immoral or unethical. More than three-quarters thought that VRFF should be an option if patients are experiencing physical, psychological or spiritual suffering. Most (95.4%) would continue to care for a patient who chose to hasten their death through VRFF. Hospice workers reported a more supportive attitude towards VRFF than PAS and expressed greater comfort in discussing VRFF with patients and colleagues than PAS. Although we found a significant difference between nurses’ and social workers’ attitudes toward PAS, there were no statistically significant differences in their attitudes toward VRFF. Conclusions: While many nurses and social workers believe that PAS is immoral or unethical, they are more accepting of patients hastening death by refusing food and fluids. Implications: Although many hospice organizations have clear guidelines regarding assisted suicide, they may be less well-prepared to address the ethical dilemmas involving alternatives to assisted suicide.
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