Telling the Painful Truth—Nurses and Physicians in the Nineteenth Century

Abstract

The ability to cope with an end-of-life situation is a key qualification in nursing care. All things considered, German nurses may be said to have seen their first exposure to a terminal patient as an initiation into the profession. When a young woman was able to deal with death and with patients, she was generally regarded as suitable for the nursing profession.1 Pivotal for this terminal care that nurses had to render was the question of whether a seriously ill patient should be told the about his or her imminent death and then, how this was to be dealt with. Under the rubric truth at the bedside (truth in the American debate), discussion is currently taking place in German-language literature on the medical ethics of whether and to what extent the physician should disclose his prognosis to a patient. In Germany, even nowadays, the question of how to deal with telling is something that has to be negotiated between nurses and physicians and sometimes gives rise to conflicts. From the legal point of view, diagnosis and prognosis as as their disclosure to the patient are exclusively reserved to the physician. However, nurses are frequently confronted with questions from seriously ill patients and their wish for comprehensive disclosure of their condition. Th us, German nurses frequently feel quite powerless when, in their view, the patient is not, or only insufficiently, informed about an incurable and fatal disease.2 This article retraces the historical roots of the medical and nursing ethical question of telling back to the nineteenth century. It focuses on the perspective of the nurses trained at the first German deaconess motherhouse at Kaiserswerth and compares their way of dealing with patients, death, and telling with the reflections of physicians on this topic in the nineteenth century. The analyses in this article are based on everyday sources on Protestant nursing care, because a large number of these historical records exist, while hardly any records are available on daily work in Catholic nursing care.3 Consequently, the results presented in this article offer only limited insight into the daily routine of nurses in dealing with patients and telling and thus have to be understood as a first approach to this topic. First, physicians' positions on telling in the nineteenth century are presented and analyzed. After that, the specific manner in which Protestant nurses, the Kaiserswerth deaconesses, dealt with the issue of disclosing the to patients about their imminent death is examined, and possible lines of conflict concerning physicians' medical-ethical views are determined. Beside medical publications, this article is based on the large stock of deaconesses' letters written to the superintendents of the deaconess motherhouse at Kaiserswerth by Christian nurses on a regular basis, in order to report about their work and their experiences at hospitals and in community and private care.4 Physicians' Positions on Truth Telling in the Nineteenth Century During the first half of the nineteenth century, physicians' reflections on the issue of telling were closely linked to views on dying well (euthanasia or, in its original German meaning, a dignified death).5 In his work Ueber Euthanasie (On Euthanasia), the Goettingen professor Karl Heinrich Marx (1840-77) made a distinction between and euthanasia. By means of exterior euthanasia the physician took care of the patient's physical health; by means of interior euthanasia he looked after the patient's spiritual well-being.6 Contemporary professional colleagues also regarded interior euthanasia as their task, stressing that the physician was not allowed to leave the patient even if he could not help him further from the medical point of view. They saw it as the physician's duty to encourage the patient and alleviate the process by means of regular visits. …