FOR IMMEDIATE RELEASE/January 7, 1997 CONTACT: Sara Foer [202/651-7023] Statement by ANA on measuring the quality of care at the end of lifePresented by Colleen Scanlon, JD, MS, RN Director, ANA Center for Ethics and Human RightsNurses have always been leaders and advocates for the delivery of dignified and humane end-of-life care. Therefore, the American Nurses Association is pleased to join today the American Geriatric Society, the Center to Improve Care of the Dying, the Project on Death in America, and the American Association of Retired Persons on this very important issue -- Measuring the Quality of Care at the End of Life. This is particularly poignant today -- the day before the Supreme Court hears arguments on two cases involving physician-assisted suicide. On November 12th, the American Nurses Association joined with more than 30 health care groups in signing an amicus brief opposing the legalization of physician-assisted suicide. The organizations who signed onto the brief are united in their belief that the two lower courts involved were wrong in taking the unprecedented step of establishing a right to control the timing and manner of one's death through the use of physician-assisted suicide. The American Nurses Association and our 180,000 nurse members have been concerned about the safety and quality of care available for today's patients in all settings, especially given that acuity levels are higher and staffing is lower. Our primary focus has been on preserving the quality of care for all patients -- whether they are being hospitalized for a few days, giving birth, undergoing surgery, or facing the end of life. In fact, we have introduced seven nursing quality indicators to measure the quality of care delivered in acute care settings, and are looking forward to partnering with the other key groups here today in tailoring quality measurement tools for end-of-life care. Nurses, individually and collectively, have an obligation to provide comprehensive and compassionate end-of-life care, which includes the promotion of comfort and the relief of pain, and, at times, supporting the patient in foregoing life-sustaining treatments. Since its inception, the nursing profession has acknowledged the importance of codes of ethics for the protection of patient care and the promotion of professional practice. The central precept of the profession's Code for Nurses especially applies today when it states that for nurses, respect for persons "extends to all who require the services of the nurse for the promotion of health, the prevention of illness, the restoration of health, the alleviation of suffering and the provision of supportive care of the dying." It is the role of the nurse and nursing as a whole to soften the hard edge of the suffering and to ensure that quality care is delivered throughout patients' lives, but especially during the end of life. Questions, controversies, and debate over the issue of assisted suicide have become widespread within society and the health care community. In spite of a seemingly contemporary American view that death is the enemy, there is an increasing willingness to precipitate death to avoid what is frequently perceived and experienced as a frightening, painful, lonely and prolonged dying process. Interest in the so-called "right to die" movement should serve as a wake-up call to health care providers because it not only represents a claim to self-determination, but it is also a response to the egregious shortcomings in the care of the dying. While the tremendous advances in technology have prolonged life, they have not necessarily provided for human dignity, personal control, or quality of life. The issue of assisted suicide has highlighted the deficits in care of the dying and focused attention on the preeminent obligation of health care professionals to provide responsible, respectful, appropriate, and ethically sound care. Traditionally, nurses have been the health care professionals who have attempted to bridge the gap between aggressive treatment interventions and the holistic, compassionate care of those who can no longer benefit from such approaches. Of all health care disciplines, nursing is most attuned to the goals of palliative care and has been the mainstay of care for persons and their families at the end of life. While it may be naive to think that introducing measurements of quality will entirely eliminate the issue of assisted suicide, they may certainly help to eradicate factors that prompt such requests. Health care professionals and society as a whole must be vigilant and aggressive in rectifying what is wrong with end-of-life care and in advocating for what is needed, such as the implementation of tools to measure the quality of end-of-life care. In addition, institutions must be held accountable for the end-of-life care they provide. The health care community must reverse the degradation of the last stages of life and recommit to improving the care of the critically ill and dying. Nurses, on behalf the patients entrusted to their care, are advocating for the delivery of dignified and humane care at the end of life. For nursing professionals, the goals espoused in palliative care are fundamentally consistent with the valued aims of the profession. Nurses have embraced the obligation to provide relief of suffering, comfort, companionship, and, when possible, a death that is congruent with the dying person's wishes. The goal of providing quality end-of-life care challenges the very integrity of health care professionals. The American Nurses Association, in its deep concern about the quality of care rendered at the end of life, is determined to meet this challenge and remains firmly committed to improving that care while upholding the ethical mandates of the nursing profession and not participating in assisted suicide. We believe that the accrued experience and expertise of nurses is essential to advancing such an initiative. Today, we join our esteemed colleagues in supporting the development and utilization of measurements to ensure quality of care at the end of life. We encourage public agencies and provider organizations to develop specific measurements using the 10 domains of care outlined here today. This is just the beginning, though. These tools will need further development, funding, research, and acceptance by health care professionals and the institutions where they work, so that they may be incorporated into continuous quality improvement of care strategies. As the life spans of Americans continue to expand and technology prolongs our lives and sometimes even our suffering, as health care professionals we must address this critical issue, so that quality of care and dignity may be preserved at the most fragile of times.
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