Dying Patients Denied Pain Relief Because Of Legal Fears

Dying patients denied pain relief because of legal fears, May 18, 2010.

More than one in 10 of the 2,311 respondents to the online survey of nurses said they had restricted a patient’s medication despite that exacerbating symptoms as they were concerned about being prosecuted.

The respondents acknowledged restricting medication left patients in more pain than necessary and prolonged their lives against their wishes.

Commenting on the survey, one nurse said: “I was worried about the authorities scrutinising the medication record with the intention of prosecuting me for over-medication, even though the dosage was ordered by a physician and necessary to relieve the patient’s pain and suffering.”

Another said increasing medication could be a difficult “balancing act”.

“Giving opiates could reduce pain but increase respiratory depression. I am acutely aware that my actions within my role could result in not being able to practice or legal proceedings.”

Senior nursing leaders said the survey finding showed a need for “urgent” action and clarification of nurses’ legal position and professional accountability.

Department of Health end of life care programme director Claire Henry told Nursing Times: “This is a disturbing finding. A competent and confident nurse should not approach pain relief with fear or trepidation.”

Queen’s Nursing Institute director Rosemary Cook said the Nursing and Midwifery Council code of conduct required nurses always to act in the patient’s best interest.

“Holding back on pain relief to the extent that pain is not controlled is clearly not in the patient’s best interest,” she said.

She said that nurses acting in the best interests of the patient and within the prescription made for that patient should not be prosecuted.

“But if the fear is there, and the anxiety has been planted, it is an urgent issue and [nurses] need to know where they stand,” she added.

In its manifesto published last year the National Council for Palliative Care called for mandatory training in palliative and end of life care for all healthcare professionals.

The council’s director of policy and parliamentary affairs Simon Chapman said better training would help remove myths and misunderstandings.

He said nurses needed to understand there is a “significant difference” between increasing drug doses in the relatively small increments required to control pain, and increasing them in such large doses that life is threatened or toxicity develops.

But one in three of the respondents to our survey said they did not understand the legal position of nurses with regards to assisted suicide.

Mr Chapman said: “It is very worrying to see this is preventing people from receiving adequate symptom control at the end of life. This is not acceptable and should be regarded as a failure of care.”

By Claire Lomas, Nursing Times