As the field of palliative nursing advances, there are many clinical aspects of care in which solutions have been found. One aspect of our care will remain as ever present, that is, the presence of ethical dilemmas in our daily work. Just as we often tell bereaved families that their intense grief is the price paid for loving deeply, ethical dilemmas are the price we as professionals pay for the immense privilege of entering into the intimate final days and sacred time of life for those we serve.
The articles in this issue are a testament to the presence of ethical issues in our work. None are specifically titled as papers on ethics, but every one includes the essential conflicts faced by patients, families, and professionals in advanced disease-use of Skype technologies, continuous infusion of midazolam for pediatric brain tumors, pediatric supportive care, assessment tools at hospital admission, and cost issues in providing pediatric palliative care. The articles on predictors of hope in Jordanian patients, comfort of pediatric patients in Sweden, and development of palliative care in Kyrgyzstan are evidence that these are international concerns.
Ethical dilemmas, and the associated moral distress experienced by palliative care nurses, are not only staying; many believe that they will become even more present and intense in the future. The demands of a burdened health care system, rising interest in palliative care, and expectations of cost containment amid an aging population are all ingredients for potential heightened ethical conflict.
Recognizing the critical nature of ethics in palliative nursing, the Hospice and Palliative Nursing Association (HPNA) and the journal have taken steps to provide nurses with support. Recently, the HPNA Board established a Special Interest Group on Ethics to be chaired by Nessa Coyle, PhD, FAAN, who is a pioneer in palliative care and ethics. The Ethics SIG is developing ideas for education and networking for nurses as they address the ethical dilemmas in daily practice.
The Journal of Hospice and Palliative Nursing will also help to address this area by launching an Ethics Series to begin with the January 2014 issue. This series will appear in each issue with each article presenting a clinical case exemplifying an ethical issue and providing a review of literature with clinical care suggestions. Readers are encouraged to contribute to this series, and more information is available in our Author Instructions on the JHPN Web site.
Recently, Joan Panke, MA, RN, ACHPN, shared with me the graduation speech delivered by her father Dr William Panke at her nursing school graduation in 1984, almost 30 years ago. Dr Panke was a surgeon and founder of the Ethics Committee at St Vincent's Hospital in New York City. As Joan shared, he was a great advocate for nurses and for compassionate and respectful care. Dr Panke spoke to the graduating nurses saying:
[horizontal ellipsis]The health care profession includes many (disciplines). Although we all cooperate in healing, you, the nurse often have the most intimate, hands-on relationship with human beings in their most vulnerable states. You are the one who is continuously at the bedside of those in need of healing. Because of this intimacy, you need not be told that you are not treating (diseases), but more importantly-people. They may be fearful of losing their ability to earn a living, afraid of dying-people in great need of moral and spiritual, as well as physical support. Their needs and your response to those needs-based on the dignity and intrinsic value of every human being from conception to the last breath of life-are the essence and focus of your profession.
Your profession is neither glamorous nor easy. Throughout history, environmental and socioeconomic conditions have presented challenges to the delivery of health care. And, we also have formidable challenges. An explosion of biomedical technology and the increasing involvement of government in health care are the major factors complicating our response to the needs of the sick and injured.
You will be constantly called upon for support, honesty, strength, advice and courage-you cannot give what you do not possess.
We hope that many HPNA members will join the Ethics SIG, read, and contribute to our Ethics series and be a part of this community of caring.
Betty Ferrell, PhD, MA, FAAN, FPCN, CHPN
Editor-in-Chief
[email protected]