To my nurse colleagues:

We are so dedicated to our profession and caring for the sick especially when it involves our families and friends. Many times we forget that our own families and friends have their wishes and ideas on how their illenesses in general will be treated and if they are terminally ill, what measures they would want done for them to alleviate their symptoms and not prolong their agonies. We as nurses are focused on alleviating suffering and are concerned for the patients' families and many times our own personal experiences and values come into play as well. We mean well and our intentions are good but when intervening in patients' treatment modalities especially when they are terminally ill, we should make sure that we are not going against the patients' wishes and families' pre-determined treatment plan. We want to make sure that we are not contradicting the medical personel's goals and treatment regimen when discussing any treatment changes for the patients. If we are not the designated or named decision makers for patients' care, we must abstain from giving our opinions unless asked by the patients' families. If we give instructions or unsolicited opinions especially changes in treatment options to patients' families, there is a huge possibility that we will confuse them and more likely get the treatment team in a precarious situation whether they are actually euthanizing the patient versus providing comfort measures when the patients are actively dying due to incurable diseases as in the late stages of cancer and the protocols, trials and care deemed appropriate for those particular diseases and stages were already exhausted.

We must remember that when the patients already signed the Advanced Directives, Living Will and Medical Power of Attorney naming designated persons to speak for them and make decisions for their care, we must honor these and not go against their decisions. It is also ethically wrong and possibly have legal ramifications if we convince the families to go against what the patients actually verbalized for their end of life care while they were coherent.

So to protect ourselves from any legal and ethical entanglement as Nursing professionals, we must be very cautious and extra careful when providing advices to the patients' families regarding end of life care if we are not the persons designated to do so no matter what experiences we have and length of Nursing experience. These do not matter but the bottom line is, what matters is the respect we should afford our families and friends at the end of their lives. We mean well for sure but we must avoid hurting the very persons we care for by our careless disregard of patients' wishes.

Cherry Sloan-Medrano RN, BSN, CCM, BC, OCN