Moral+Issue+Article+3+-+Right+to+Die

=More nurses want to help people die=

Up to one in three nurses believe they should be allowed to help patients end their lives, according to a survey which gives an insight into changing medical attitudes towards death. In a move which is set to reignite the debate over euthanasia, a new book on medical ethics will be published this week, spelling out what doctors can and cannot do to help patients at the end of their lives. Yet both carers and the public are confused about how much can be done for patients in their final days - an issue which will become more urgent as the number of people over 65 grows to eventually exceed the young. The nurses' survey shows they want more honesty about the dilemmas they face. It reveals that four out of 10 have given a painkiller to a dying patient, knowing that it could hasten their death. One in two nurses do not feel it is unethical to administer a lethal injection at a patient's request. A surprising 31 per cent of the 2,700 nurses questioned by Nursing Times magazine said they should be allowed to assist in a patient's suicide. Most felt euthanasia should only be allowed only to the terminally ill, but 40 per cent said it should be permitted for patients in 'extreme pain or distress'. The British Medical Association, which represents doctors, opposes euthanasia, saying its members' primary role is to preserve life, and allowing it would contaminate their relationship with patients. The BMA says doctors often feel caught between the wishes of a patient and those relatives who see death as 'a failure' and want the patient kept alive even if this is not the kindest approach. Many medical staff want far more clarity on euthanasia, and earlier this year, cancer nurses called for a proper debate on the issue. Many of them are worried that patients are prevented from having a dignified death due to inappropriate care and because relatives sometimes refuse to accept that the patients are dying. Maura Buchanan, deputy chair of the Royal College of Nursing's council, said: 'The most rewarding part of nursing is taking the family through to a peaceful and good death. This is about how we care as a profession and a society to help patients achieve a good death.' Nurses tend to give most care to dying patients, but doctors decide when to withdraw or withhold treatment. A book to be published by the BMA this week highlights the pressure on doctors to go on giving treatment when it might be more humane to give palliative care and pain relief, and to tell patients if they are dying - a move often blocked by relatives. Death has become 'medicalised, sanitised, and to an extent, hidden in hospital,' the book states. 'While development in some areas of medicine have saved and prolonged lives, there have also led increasingly to death being seen as a failure, often for which someone must be to blame rather than a natural, inevitable event.' Ann Somerville, a BMA ethics expert, said: 'We receive around 100 calls a week from doctors needing advice on end-of-life issues. There are some difficult areas, such as cases where relatives do not want a patient to know that they are terminally ill. The doctors have to tell them, because they have to discuss treatment and pain relief with them, and you need the patient's consent for some treatments.' Around 1,500 people a day die in the UK, mostly in hospital. Hospice beds are limited, and the NHS leaders want more people to be able to die in comfort at home, but this often means community teams going in to provide pain relief. It is illegal in Britain to help anyone to die, including the seriously ill, but there is a growing sense in the NHS that there needs to be an open debate about the way patients face the end of life. Diane Pretty, a motor neurone disease patient who went to the European Court of Human Rights to challenge the rules on euthanasia, won widespread support. She lost her case, but the House of Lords is to examine a bill on the right to die next year. Ruth Trout, a senior nurse at the Radcliffe Infirmary in Oxford, told Nursing Times last week: 'I favour euthanasia because I don't like to see people suffering. 'Working on intensive care you know that interventions keep people alive, but keeping people alive is not necessarily the best thing for them.'