Letters to the Editor
Susan Tregoning
School of Nursing and Midwifery, University of South Australia, SA
PP: 005 - 005
Article Text
Dear Editor,
The debate that surrounds The Consent to Medical Treatment and Palliative Care Bill, 1992 is a vitally important one for nurses and it is pleasing to see this being reflected in your journal: Letters to the Editor, Volume 2(2) and Guest Editorial, Volume 2(1). I would like to add to this debate to give your readers, especially those who work in aged care settings, an adequate sense of the magnitude of change represented by the impending modifications to the law.
One of the commonplaces of social commentary in the West in recent decades has been the observation that our technological capabilities have been outrunning our social conventions and moral frameworks. Scientific and medical developments have created a plethora of often perplexing choices at each end of the life cycle.
The choices relating to the process of fertilization, gestation and delivery have received much popular attention. The choices concerning our leaving of life have been comparatively neglected, perhaps due in part to the embarrassment and avoidance associated with death.
For the past twelve months I have been a close observer of the deaths of nursing home residents with late-stage dementia. I am aware that there is a time when staff and family want to assist individuals, who are incompetent to speak for themselves, to pass away peacefully. Recent research shows that many nurses who care for the terminally ill feel the same. Once legislation clarifying consumers' choices about health care interventions during the terminal phase of an illness exists, appropriate protocols developed, and education strategies are in place, then well worked out decisions will result in health care workers assisting patients, who so choose, to be released from a life that is intolerable.
A change from cure to care, supported by the death with dignity legislation that is occurring in all Australian states, is likely to trigger a noticeable move away from the 'medical model' and is an opportunity not to be missed. The implications for the profession's ethical reasoning and socialization practices are immense. We must accept that the locus of control for death will now lie with the consumer. The continuation of this debate amongst all health professionals is one very good way to hasten our preparations for this.
Jennifer Abbey, Lecturer in Nursing, Adelaide SA
Dear Editor,
I am pleased to inform you that following the technology assessment procedure described in Contemporary Nurse, Volume 2(1): 23-28, the decision has been made to continue to use a fundal camera to detect diabetic retinopathy among Aboriginal people in Central Australia. This informed decision is believed to be the most appropriate in the circumstances, and is welcomed by the nurses involved in this interdisciplinary procedure.
Feedback has indicated that it was our expertise in exploring the social impact of the two technological devices that particularly influenced the final choice of technology. Nurses have a great deal to contribute to any debate about health care technology, and need to be encouraged to use a structured and detailed assessment method in order to be effective. Any comments from your readers about the assessment procedure would be welcome.
Merri Paech, Lecturer, Faculty of Nursing ,University of South Australia
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