I would like some clarification of Douglas P. Olsen's comments on the New Orleans nurses who have been accused of giving lethal injections to four patients in the midst of a hospital evacuation (In the News, "Katrina's Effects Linger," January). How would it be a disservice for nurses to question or be hesitant to implement an order that is ethically suspect?

Aaron Carpenter, MSN, APRN, CPNP, CEN

Moon Township, PA

Douglas P. Olsen responds: The "ethical suspicion" I allude to occurs when a provider hesitates to give care for fear that it will be questioned later by others. For example, providers might hesitate to prescribe pain medication because they may appear to be overprescribing narcotics. It would be a disservice if, because of the New Orleans case, clinicians in a similar situation become hesitant to provide good palliative care for fear that the patient will die and they may be prosecuted.

Possibly, the public misunderstands the meaning of palliative care. Palliative care involves assisting individuals with terminal illness in coping with the physical and emotional demands of the dying process. Often this means pain relief, which involves risks such as respiratory depression from morphine in an already debilitated patient. In usual care situations these risks are manageable or judged acceptable in light of the overall situation. In the extreme conditions created by the poor response to Katrina, risk will be increased but should not change the overall goal of making patients as comfortable as possible at the end of life.