Nursing Ethics 2009 16 (1) © 2009 SAGE Publications 10.1177/0969733008097994
*The first part of this study was given as an oral presentation at the 2nd National Congress
of Intensive Care Nursing; 2005 Sept 26–28; I
.
zmir, Turkey. Akpinar A, Senses M, Er RA
Yogun Bakim Hemsirelerinin Pediatride Yasamin Sonuna I
.
liskin Tutumlari. (Attitudes of intensive care
nurses in paediatric end-of-life care.) Abstract book p. 64.
Address for correspondence: Aslihan Akpinar, Kocaeli University Medical Faculty, Department
of History of Medicine and Medical Ethics, Umuttepe 41380, Kocaeli, Turkey. Tel: +90 262 303
7450; Fax: +90 262 303 7003; E-mail: aslyakcay@yahoo.com
A TTITUDES TO END-OF-LIFE DECISIONS
IN P AEDIATRIC INTENSIVE CARE*
Aslihan Akpinar, Muesser Ozcan Senses and Rahime Aydin Er
Key words: attitudes of health personnel; clinical ethics; end-of-life care; paediatric
intensive care; treatment futility
The aim of this study was to assess attitudes of intensive care nurses to selected ethical
issues related to end-of-life decisions in paediatric intensive care units. A self-administered
questionnaire was distributed in 2005 to intensive care nurses at two different scientific
occasions in Turkey. Of the 155 intensive care nurse participants, 98% were women. Fifty-
three percent of these had intensive care experience of more than four years. Most of
the nurses failed to agree about withholding (65%) or withdrawing (60%) futile treat-
ment. In addition, 68% agreed that intravenous nutrition must continue at all costs. In
futile treatment cases, the nurses tended to leave the decision to parents or act mater-
nalistically. The results showed that intensive care nurses could ignore essential ethical
duties in end-of-life care. We suggest that it is necessary to educate Turkish intensive
care nurses about ethical issues at the end of life.
Introduction
Prolonging life by artificial means has brought about various ethical problems in
addition to the severe sequelae suffered by infants and children undergoing paedi-
atric intensive care, apart from the high costs incurred. Recognition of the limits of
good medicine requires effective monitoring of when continuing treatment is no
longer in the patient’s best interest. At this point, it would not be possible to deter-
mine futile treatment without consideration of both medical and ethical issues.
1,2
When children become seriously ill and experience life-threatening problems in
paediatric intensive care units, they are dependent on nurses for their essential needs.
The nurses are expected to provide care to a high degree of professional competence,