It is clichéd to say that we live in uncertain times, but undoubtedly we do. Globally and locally, and almost daily, there are stories in the media that engender uncertainty and apprehension. This is particularly true in health, making people afraid that our health care systems can no longer keep them safe. These fears impact on the public's relationships with health professionals, creating the need for more informed and rounded debate rather than the media frenzy and hype that often accompanies the media coverage of health. Last year, several health issues were dominant in the UK press. A man suffering from cerebellar ataxia had sought judicial review from the High Court, afraid that the General Medical Council's Guidance on Withholding and Withdrawing Life Prolonging Treatments (GMC 2002) might mean that artificial nutrition and hydration could be withdrawn against his wishes (and in contravention of statutory human rights). Although commending the GMC document as excellent overall, the court held that certain sections were unlawful and required review. The GMC is appealing the decision (Dyer 2004). Two other cases concerned doctors seeking judgment from the High Court regarding their decisions not to resuscitate severely disabled infants. The doctors had been unable to reach resolution with the parents who sought ongoing resuscitation despite contrary clinical advice and hopeless prognoses. In one of the cases, the Court determined that any further aggressive treatment, even if necessary to prolong life, would not be in the child's best interests. There also was great media concern when it was announced in one English city (Lincoln) that nurses would be providing 24-hour frontline coverage for emergencies in future, rather than doctors. A spokesperson for the National Health Service (NHS) was anxious to provide public reassurance that doctors would still be on call – and thus everyone would still be safe. Doctors always have made decisions about end-of-life care, and nurses always have provided frontline care in emergencies, particularly in rural and remote locations and after hours. Both the GMC Guidance and the NHS announcement are seeking to standardize and legitimate custom and practice, which, usually results in better quality, education and documentation. In contrast, the infant resuscitation cases demonstrate that parents are no longer necessarily prepared to accept medical advice. Thus, external review becomes the solution and the courts are now making difficult decisions in health care situations where there is no consensus. These issues have significant implications for nurses. It is nurses who care for patients after artificial life support is withdrawn, just as it is nurses who watch patients’ lives being prolonged unnecessarily when it is not. It will be nurses who receive the patients in the emergency rooms, perhaps now more anxious because it is a nurse in charge and not a doctor. Yet, in the media coverage, the voices of nursing leaders were not heard. It was a NHS ‘spokesman’ who appeared on television to reassure the public that doctors would still be available after hours if required. What was absent was reassurance from the nursing profession that the nurses providing that service would be highly skilled practitioners, arguably just as effective as the doctors. This lack of nursing input to media debates about health is not unique to the UK: it would be the same in my own country, Australia. However, it is not axiomatic that nurse leaders are entirely passive: it is probable that several nursing organizations issued press releases. Who read these statements? And if they were read, why were they not picked up in the press? Were they too measured, lacking in clarity or just not regarded as ‘newsworthy'? I have heard journalists say that it is not their job to provide public relations services to nursing; and, in contrast, that other professional organizations swamp them with press releases, are always available for comment, and have spokespeople who perform well on TV. Clearly we need to learn how to express our opinions cogently and consistently. We need to develop better media contacts who then learn that a ‘nursing angle’ is important – and newsworthy. We need to take a whole-of-health care approach to issues, rather than imagining that if the matter is not only or directly about nurses, that we have no place or authority to offer comment. In short – in these uncertain times in the world of health care – we, as nurses, need to start speaking out.
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May 1, 2009
Otto F Kernberg + 1
Open Access