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An historical analysis of disclosure of terminal status
1University of Pennsylvania, School of Nursing, Philadelphia 19104, USA. krisman@nursing.upenn.edu
Purpose:
To examine the concept of disclosure of terminal status and trace its development and implementation over time. An individual's ability to make appropriate end-of-life decisions, exert some control over the place and manner of death, and prepare self and significant others for this loss depends on knowing that life is drawing to a close.
Organizing Framework:
An analysis of disclosure of terminal status was performed within the context of American social, political, and cultural history from 1930 to 1990.
Methods:
A combination of manual and computerized search mechanisms was performed utilizing popular, nursing, medical, sociological, psychological, and thanatological literature from 1930 to 1990. The articles and books obtained through these searches were scanned and those articles and books that dealt with health care disclosure issues were selected. Works included in the review were 149 articles and 22 books.
Findings:
A long-standing tradition of nondisclosure exists in the medical profession. Societal events in the 1950s and 1960s influenced individuals' perceptions of death, individual rights, and physician responsibility, and culminated in some change in this tradition in the 1970s. The magnitude of this change is unknown. Current practice has not been investigated. This topic is rarely addressed in nursing literature even though nursing care is influenced by physicians' practice.
Conclusions:
A tradition of nondisclosure prohibits patients from managing the end of their lives and making choices about their manner of death. Nursing care of terminally ill patients is compromised when patients are uninformed.